Strittmatter, Beate-Identifying and treating blockages to healing new approaches to therapy resistant patients _ [according to the work of Frank Bahr, M. D. and Paul Nogier, M (1)

Strittmatter

Identifying and Treating Blockages to Healing New Approaches to Therapy-Resistant Patients

The method of identifying a focus by means of active acupuncture points in the reflex zones of the ear is so simple and so easy to learn that it doesn’t come as a surprise that, in Germany and many other European countries, focus diagnosis has now become a widely practiced method of complementary medicine, especially for patients who are resistant to therapy. In many cases, where such foci were found and treated with ear acupuncture or neural therapy, an improvement in chronic ailments that previously resisted conventional treatments could be seen. This book, based on the seminal work of P. Nogier and F. Bahr, addresses the basic concepts and information about this revolutionary approach to healing. Profit from the author’s years of international teaching experience and learn the basics and application of this important diagnostic tool to remove blockages to healing and expand your treatment possibilities.

Beate Strittmatter, M.D., was born in 1956 and attended medical school in Frankfurt and Homburg, Germany, and in Glasgow, Scotland. She completed her degree in 1982. This was followed by 10 years of clinical specialization in orthopedics, with further training in body and ear acupuncture, neural therapy, and manual medicine. In 1990, she set herself up as a general practitioner, specializing additionally in naturopathic medicine and sports medicine. Her main emphasis in the practice has been on pain management and acupuncture. Since 1985 she has been a lecturer at the German Academy for Acupuncture and Auriculomedicine in Munich, Germany, and at the Society for Therapeutic Local Anesthesia in Cologne, Germany. For the last 10 years she has been Director of Education at the German Academy for Acupuncture and Auriculomedicine. She has published widely (numerous articles, two textbooks for MDs, an interactive computer-learning program) and has been instrumental in developing the methods of focus diagnosis practiced today in the field of auriculotherapy. She is a board member of the Saarland Conference on Pain. Since 1989 she has been Senior Editor of the auriculomedical branch of the journal Der Akupunkturarzt/Aurikulotherapeut, and was Editor-in-Chief of this specialist journal for 4 years. She is also a board member of the ACI (Acupuncture Certification Institute, Los Angeles) and teaches in Germany, Switzerland, at the University of Miami, Florida, and at the Mt. St. Vincent University, Bedford, Nova Scotia, Canada.

The Americas ISBN 1-58890-106-8

,!7IB5I8-jabage!

ISBN 3-13-127871-4 (GTV) ISBN 1-58890-106-8 (TNY) www.thieme.com

Identifying and Treating Blockages to Healing

Therapists around the world know the following problem from their daily practice: some patients seem to be resistant to treatment despite all diagnostic and therapeutic efforts. Whether it is a young and healthy woman with recurrent inflammation of the bladder or a fit man with tormenting back pain—the symptoms have become chronic, and the key for unlocking the vicious cycle seems to be lost. Quite often the key to solving the health problem is a focus.

Identifying and Treating Blockages to Healing Complementary Medicine

New Approaches to Therapy-Resistant Patients

Beate Strittmatter, M.D.

Rest of World ISBN 3-13-127871-4

,!7ID1D1-chihbf!

According to the Work of Frank Bahr, M.D. and Paul Nogier, M.D.

Titelei.fm Seite I Montag, 20. Dezember 2010 10:32 10

Titelei.fm Seite II Montag, 20. Dezember 2010 10:32 10

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Identifying and Treating Blockages to Healing New Approaches to Therapy-Resistant Patients

Beate Strittmatter, M.D. Elversberg Germany

150 illustrations

Thieme Stuttgart · New York

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Library of Congress Cataloging-in-Publication Data is available from the publisher

This book is an authorized and revised translation of the German edition published and copyrighted 1998 by Hippokrates Verlag GmbH, Stuttgart, Germany. Title of the German edition: Das Störfeld in Diagnostik und Therapie: Eine Praxisanleitung für Ärzte und Zahnärzte, Mit den Kontrolltechniken nach BAHR

Translator: Ursula Vielkind, PhD, CTran, Dundas, Ontario, Canada

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

Thieme New York, 333 Seventh Avenue, New York, NY 10001 USA http://www.thieme.com

Cover design: Martina Berge, Erbach Typesetting by Satzpunkt Ewert GmbH Printed in Germany by Druckhaus Götz, Ludwigsburg ISBN 3-13-127871-4 (GTV) ISBN 1-58890-106-8 (TNY)

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.

1 2 3 4 5

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

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Foreword Therapists around the world know the following problem from their daily practice: some patients seem to be resistant to treatment despite all diagnostic and therapeutic efforts. Whether it is a young and healthy woman with recurrent inflammation of the bladder or a fit man with tormenting back pain–the symptoms have become chronic, and the key for unlocking the vicious cycle seems to be lost. Quite often the key to solving the health problem is a focus. Ever since Ferdinand Huneke made his first observations about focal disturbances more than 60 years ago, foci have been investigated from various angles over the last decades by committed medical doctors and scientists. In cases of chronic diseases or resistance to therapy, the many disciplines of complementary medicine–but also conventional medicine–have been paying special attention to the diagnosis and therapy of foci that maintain or promote a disease. Unfortunately, many foci (such as minimal chronic inflammation, scars, devitalized teeth) are still inaccessible to diagnosis by means of imaging procedures or laboratory tests. However, identification of the focus is the key to treating any focal disturbance. The method of identifying a focus by means of active acupuncture points in the reflex zones of the ear is simple and easy to learn; thus it comes as no surprise that, in Germany and many other European countries, focus diagnosis has now become a widely practiced method of complementary medicine, especially for patients who are resistant to therapy. The present book is a practical guide to the identification and treatment of foci. It is exemplary in didactic and systematic terms, simple and precise in its writing, and set up with many instructive illustrations. The author never loses sight of the reader, who will directly profit from the many years of the author’s experience in research and teaching as well as in applying the method in her own practice. During many years of teaching at the University of Nanjing and at the Institute of Applied Chemistry of the Chinese Academy of Sciences in Beijing, I experienced that the phenomenon of focal disturbances has no limits in terms of geography or methodology. The traditional schools of acupuncture have accepted with enthusiasm the methods of focus diagnosis that have been developed by Nogier, myself, and our co-workers. In European countries, the German edition of the present book is already part of the standard literature of many therapists. I would like to see this book become an effective guide to focus diagnosis and therapy in the English-speaking world as well, for application is the first step to experience, and only experience can provide evidence. I hope it will be of help to numerous patients who have not yet found relief by even the best evidence-based methods or to those who are already taking good care of their health by prevention. Frank Bahr, M.D., Prof. mult. h.c./China

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Preface During almost 20 years of intense teaching activities, I have been repeatedly approached by course participants with requests for a specific book dealing with the diagnosis of focal disturbances. The testing for focal disturbances is an integral part of the ear and body acupuncture training offered by the German Academy for Acupuncture and Auriculomedicine, Munich, and its affiliated societies in Switzerland, Austria, and The Netherlands. Until recently, however, only those of my medical colleagues who where willing to get involved with training in acupuncture, both in terms of time and content, were able to get to know our practical and comparatively less costly procedure of diagnosing focal disturbances. I always regretted this. In the present book, I have attempted to explain the concept of focus diagnosis in a way that is not only practice-oriented but also easy to understand for the non-acupuncturist. For this purpose, I have selected only focus-related methods of the standard curriculum on ear acupuncture and have presented them here in detail. They can be used on their own for the sole purpose of focus diagnosis in the medical practice. The result is a book that can be used as a guide for study, review, and reference even by the experienced ear or body acupuncturist. I dedicate this book to my mentor, Frank Bahr, M.D., to whom I owe my knowledge of these methods (most of which are his) and the passion for acupuncture in general. He has been urging me for years to write this book. I wish to thank my family – without their patience and understanding this book would never have been completed. The success of any book ultimately depends on the quality of the editing and translation process. My special thanks go to Andrea Wülker, M.D., Offenburg, Germany, for editing the 1st German edition, Liane Platt-Rohloff, Ph.D. and Melissa von Rohr, Editors at George Thieme Verlag, Stuttgart, and Thieme New York, respectively, for handling the translation project, and Ursula Vielkind, Ph.D., C.Tran., Dundas, Ontario, Canada, for translating the book. They not only showed a perfect command of the tools of their trades but have also acquired great competence for the topic during years of collaboration. Autumn 2003

Beate Strittmatter

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VII

Contents Foreword Part A

The Basics

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 2 The Focus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Clinical Implications . . . . . . . . . . . . . . . . . . . 6 An Example from My Practice . . . . . . 7 Focal Activity—Some Basics . . . . . . . . . . . . . 7 Huneke’s Phenomenon: The Immediate Reaction. . . . . . . . . . . . . . . 11 Potential Foci . . . . . . . . . . . . . . . . . . . . . . . . 15 Paranasal Sinuses . . . . . . . . . . . . . . . . . 16 Tonsils . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Appendix . . . . . . . . . . . . . . . . . . . . . . . . 17 Temporomandibular Joint . . . . . . . . . 17 The Teeth as Foci. . . . . . . . . . . . . . . . . . . . . . . 18 Teeth with Inflamed or Decayed Pulp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Root Canal Therapy of Devitalized Teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Root Remnants in the Jaw . . . . . . . . . 21 An Example from My Practice . . . . . 21 Displaced Teeth and Impacted Wisdom Teeth. . . . . . . . . . . . . . . . . . . . 23 Foreign Bodies. . . . . . . . . . . . . . . . . . . . 23 Cysts in the Jaw Region . . . . . . . . . . . 23 Chronic Gnathitis Following Tooth Extraction or Surgery . . . . . . . 24 Diseases of the Marginal Periodontium . . . . . . . . . . . . . . . . . . . . 25 The Link to Traditional Chinese Medicine. . . . . . . . . . . . . . . . . . . . . . . . . 26 Scars Acting as Foci . . . . . . . . . . . . . . . . . . . 26 Scars Located on a Meridian . . . . . . . 28 Fresh Scars and Meridianitis. . . . . . . 30 An Example from My Practice . . . . . 31 Intestinal Dysbiosis . . . . . . . . . . . . . . . . . . . 33 Gastrointestinal Allergy and Migraine . . . . . . . . . . . . . . . . . . . . . . . . . 35 Substance Intolerance . . . . . . . . . . . . . . . . . 36

Other Potential Foci . . . . . . . . . . . . . . . . . . . 37 An Example from My Practice. . . . . . 38 Test Procedures for Focal Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . The Role of Ear Acupuncture in the Testing for Foci. . . . . . . . . . . . . . . . . . General Remarks Regarding the Testing . Test Procedure for Foci According to Bahr—An Overview . . . . . . . . . . . . . . . . . Focus Diagnosis for Beginners (Level 1). . . . . . . . . . . . . . . . . . . . . . . . . . More Advanced Focus Diagnosis (Level 2). . . . . . . . . . . . . . . . . . . . . . . . . . Where to Start . . . . . . . . . . . . . . . . . . . . Comparison of the Various Methods for Focus Diagnosis and Therapy . . .

Part B

41 41 43 46 46 47 47 48

Practical Application

Learning and Mastering Knowledge Level 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Focus Diagnosis by Means of Ear Reflex Zones . . . . . . . . . . . . . . . . . . . . . . Essential Requirements . . . . . . . . . . . . . . . . Grounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . Finding the Ear Points . . . . . . . . . . . . . . . . . Mechanical Search for Points . . . . . . . . . . . Locating Points with the Stirrup Probe . . . . . . . . . . . . . . . . . . . . . Locating Points with the Pressure Probe. . . . . . . . . . . . . . . . . . . . Locating Points with an Electrical Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Basics of Locating Points Electrically . . . . . . . . . . . . . . . . . . . . . . . Procedure for Locating Points with the Electrical Point-Finder . . . . Sources of Error during Electrical Point Measurement . . . . . . . . . . . . . . . Suitable Point-Finding Devices . . . . . Preliminary Examination . . . . . . . . . . . . . . Locating Focus Points on the Ear. . . . . . . . An Example from My Practice. . . . . . The Special Case of Amalgam. . . . . . . . . . .

54 54 54 55 56 57 57 59 60 61 63 66 68 69 70 71 71

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VIII Mental Fields of Disturbance . . . . . . . . . . . 72 Practical Approach at Knowledge Level 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Summary of Diagnostic Steps at Knowledge Level 1. . . . . . . . . . . . . . . . . . . . . 76

Focus Therapy Via Ear Reflex Zones . . . Therapeutic Principle . . . . . . . . . . . . . . . . . . Needling the Ear Reflex Zone That Corresponds to the Focus. . . . . . Infiltrating the Focus with a Local Anesthetic . . . . . . . . . . . . . . . . . . . . . . . . Laser Treatment Using Specific Frequencies . . . . . . . . . . . . . . . . . . . . . . . Therapeutic Procedure . . . . . . . . . . . . . . . . . Sieve Method . . . . . . . . . . . . . . . . . . . . . Moxibustion . . . . . . . . . . . . . . . . . . . . . . Additional Ear Points for Focus Therapy . . . . . . . . . . . . . . . . . . . . How to Proceed in Case of Amalgam Load . . . . . . . . . . . . . . . . . . . . Mental Fields of Disturbance . . . . . . . A Note Regarding Therapy in a Left-handed Person. . . . . . . . . . . . Practical Tips for Therapy . . . . . . . . . . Measures Supporting the Therapy . . . . . . Massage of Acupuncture Points by the Patient . . . . . . . . . . . . . . . . . . . . . Transcutaneous Nerve Stimulation . . . . . . . . . . . . . . . . . . . . . . . Improving Muscle Balance and Stability . . . . . . . . . . . . . . . . . . . . . . . . . . Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Problems during Therapy . . . . . . . . . . . . . . No Improvement of Symptoms . . . . . The Focus Cannot Be Eliminated . . . . Ear Inflammation Due to a Permanent Needle. . . . . . . . . . . . . . . . . Condition after Otoplasty . . . . . . . . . . Uncertain Handedness. . . . . . . . . . . . . Initial Aggravation. . . . . . . . . . . . . . . . . Fear of Needles. . . . . . . . . . . . . . . . . . . . The Course of Therapy . . . . . . . . . . . . . . . . . Summary of Therapeutic Steps at Knowledge Level 1 . . . . . . . . . . . . . . . . . . Notes Regarding Acupuncture Needles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disposable Needles . . . . . . . . . . . . . . . . Reusable Needles. . . . . . . . . . . . . . . . . .

77 77 77 77 79 80 81 81 82 83 84 84 85 85 86 86 88 88 89 89 89 90 90 91 91 91 92 92 93 93 94

Permanent Needles . . . . . . . . . . . . . . . . 95 Range of Uses for Permanent Needles . . . . . . . . . . . . . . . . 96 Covering the Permanent Needle . . . . 97 Stimulation of the Permanent Needle . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Other Systems of Permanent Needles . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Essential Equipment . . . . . . . . . . . . . . 99 Learning and Mastering Knowledge Level 2 Focus Diagnosis under Vascular Autonomic Signal Control . . .101 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . .101 The Vascular Autonomic Signal (Nogier’s Reflex) . . . . . . . . . . . . . . . . . . . . . .103 Discovery of the VAS . . . . . . . . . . . . . .103 The Basics . . . . . . . . . . . . . . . . . . . . . . . .104 Technique of Palpating the VAS . . . .108 Sources of Error When Palpating the VAS. . . . . . . . . . . . . . . . .112 The Electric Hammer (3-Volt Hammer) . . . . . . . . . . . . . . . . .113 The Five Focus Indicator Points According to Bahr . . . . . . . . . . . . . . . . . . . . .115 Focus Indicator Point Type 1: Histamine Point (Synonym: Allergy Point 1) . . . . . . . .118 Focus Indicator Point Type 2: Endoxan Point (Synonym: Allergy Point 2) . . . . . . . .120 Focus Indicator Point Type 3: Point PGE1 . . . . . . . . . . . . . . . . . . . . . . .121 Focus Indicator Point Type 4: Vitamin C Point. . . . . . . . . . . . . . . . . . .122 Focus Indicator Point Type 5: Laterality Point (Synonym: Ginseng Point). . . . . . . . .122 Locating the Focus Indicator Points. . . . . . . . . . . . . . . . . . . . . . . . . . . .124 Assigning the Foci Belonging to the Focus Indicator Points . . . . . . . . . . . . . . . . .125 Cable Method . . . . . . . . . . . . . . . . . . . .125 Other Applications of the Cable . . . .129 The Phenomenon of Local Resonance . . .130 Grounding. . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Preliminary Examination . . . . . . . . . . . . . .135 Determining Laterality . . . . . . . . . . . .135 Obstacle to Diagnosis and Therapy: Oscillation . . . . . . . . . . . . . .136

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IX Examination for Oscillation. . . . . . . . 137 Suppression of Oscillation . . . . . . . . . 139 Method of Detecting the Cause of Oscillation . . . . . . . . . . . . . . . . . . . . . 140 Focus Therapy under Vascular Autonomic Signal Control . . . . . . . . . . . . 144 Therapeutic Principle . . . . . . . . . . . . . . . . . 144 Needling of the Ear Reflex Zone That Corresponds to the Focus . . . . . . . . . 144 Infiltration of the Focus With a Local Anesthetic . . . . . . . . . . . . . . . 148 Dry Needling of the Affected Focal Site on the Body . . . . . . . . . . . . . . . . . 149 Combination of Methods . . . . . . . . . . . . . . 149 Sieve Method . . . . . . . . . . . . . . . . . . . . . . . . . 150 Moxibustion. . . . . . . . . . . . . . . . . . . . . . . . . . 150 Monitoring the Therapy . . . . . . . . . . . . . . . 151 Immediate Checking . . . . . . . . . . . . . . 151 Monitoring the Course of Therapy . 151 Procedure in Case of Amalgam Load . . . . 153 Additional Points for Focus Therapy . . . . 154 Mental Fields of Disturbance. . . . . . . . . . . 155 Problems during Therapy . . . . . . . . . . . . . . 155 Measures Supporting the Therapy. . . . . . 156 Long-Term Course of the Therapy . . . . . . 156 VAS Method: Case Histories from My Practice . . . . . . 158 Shoulder Pain Due to a Dental Focus. . . . 158 Chronic Back Pain Due to Impacted Wisdom Teeth . . . . . . . . . . . . . . 159 “Meridianitis” . . . . . . . . . . . . . . . . . . . . . . . . 160 Migraine Therapy—A 5-Year Follow-up . 163 Posttraumatic Migraine . . . . . . . . . . . . . . . 164 Optimizing the Methods. . . . . . . . . . . . . . 166 Tools to Improve the Diagnostic Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 The Three Tissue Layers . . . . . . . . . . . . . . . 166 Deep Tissue Layer . . . . . . . . . . . . . . . . 167 Intermediate Tissue Layer . . . . . . . . . 167 Superficial Tissue Layer . . . . . . . . . . . 167 Examining the Tissue Layers . . . . . . . . . . . 168 Examining the Deep Tissue Layer . . 168 Examining the Intermediate Tissue Layer . . . . . . . . . . . . . . . . . . . . . . 168 Examining the Superficial Tissue Layer . . . . . . . . . . . . . . . . . . . . . . 170 Checking for Inversion . . . . . . . . . . . . . . . . 171

Checking for Inversion on the Right Side . . . . . . . . . . . . . . . . . . . . . . . Checking for Inversion on the Left Side. . . . . . . . . . . . . . . . . . . . . . . . . Procedure in Case of Inversion . . . . Monitoring the Treatment for Inversion . . . . . . . . . . . . . . . . . . . . . . . . Determining Laterality. . . . . . . . . . . . . . . . Preliminary Examination with the 9-Volt Rod . . . . . . . . . . . . . . . . . . Examination Procedure . . . . . . . . . . . . . . .

172 172 173 174 174 176 177

The Laser in Focus Diagnosis and Therapy . . . . . . . . . . . . . . . . . . . . . . . . . Application of the Laser. . . . . . . . . . . . . . . Finding Focus Indicator Points with the Laser . . . . . . . . . . . . . . . . . . . Focus Diagnosis with the Laser . . . . Focus Therapy with the Laser . . . . . Hidden Dental Foci . . . . . . . . . . . . . . . . . . . Complete Examination Procedure . Therapy of a Dental Focus. . . . . . . . . . . . . Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . .

181 182 184 185 187 187 189

Other Applications of the Vascular Autonomic Signal . . . . . . . . . . VAS in Orthopedics . . . . . . . . . . . . . . . . . . . VAS in Neural Therapy . . . . . . . . . . . . . . . . VAS in Allergy Treatment . . . . . . . . . . . . . VAS in Dentistry. . . . . . . . . . . . . . . . . . . . . .

196 196 200 202 203

Other Applications of Ear Acupuncture . . . . . . . . . . . . . . . . . . . . Symptomatic Therapy . . . . . . . . . . . . . . . . Focus Diagnosis and Therapy. . . . . . . . . . Functional or Constitutional Therapy . . Indications for Ear Acupuncture Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contraindications for Ear Acupuncture Therapy. . . . . . . . . . . . . . . . . Ear Acupuncture: Case Histories From My Practice . . . . . Back Pain Following Ankle Surgery . . . . Hay Fever in a Child . . . . . . . . . . . . . . . . . . Unclear Pain in the Knee . . . . . . . . . . . . . .

178 181

204 204 204 205 205 207

209 209 212 213

Focus-Relevant Reflex Localizations on the Auricle. . . . . . . . . . 216 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216

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X Locomotor System . . . . . . . . . . . . . . . . . . . . 218 Vertebral Column . . . . . . . . . . . . . . . . 218 Thorax . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Pelvis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Upper Limb . . . . . . . . . . . . . . . . . . . . . . 221 Lower Limb . . . . . . . . . . . . . . . . . . . . . . 222 Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Part C

Training, Equipment, and Practical Aids

Level 3—Crash Course on Scientific Body/Scalp Acupuncture for the More Advanced . . . . . . . . . . . . . . . . . . . . . . 235 Training Institutions . . . . . . . . . . . . . . . . Supply Sources . . . . . . . . . . . . . . . . . . . . . . Acupuncture Supplies . . . . . . . . . . . . . . . . Point-Finders, Ear Models Made of Rubber . . . . . . . . . . . . . . . . . . . . . . Acupuncture Needles. . . . . . . . . . . . . . . . . Focus Indicator Ampoules . . . . . . . . . . . . Laser and TNS Equipment. . . . . . . . . . . . .

236 237 237 237 237 237 237

Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Market for Second-Hand Equipment . 238

Courses for Focus Therapists at the German Academy of Acupuncture and Auriculomedicine . . . . . . . . . . . . . . Level 0—Introductory Course on Ear, Body, and Scalp Acupuncture . . . . . . . . . Level 1—Crash Course on Ear, Body, and Scalp Acupuncture for Beginners . Level 2—Crash Course on Scientific Ear Acupuncture for the Moderately Advanced . . . . . . . . . . . . . . . . . . . . . . . . . . . Level 3—Crash Course on Scientific Ear Acupuncture for the More Advanced . . Level 4—Crash Course on Scientific Ear Acupuncture for the Most Advanced . . Clinical Courses under Supervision. . . . Level 2—Crash Course on Scientific Body/Scalp Acupuncture for the Moderately Advanced. . . . . . . . . . . . . . . .

Experienced Acupuncturists . . . . . . . . . 239 233 233 233

234 234 234 234

235

Patient Information Leaflets . . . . . . . . . Patient Information Leaflet: What Is Acupuncture?. . . . . . . . . . . . . . . . Ear Acupuncture. . . . . . . . . . . . . . . . . Patient Information Leaflet: Permanent Needles . . . . . . . . . . . . . . . . . . Patient Information Leaflet: What Is Laser Acupuncture? . . . . . . . . . . The Importance of Focal Disturbances . . . . . . . . . . . . . . . . . . . . Who Benefits from Laser Acupuncture?. . . . . . . . . . . . . . Patient Information Leaflet: What Is Neural Therapy? . . . . . . . . . . . . .

240 240 241 244 245 245 246 246

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253

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Part A The Basics “The value of an important phenomenon can only be recognized by using it. This is why the truth—once revealed and, at first, only secretly admitted—begins to spread further and further until that which has been persistently denied finally appears as something natural.” Wolfgang von Goethe

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2 The Basics

Introduction The diagnosis of foci is receiving more and more attention, even among those of my colleagues who are working exclusively in the field of conventional medicine. One of the main reasons for this growing interest is perhaps the frustration with therapy resistance, a phenomenon frequently observed in hospitals and private practice. With chronic illnesses on the rise, many of which are resistant to therapy, attention is increasingly focused on new ways of understanding disease processes. Regions of minor chronic stress are often neglected as potential causes of disease due to their lack of symptoms, when in fact they may be the actual blockage to the healing process. These blockages are known as focal disturbances. In many cases, where such foci were found and treated with ear acupuncture or neural therapy, chronic ailments that previously resisted conventional treatments subsided.

The Holistic Approach

The increase in chronic illnesses in recent decades called for new approaches in the field of diagnostics which, together with the established methods of conventional medicine, would lead to a better understanding of the causes of certain disease processes. In 1975, the Viennese professor of histology and embryology, Pischinger, presented his findings on the system of homeostasis. Ever since, the holistic view that a human being is a highly connected, energetically open system has become indispensable (4). According to Virchow’s cellular pathology, illness is caused by pathological changes of certain cells or organs. However, this view of the pathological process is no longer sufficient as the exclusive explanation. The center of attention is now shifting to regions of minor chronic stress; such a region is called a field of disturbance (German: “Störfeld”), focal disturbance, or focus. Often neglected due to their lack of symptoms, these foci can over many years lead to cell damage in remote organs because they act on the cellular, tissue, humoral, and neural levels. Hence, a focus is regarded as the chief center of a morbid process. The high rate of therapeutic failure in both general and specialized medicine is due to the lack of knowledge about such fields of disturbance. No matter what medical specialty or method of treatment a therapist practices, long-term success will only be achieved when all possible causes of an illness are considered and comprehensive action is taken.

Focal Processes

Every physician engaged in neural therapy, acupuncture, electroacupuncture, homeopathy, and other complementary methods should deal with the focal process as a primary obstacle to healing. Why, for instance, does a knee injury in patient A heal within a few weeks without complications, while all therapeutic efforts seem to be useless in knee patient B? Both patients have similar injuries,

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Introduction 3

both are about the same age, and both seem to be in a similar physical condition. However, patient B had been suffering from a focal disturbance prior to the injury, and this is now interfering with the body’s power to heal itself. The body is no longer able to control the severe stimulus coming from the knee injury. This book describes in detail the mechanisms of such disturbances. But where should we search for such foci that interfere with the healing process? In the field of internal medicine, the screening for foci is already standard procedure, and all available techniques are enlisted in the search for foci. Inflammatory processes are considered first of all, for example, affections of the paranasal sinuses, gallbladder, pancreas, urogenital system, or teeth. Unfortunately, many foci escape detection even by today’s highly sophisticated medical imaging procedures and modern laboratory diagnostics. Quite a few teeth have been extracted based on suspicion — without any effect on the symptoms. Up to now, only few therapists consider tissue scars as potential fields of disturbance. Some naturopathic procedures, such as neural therapy and therapeutic local anesthesia, do consider various potential foci, but they do not allow unambiguous identification of foci or the grading of their intensity prior to treatment. The multitude of possible foci in inflammatory and degenerative regions may render treatment difficult, time-consuming, and painful for the patient if all suspected foci are to be included in the treatment plan by way of trial. For example, all scars present are injected tentatively, and injections are applied to the prostate, pelvic region, tonsils, or suspected teeth— for the purpose of eliminating a possible focus in this way. The merit of having discovered the phenomenon of focal processes certainly belongs to Ferdinand Huneke, the founder of focus theory and neural therapy (see p. 11ff.). The significance of his discovery cannot be overestimated. Within the methods available to him, however, even Huneke was unable to diagnose foci in a targeted way; in particular, he could not diagnose the primary focus which plays such a key role in focal processes. Like most of today’s neural therapists, he had to rely on a detailed patient history, perhaps on a finding by palpation within the respective segment and, apart from that, on injections by trial and error.

Targeted Search for Foci

An obstacle to healing that does not show up in the patient’s history or during clinical examination is easily overlooked. Internal scars (resulting, for example, from appendectomy or cesarean section) fail to be diagnosed as interfering with healing and are therefore not treated. Huneke’s findings, however, created the foundation on which Nogier, the founder of ear acupuncture, took the first steps toward a targeted search for foci more than 40 years ago (3). On this basis, Bahr then developed the differentiated and practical focus diagnosis described in this book (1, 2). Focus diagnosis does not require extensive technical equipment and can be performed by every physician in his/her practice. The topic of focus therapy, especially the treatment of internal foci which are difficult to get at, will also be discussed within the scope of this book.

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4 The Basics

References 1. Bahr, F.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für mäßig Fortgeschrittene. Self-published, Munich 1989 2. Bahr, F.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für Fortgeschrittene (Stufe 3). Self-published, Munich 1994 3. Nogier, P.: Lehrbuch der Aurikulotherapie. Maisonneuve, Sainte Ruffine 1969 4. Pischinger, A.: Das System der Grundregulation. Haug, Heidelberg 1990

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The Focus 5

The Focus Definition

Obstacle to Healing

A focus is a harmful influence which interferes with the body’s system of self-regulation, especially with the control of stimuli that disturb the body’s order. The definition above already includes the essential features of focal activity. The body normally endures and tolerates a wide range of stimuli that temporarily disturb its order: the knocked knee, the strained shoulder, the common cold in the family, noxious substances (pollutants) in food and the environment. Although the duration of an illness correlates with the intensity of the stimulus, the processes of healing and defense start on day one. Once the body has overcome the negative stimulus, a state of equilibrium sets in. However, if a focus is present in the body, the healing process is hampered or, in serious cases, even prevented. Based on the observation that bacterial inflammation can have a disseminating effect and can affect other organ systems of the body, classic somatic medicine coined the term “focus” many years ago (e. g., a focus in the tonsils, teeth, or appendix).

Overload of the Feedback System

In view of today’s knowledge, the idea that bacterial dissemination or the release of toxins is the sole cause of a focus has become untenable. Today, we define a focus as a disturbed site anywhere in the body. Through nonphysiological tissue changes and abnormal reactions, a focus subjects the complex feedback mechanism to stress by overstimulation and induces disturbances of remote structures that are already under stress. The terms “field of disturbance,” “focal disturbance,” and “focus” are synonyms. They apply to all inflammatory changes (i. e., foci in the original sense) as well as disturbing scars and an overload of the body by substances and toxins. An acute inflammatory process can usually be diagnosed by the conventional imaging techniques or laboratory tests and, hence, can be treated. The following discussion will deal primarily with those foci that cannot be easily discovered with the common diagnostic tools. These foci, in particular, may be responsible for the fact that a disease does not respond to therapy or has become chronic, just because the underlying foci cannot be discovered by the usual methods. In many cases, the detection and treatment of such foci may lead to long-term healing or relief, especially in disorders that cannot be treated at all or only symptomatically, such as migraine. In conventional medicine, the search for foci usually begins when there are already symptoms of mostly unknown origin. Once and again, our focus diagnosis (the diagnosis of fields of disturbance, according to Bahr) is an eye-opener; an altered body structure is of-

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6 The Basics ten already a focus before it causes noticeable symptoms for the patient. Complaints often begin with a disturbed state of health and in such a small area that a person is not yet declared ill. Hence, a focal disturbance that goes unnoticed is like a smoldering fire which threatens to flare up with the next gust of wind.

First Strike, Second Strike

The fire analogy nicely illustrates the theory of neural therapists of the first strike (this may be a focus of any kind that has been discussed here), where there are no symptoms or none can be detected and where the body still copes well with the blow. The second strike—an unfavorable, weaker influence (wind, cold, accident, dietary error, mental trauma, repeat surgery)—leads to activation of the dormant focus, and the illness triggered through the weakening influence (common cold, injury, etc.) does not heal.

Hence, the body only falls ill when it is no longer able to ward off a chronic focal activity or when a second blow strikes. In my practice, I like to explain this relationship to my patients by using the example of a shopping bag that already contains a heavy weight (a focus). By adding bread, butter, and vegetables (normal daily stress) during the shopping trip, the weight of the bag becomes a burden. If another heavy item is then added on top of that, the bag might become too heavy to be carried (any additional strain to the body, e. g., an injury or the common cold, may cause disease). Another way of explaining this is the image of a bucket that is slowly filling up. Genetic predisposition, environmental factors, foci, substance sensitivity, and psychological stress can be compensated individually by the body’s innate potential to heal. It is the sum of all loads that causes the bucket to overflow; the result is disease.

Resistance to Treatment

A focus may render the body largely unresponsive to regulatory therapies like acupuncture, homeopathy, or neural therapy. Thus, when repeated chiropractic treatments remain unsuccessful or neural therapy treatments bring only a few hours of relief, it must be assumed that the blocked vertebral joint or the irritated rotator cuff of the shoulder is not the primary impairment itself, but that these conditions are the result of a primary impairment, which is in most cases a focus. It clearly follows from the above statement that focus diagnosis and therapy can be worthwhile also in a clinically healthy, symptom-free person. Treatment may free the organism from the strain of a potentially existing focus so that it can respond with full strength to new stimuli.

Clinical Implications It is certainly not a matter of chance which organ is negatively affected by the primary disturbance (focal process). We rather must assume that the organ affected by disturbance or malfunction just happened to show some weakness during the period in which the disease developed. Such a weakness may have a genetic basis

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The Focus 7

(check the family history regarding lungs, liver, stomach, spinal column), but it may also be caused by overload (e. g., heavy lifting, physical overexertion, stress, climatic changes, malnutrition, infection).

Chronicity of Symptoms

In an otherwise healthy person (without foci), an organ showing signs of weakness usually means a short period of illness. The patient goes through an acute phase and reaches the stage of healing, usually without any aftereffect. However, if the patient is under the influence of a chronic focus, the disturbing stimulus of the focus will affect the currently weakened organ, causing chronicity or worsening of symptoms in most cases. The source of disturbance has usually been present in the body before the patient noticed the illness (e. g., symptom-free chronic inflammation of the paranasal sinuses). Or it may have been acquired after the onset of the illness (e. g., a scar from injury) and now interferes with the healing process which has so far been normal.

Preferred Target Organs

In principle, whether preexisting or acquired later, a focus is able to interfere everywhere, that is, wherever there happens to be a weak spot in the body. Depending on their location, however, some foci have preferred target organs. A good example is teeth where the target direction is more or less known for each tooth. For example, experience has shown that the front teeth often target the urogenital system if they harbor a focus. Women then suffer from an irritable bladder that is resistant to treatment, while men have prostate problems.

An Example from My Practice Devitalized Tooth – Irritable Bladder

In one of my courses, I demonstrated this on a colleague who had volunteered to be a patient because she suffered from an irritable bladder. I was able to identify a devitalized frontal tooth as the disturbing focus. As I was going to explain to the other course participants that, in such a case, one often finds an episode of pyelonephritis in the patient’s history, my colleague lifted her hand and informed us that she had, indeed, suffered from pyelonephritis on several(!) occasions. Because of the irritable bladder, she had also undergone hysterectomy several years ago, without any improvement in her symptoms (such scars, of course, may themselves turn into additional fields of disturbance).

Focal Activity—Some Basics The body normally responds to structural damages with a nonspecific mesenchyme reaction which runs a typical course. The initial release of enzymes is followed by a histiocytic period, during which macrophages degrade and remove damaged tissue, and a temporary involvement of glycosaminoglycans (acid mucopolysaccharides) in the repair process. This creates a cell-rich granulation tissue in which numerous collagen fibers are embedded. The various stages of healing should take no more than six weeks. If inflammatory, traumatic, metabolic, or iatrogenic harmful factors

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8 The Basics interfere with this normal sequence of events and nondegradable material remains in the tissue, a series of abnormal regulatory processes are triggered which finally lead to abnormal function.

Role of the Connective Tissue

Pischinger was the first to recognize the overwhelming importance of the connective tissue for the human body (12). For a long time, anatomically oriented conventional medicine regarded the entire connective tissue of the organism as a kind of glue, the only function of which was to hold the organs together. The tissue does, however, play a vital role by acting as a “transit system” which facilitates the many functions of the cells in the body. Every molecule that needs to be transferred to a cell, the specific unit of the body’s functions, must pass through the connective tissue because the body’s distribution channels—the arteries for supply and the veins for removal—do not reach the cells directly. This task of precision distribution within the body is performed by the connective tissue. Through partially still unknown mechanisms, each cell receives its supply and eliminates its waste. Neural stimuli and hormonal controls are also mediated by the connective tissue which Pischinger therefore regards as an organ in its own right. As long as the routes through this tissue (mesenchyme) are not blocked, all systems will function. If for any reason the body loses its equilibrium or its feedback regulation, this fine-tuned system no longer functions. The reasons for this include:

Starting Point of a Focus

poor or unbalanced nutrition, insufficient fluid intake, inappropriate allopathic medication, lack of exercise, fields of disturbance(!), stressful conditions as precursors of possible fields of disturbance (e. g., amalgam, palladium, other biologically unsuitable fillings and denture materials, pollutants).

The pathological mesenchyme reaction, which may also be the starting point of a focal disturbance, is characterized by perivascular round–cell infiltrates, permanence of glycosaminoglycans, and decompensation of neurovascular regulation (22). In a pathophysiological sense, the disaggregation of ground substance associated with increased colloidal swelling interferes with the continuous decrease in blood pressure from the arterial to the venous portion of the capillaries. Compensation is achieved by neurovascular regulatory impulses for permanent stimulation of the arteriovenous anastomoses. This pressure equalization initially covers up the localized pathological area, but it induces feedback in tissue regions that no longer need an increased capillary pressure. These regions, in turn, have a negative effect on the capillary pressure in the inflammatory surroundings of the focal disturbance. As the irritation increases, regulatory systems of a higher order are affected and finally lead to neurovascular dystonia. The disaggregation of ground substance ultimately leads to the incorporation of glycosaminoglycans into the vascular walls and subsequent loss of vascular flexibility. A primary functional disorder thus turns into a

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The Focus 9

fixed pathological change of the organ. The focal disturbance (or focus) thus creates the inflammatory surroundings which, in turn, form the basis for the development of clinical symptoms.

Energy Level

Apart from these pathophysiological considerations, there is the question of whether there may also be a disturbance at a higher level, the energy level. Here, we have to draw on the ancient wisdom of Traditional Chinese Medicine which is based on the assumption that there is a so-called life energy, or Qi, which moves through the body along specific pathways. On its way through the energetic body, it preferably stays for two hours daily in one of the twelve classic meridians (Lung Meridian, Large Intestine Meridian, Stomach Meridian, etc.). These meridians are imaginary channels, each belonging to a specific organ (both in energetic and medical terms) and connecting different parts of the body. At first glance, they have nothing to do with one another. However, they seem to share a common pattern of oscillating energy, or resonance in modern technical terminology. The system of energetically coupled organs can be visualized as a resonance chain (23). Figure 1 illustrates the principle of mutual dependency in the human body (and of course also in the animal body). All the beads are parts of the chain, and it would be impossible to set a single bead in motion without setting the other ones in resonance as well. The intensity of the resonance depends on the intensity of the impulse. Based on the principle of interconnection in analogy to the resonance chain, a severely disturbed organ will upset other organs, with the disturbance being the more intense the closer the organ lies to the troublemaker in the chain. For an example of how the resonance chain works see also the example on page 7.

Fig. 1 Resonance chain (from: 23).

The model of energetic coupling also helps us to visualize the socalled energetic order of the meridians. A disturbance or weakness in one part (meridian) of the entire energetic body (the system of twelve paired meridians coupled in tandem) may cause a disturbance or weakness in other regions (subsequent and previous meridians in-line). The effects can be regularly observed in practice. For example, a disturbance in the region of the large intestine (Large Intestine Meridian) may lead to a weakness in the region of the lungs (Lung Meridian), and vice versa, with the respective clinical symptoms. Frequently, even the time of day during which the symptoms seem to be particularly severe corresponds to the time of peak energy in the respective meridian (Fig. 2; see also example on p. 29f.). In this resonance chain, a field of disturbance may act like a hook holding the chain at a specific site (change in oscillation pattern, interference with the physiological resonance). It may also act like a persistently active, additional disturbance due to an external impulse, which may also lead to interference with or alteration of the physiological resonance.

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n lee Sp Heart Sm all Int est in

10 The Basics

la yB

r ina Ur Kidney

Large Intestine S t o ma ch ng Lu

r rne Bu ple Tri Gallbladder Live r

Pe ric ard ium

Fig. 2 Meridian clock.

Expansion of Focal Stimulation

In many cases, the spread of information derived from a focus, or from stimuli produced by a focus, becomes clear when studying the autonomic nervous system in detail, in particular, the autonomic neural coupling spreading from segment to segment (15). Diseased segments may render distant zones hyperalgesic and later pathological because their nutrition is disturbed. This often happens only after the symptoms have been present for a long time. It is assumed that the long visceral sensory fibers, which can affect the cervical plexus and cranial ganglia, are responsible for the clinically known phenomena (16). These include, for example, referred pain in head and shoulder in case of intestinal diseases.

Hyperalgesia The spread of hyperalgesia from one segment to the next occurs not only in front of the spinal cord through visceral sensory fibers Spreading from Segment to Segment but also inside the spinal cord. Depending on the segment, inhibitory mechanisms of various strengths are being discussed as the origin of this spread, and certain regions of a segment seem to be particularly prone to the spread of pathological information. For example, it has been reported that the T10 region easily becomes hyperalgesic in connection with a secondary affection (16). From here, the pain often and easily spreads to segments T6 and T7.

The relationships between the cervical and thoracic dermatomes and the cranial regions have already been studied by Head, and they may provide useful diagnostic clues when searching for a focus. For example, irritation of regions T5 and T6 may be accompanied by frontotemporal headache. These segments include, among others, the lungs and the heart. Irritation of the T10 region (liver, intestine, ovaries, testes) may cause occipital headache.

Myokinetic Chains

Bergsmann has explained the pathways of the focus-induced spread of stimulation not only by autonomic coupling from seg-

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The Focus 11

ment to segment but also by myokinetic chains (3). Because muscular coupling is organized in kinetic chains, a muscle cannot be activated on its own but only within the activity of a kinetic chain spreading from one segment to the next. The connections between the kinetic chains are established during postembryonic development and serve the preprogrammed, automatic performance of complex movements. However, muscle tension also follows these kinetic chains. During segmental reflex stimulation of a muscle, the entire kinetic chain is set under tension by means of a visceromotor reflex (e. g., as a result of a focus). On the one hand, this ensures that the spread of a stimulus from one segment to the next takes place along these functional myokinetic chains. On the other hand, increased muscle tension is the basis of tono-algesic symptoms which may occur in the area of the entire kinetic chain and, hence, far away from the source of stimulation. This easily explains the frequent observation that symptoms caused by a focus are usually not near the focus itself and not always on the same side of the body.

The Course of Meridians

In this connection, it is interesting to have a look at the system of meridians. Most of the meridians run along a functional myokinetic chain, in the same way as many acupuncture points happen to correspond to the classic trigger and infiltration points of neural therapy. In practice, we often realize that the site of the symptoms caused by a focus can be explained by the course of the disturbed meridian (see p. 29). This does not contradict the above comments regarding myokinetic chains. On the contrary, there are amazing similarities.

Huneke’s Phenomenon: The Immediate Reaction As already mentioned, the discovery of focal disturbances is entirely due to Ferdinand Huneke. In 1928, F. and W. Huneke reported them for the first time in a paper entitled Unbekannte Fernwirkungen der Lokalanästhesie (Unknown Distal Effects of Local Anesthesia) (see ref. 4). In this study they pointed out the importance of the segmental relationships and the resulting possibilities of influencing the segment. They first called their therapy “Heilanästhesie” (healing anesthesia), while Kibler suggested the term still in use today: “Segmenttherapie” (segment therapy) (10). In the English literature, it is known as viscerocutaneous reflex therapy. Leriche, a French surgeon, observed in 1928 that distant pain disappeared “within seconds” after procaine infiltration of surgical scars. However, he did not draw any conclusions from this observation because he did not recognize its implications (11).

An Historical Example: The Immediate Reaction

In 1940, Ferdinand Huneke treated a woman with capsular arthritis of the left shoulder joint which, so far, had resisted all treatment (4). Based on the prevailing view that a “focus” would disseminate bacteria and toxins through the blood vessels and that this would cause the painful symptoms, she had already undergone the re-

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12 The Basics moval of most of her teeth as well as her tonsils. Now she was supposed to have her lower leg amputated because the focus was suspected to reside here. As a child, 35 years previously, the patient had suffered from osteomyelitis at this site. Huneke infiltrated the tissue around the shoulder joint with a procaine preparation mixed with caffeine. He also performed periarticular and intra-articular injections, injections into the stellate ganglion, and even intravenous injections on the side of the diseased shoulder (a regimen previously effective in many cases like this), but nothing helped. He had to send this woman home without being cured. Fortunately, she returned two weeks later because of an inflammation around the old osteomyelitis scar on her right leg. Now, Huneke just wanted to treat this inflammation above the tibia by infiltration. While he was still treating the patient, the shoulder pain suddenly disappeared and she was able to move her arm again without pain. After this single treatment the shoulder joint was permanently cured. (The body obviously had interpreted the injections during the first session as a provocation and responded with an exacerbation of the underlying focus.) From now on, Huneke was able to observe this phenomenon repeatedly because he was specifically looking for it. When injecting a local anesthetic into chronic sites of irritation (e. g., scars), persistent or even refractory symptoms far away from the injection site suddenly disappeared. Because this effect set in within seconds of the injection, Huneke chose the term “Sekundenphänomen,” the phenomenon of the immediate reaction. He concluded that there is a causal relationship between the infiltrated focus (field of disturbance, focal disturbance) and the symptoms of the patient.

A Controversial Phenomenon

This phenomenon of the immediate reaction is difficult to explain and understand. Also, it often cannot be reproduced in individual cases when the symptoms have disappeared after a single treatment. Huneke’s phenomenon therefore still remains an academic bone of contention. However, it is not important whether or not one “believes” in the phenomenon. Anyone serious enough about learning how to diagnose focal disturbances and regularly applying this knowledge in practice, will every once in a while experience the immediate alleviation of symptoms if:

the main focus has been successfully found, the focus has been completely inactivated (e. g., by neural therapy, therapeutic local anesthesia, acupuncture, surgery), and

the illness has indeed been maintained by this focus (this is essential). In my experience, Huneke’s phenomenon is real, even though it cannot be observed very often. A demonstration by using objective parameters is possible (see p. 41ff.), and neither placebo effect nor suggestions play a significant role (22).

Causes of Failed Treatment

If symptoms do not improve following the infiltration of scars, this does not mean that Huneke’s phenomenon does not exist. Failure

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The Focus 13

might be due to a number of factors: the focus responsible for the illness has not been found, or it has been found but infiltration was not deep or accurate enough, or the illness was not induced by a focus at all. It is widespread practice to infiltrate various suspected foci in a single session and without detailed testing. This approach should be criticized because it blurs the overall picture and interferes with the therapist’s ability to interpret potential results, especially when delayed improvement needs to be evaluated. It is unrealistic to expect an immediate reaction through focus inactivation in polypathic patients who no longer present a clear clinical picture after years of failed attempts of treatment and resistance to therapy. Similarly, a complete recovery may be hampered by processes that have become irreversible during the illness. For example, a focus-supported muscular trigger point may itself have assumed focal activity, or many diseases of civilization may have accumulated over the years, or an organ weakened by the focus may show advanced signs of wear and tear. However, even in cases like these, targeted focus diagnosis and therapy together with a thorough support of the affected organs or feedback circuits (e. g., through targeted acupuncture or neural therapy) may yield surprising results. Studies by various investigators confirm that Huneke’s phenomenon is real and that the focus can be demonstrated by means of parameters used to determine the regulatory situation (1, 2, 5–9, 13, 14, 17–21).

References 1. Bergsmann, O.: Asymmetrische Leukozytenbefunde bei Lungentuberkulose. Wien, klin. Wschr. 77 (1965) 618–621 2. Bergsmann, O.: Herdwirkung in der Pulmologie. Therapiewoche 15 (1965) 1284–1287 3. Bergsmann, O.: Pathogenetische Aktivität der Störfelder. Der informierte Arzt 20 (1980) 41–48 4. Dosch, P.: Lehrbuch der Neuraltherapie nach Huneke, Haug. Heidelberg 1989 5. Gross, D.: Innervierte Strombahn, Gefäßzone, Quadrant und ihre Bedeutung für die Therapie. Acta neuroveg. 39 (1967) 522–535 6. Kellner, G.: Wirkung des Herdes auf die Labilität des humoralen Systems. Öst. Z. Stomatol. 60 (1963) 312 7. Kellner, G.: Nachweismethoden der Herderkrankungen und ihre Grundlagen. Therapiewoche 15 (1965) 1267–1274 8. Kellner, G.: Zur Histochemie der Narbe. Hippokrates 36 (1965) 777–785 9. Kellner, G., Klenkhart, E.: Zur Differenzierung der Serumjodometrie nach A. Pischinger (Elektrometrische Titration). Österr. Zschr. f. Erf. u. Bek. Krebskrankh. 25 (1970) 81–88 10. Kibler, M.: Segment-Therapie. Hippokrates, Stuttgart 1950 11. Leriche, R.: Die Chirurgie des Schmerzes. Masson, Paris 1949 12. Pischinger, A.: Das System der Grundregulation. Haug, Heidelberg 1990 13. Rost, A.: Verifizierung der Wirksamkeit der Neuraltherapie durch die Thermographie. Ärztez. Naturheilverf. 23 (1982) 713–719

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14 The Basics 14. Rost, A.: Objektivierung der Neuraltherapie nach Huneke durch die Thermographie. In: Feudenstädter Vorträge 1986, vol. 11, editor P. Dosch. Haug, Heidelberg 1987 15. Schiffter, R.: Neurologie des vegetativen Systems. Springer, Berlin 1985 16. Schmid, J.: Neuraltherapie. Springer, Berlin 1988 17. Schoeler, H.: Zur elektrischen Untersuchung von Narben. In: Therapie über das Nervensystem, vol. 2, editor D. Gross. Hippokrates, Stuttgart 1965 18. Schwamm, E.: Thermographischer Bericht über das Infrarot-Symposium 1969 in Feudenstadt. Verlag für Physikalische Medizin, Heidelberg 1971, 19. Schwamm, E.: Thermographische Störfelddiagnostik. In: Freudenstädter Vorträge 1974, vol. 2, editor P. Dosch. Haug, Heidelberg 1974 20. Stacher A.: Die Wirkung der Neuraltherapie auf das Blutbild. Ärztl. Prax. 18 (1966) 827–829 21. Steinhäusler, F. et al.: Membrane resting potential (MRP) as indicator of cell transformation in human lung biopsy samples (preliminary report). 2nd International Workshop on Experimental Oncology. Madison, Wisconsin USA, May 29 and 30, 1981 22. Tilscher, H., Eder, M.: Therapeutische Lokalanästhesie. Hippokrates, Stuttgart 1989 23. Volkmer, D.: Eigener Herd, Goldes wert, Energetik, Sulzbach 1993

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Potential Foci 15

Potential Foci It is certainly very interesting to study the scientific aspects of focal disturbances. For the medical practice, however, it is even more important to have a general understanding of what a potential focus is, how to identify the primary focus by using proper diagnostics, and how to eliminate it specifically (1). Based on what we know today, the following classification of foci is used:

chronically inflamed foci, foci in the mouth, teeth, and jaw region (they sometimes include chronically inflamed foci),

scars acting as foci, intestinal dysbiosis, substance intolerance, foreign bodies (dental materials, prostheses, implants, suture material, etc.), and

toxic loads (food toxins, indoor and outdoor pollution, etc.). Psychological strain and emotional stress may also be regarded as focal disturbances in a wider sense, or as adverse stimuli that tend to disturb the functioning of the body (mental foci). External fields of disturbance, such as electromagnetic radiation (electrosmog) are not discussed in this book.

Chronically Inflamed Chronically inflamed foci, such as an afflicted maxillary sinus, may render the body permanently susceptible to inflammation, thereby Foci increasing the susceptibility to illness as discussed previously:

maxillary and frontal sinuses, chronically inflamed tonsils, teeth (for a detailed discussion, see p. 18ff.), temporomandibular joint syndrome (inflammatory reaction to malocclusion), chronic adnexitis (pelvic inflammation disease), chronic prostatitis, chronic appendicitis, chronic irritation of the uterine mucosa due to an intrauterine device, chronically inflamed gallbladder, possibly also biliary stones with concomitant inflammation, chronic pancreatitis, inflamed hemorrhoids, and chronic immune defense reactions, such as granuloma, tuberculosis tubercles.

Most of the potential foci listed above are not noticed by the patient. They are therefore not normally recorded in the patient’s history. However, they can be discovered by proper focal diagnosis.

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Paranasal Sinuses Maxillary Sinuses

The anatomically unfortunate shape of the maxillary sinuses, with their exits lying above the floor and the resulting “cul-de-sac effect,” often causes chronic infection, which may or may not manifest itself clinically and, quite often, is not visible on a radiograph either (according to Lechner, only 30–40% of the afflicted maxillary sinuses can be seen on a radiograph) (22, 23). Indeed, many patients suffer from nothing else than an undiagnosed problem of the maxillary sinuses and the resulting severe focal activity. There is an energetic connection between the intestine and the maxillary sinuses. In the medical practice, this connection is frequently observed and plays a special role in children with a persistent runny nose and frequent otitis: almost all of them have an intestinal focus (p. 33ff.). A possible explanation lies in the fact that the Large Intestine Meridian runs through the maxillary sinuses. On the other hand, chronically irritated maxillary sinuses (e. g., due to amalgam load) may themselves cause a disturbance of the gastrointestinal tract. This ping-pong effect creates a vicious circle.

Ethmoidal Sinuses

In newborns, the maxillary and ethmoidal sinuses are still small, and the frontal and sphenoidal sinuses have not yet developed. In infants and children, a focal process in the paranasal sinuses manifests itself primarily in the ethmoidal sinuses. Growth of the paranasal sinuses comes to an end between age 15 and 20. An understanding of this development is helpful in the diagnosis and therapy of a focus in this region.

Tonsils At this point, I would like to cite the following (perhaps slightly exaggerated) passage by Volkmer: “The tonsils are not an organ designed by nature for the sole purpose of filling the hospital beds of ear, nose, and throat specialists. Evolution cannot afford to hold on to useless organs.” (49) The palatine tonsils and their lymphocyte-producing crypts are a part of the body’s defense system. Furthermore, they come into contact with the breath and respiratory air as well as the chyme, where they have a direct control function.

Chronically Inflamed When an acute tonsillitis constantly relapses or does not heal completely, we are dealing with a focus (chronically inflamed tonsils). Tonsils Chronicity always includes time as a factor:

long period of development, constant demands on the body’s defense mechanisms, delimitation problems, blockage of the energy flow through the body, deposition of toxins, etc.

All these phenomena are closely related to the concept of a focus (field of disturbance, focal disturbance).

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In cases like these, tonsillectomy was still performed in the 1960s, whereby only the protruding part of the tonsils was excised. However, this method had several serious disadvantages, and has not been standard practice for quite some time now. Tonsillectomy leads to scarring and hinders the stream of secretion coming from the depth of the crypts. Apart from this, streptococcal foci still remain deep down. When searching for a focus, one should ask the patient how much of the tonsils were removed (if the patient still remembers).

Appendix Stasis Increases the Risk of Infection

Like the tonsils, the vermiform appendix is a lymphatic organ located at a strategically important site of passage or transition. At the transition of the small intestine to the large intestine, Bauhin’s valve (ileocecal valve) does in fact prevent a reflux of the intestinal contents, but the renewed upward transport may cause standstill and stagnation. Like a backwater, this site is where the risk of infection is the greatest. It is thus especially in this region that increased immune system activity is required.

Chronic Affliction of the Appendix

Once in a while, and much to the surprise of the patient, the search for a focus will yield an affliction in the region of the appendix, although appendectomy has never been performed (and no scars are therefore present). These findings must be regarded as chronic, though clinically silent, appendicitis. When questioned directly, about 50 % of these patients report that they had been in the care of a doctor because of suspected appendicitis during adolescence or childhood, or they remember having had colicky pain in this region. Such a chronic inflammatory process may be responsible for all kinds of disturbances, for example, disorders of the internal organs or of the locomotor system. In many cases it is very difficult, or even impossible, to diagnose a chronic appendicitis with the usual imaging methods and laboratory tests.

Temporomandibular Joint The temporomandibular joints are used and overworked more than any other movable junctions of the body. In contrast to all other joints, the temporomandibular joint is always active together with its partner, the contralateral temporomandibular joint, and the functions of the two joints are coordinated.

Heavy Use

A state of constant irritation can be provoked, or maintained, not only by the continuous movements of the jaws during speaking but also by mastication, nightly grinding, loss of occlusion resulting in an insecure resting position, as well as any preexisting obstacles to articulation and gliding, even daily tension of the masticatory muscles during stress. Once the inflamed temporomandibular joints have been diagnosed as foci, it is essential to look also for the possible mechanical causes, such as gnathological problems (orthodontic treatment in the patient’s history), insufficient restorative fillings, or inadequate prostheses.

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The Teeth as Foci Excessive Exodontics At the beginning of the twentieth century is was observed that tooth extraction sometimes had a positive effect on other diseased parts of the body. This prompted many dentists and physicians to suspect a tooth—or even worse, all teeth—of being at the root of any unexplained symptom. A true exodentism took place as countless teeth (both diseased and healthy ones) were extracted, usually without the desired effect. Testing for a focus by trial injections of local anesthetic into the region around the root apex of the tooth does not always provide a definitive answer, and trial extraction of teeth is out of the question. It is therefore essential to reach a convincing differential diagnosis of the focus. A dental focus does not always constitute a purulent wisdom tooth or painful tooth decay—these will be found out by dentist and patient anyway. An acute pulpitis will drive any patient to the dentist in the middle of the night, but many other foci in the dentoalveolar region have few, if any, symptoms—at least not locally, which is why the patient will not consult a dentist. It is only much later that the patient will turn to other specialists because of the aftereffects (e. g., migraine, rheumatism).

Difficult Diagnosis

Such clinically unsuspicious processes are sometimes hard, if not impossible, to identify as foci on the radiograph. They may include:

teeth with an inflamed or decayed pulp, devitalized teeth after root canal treatment, root remnants in the jaw, displaced teeth and impacted wisdom teeth, cysts in the region of the jaws, chronic osteitis of the jaw following tooth extraction or surgery, affliction of the periodontium, and intrabony pockets.

Even though the clinical and radiological diagnosis in the mouth, teeth, and jaw region will be performed by the dentist, the nondental physician specializing in the diagnosis and therapy of foci should be aware of the possible causes of foci in the dental area. Such understanding will also contribute to better collaboration with the dentist. I have therefore tried to keep the following discussion as general as possible.

Teeth with Inflamed or Decayed Pulp The possible causes of an inflamed tooth pulp (pulpitis) include deep carious lesion, wrong or unsuited filling materials, and trauma from dental work.

Deep Tooth Decay (Dental Caries)

This process sometimes occurs unnoticed in the form of secondary caries underneath crowns, inlays, and fillings. Bacteria entering from the edges will at some point in time reach the deeper layers of the dentin and finally attack the tooth pulp.

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Wrong or Unsuited Filling Materials

Underneath every filling there should be another filling that protects the deeper portions of the tooth from the thermal and chemical effects of the filling material proper. Synthetic resins, as well as the silicates often used in the past, have toxic effects on the pulp (monomers from the resins, acidic shock from the silicates). If the buffering layer is absent or insufficient, these effects have a direct impact on the pulp. This is why toothache sometimes occurs only after restoration of the tooth.

Trauma from Dental Work

For a crown or bridgework the tooth needs to be ground down to a cone so that the crown can be placed over its stump. The introduction of high-speed drills (turbines) has eliminated the uncomfortable rumbling of the earlier drills and has shortened the preparation time.

Damage Caused by the Turbine

The turbine, however, produces heat which must be cooled by sufficient amounts of water. Inadequate cooling will lead to local overheating of organic substances, especially when the drill touches the dentin. Apart from this, Glaser and Türk were able to demonstrate that the harmful effects of the turbine can be traced to the resulting negative pressure which pulls odontoblast processes out of the tubules in the dentin (10). The consequences are irreversible; the tooth either causes pain after further manipulation, or a chronic pulpitis remains underneath the crown, causing permanent stress as a precursor of a focus.

Dental Foci Free of Pain

Careful grinding (not with a turbine) and paying attention to the water cooling system are basic measures by which the dentist can prevent a dental focus from developing. In some cases the normally violent inflammatory process runs its course in a quiet, barely noticeable way. The tooth dies, and the entire organic tissue within the tooth decays. When such a tooth is discovered—often by accident, sometimes because of pain—and opened by trephination, a foul manure-like odor will escape. Hence, the absence or presence of pain is no criterion for a focal process (20, 36). Such products of decay (e. g., mercaptan, thioether) can spread throughout the area of the tooth and pollute the entire neighborhood. Apical processes can further spread into the bone, causing devitalization of the neighboring teeth. Teeth with dead pulp can sensitize the entire body through protein decay and detritus (tissue debris) deposited in the mesenchyme. Once the local defense barriers have broken down, a permanent decompensated mesenchymal reaction develops and thus destabilizes the entire regulatory system (Pischinger, see p. 8).

A devitalized tooth that has not undergone root canal filling should always be suspected as a focus.

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Root Canal Therapy of Devitalized Teeth Root canal therapy is usually the consequence of chronic or acute pulpitis; in other words, it is mandated by those conditions. During root canal therapy, the dentist opens the tooth cavity (pulp cavity) and removes all soft tissue from the tooth, then disinfects the root canal and washes thoroughly (e. g., with hydrogen peroxide) in order to eliminate all germs. Careful cleaning and preparation of the root canal determines how watertight the future root filling will be and, therefore, also the risk of focal activity of the tooth in the future. Root canals are temporarily closed with a medicinal inlay and later filled with a nonshrinking paste and guttapercha, for example. From a technical point of view, the dentist has thus fulfilled all requirements of modern dentistry.

Products from Protein Decay

Fig. 3 Chronic apical periodontitis (from: 13).

Any reflection on the development of a potential focus should include the following consideration: Despite the most careful cleaning, it will never be possible to extract completely all organic substances from the fine lateral tubules of the former pulp. Thus, products from protein decay will always remain in the tooth and at

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its interface, representing a burden for the surrounding tissue and, depending on the amount, also for the liver. Furthermore, the position of the liver in the resonance chain as well as in the succession of meridians in many cases also explains other diseases that develop as a result of focal activity of the tooth in question (29, 32, 50).

Chronic Apical Periodontitis

Another problem of root canal therapy is as follows: In many cases the preexisting acute or chronic pulpitis has already spread through the root canal and caused a chronic apical periodontitis (periapical granuloma)—an inflammation of the tissue around the root apex, that is, outside the root (Fig. 3). For technical reasons, the latter cannot be cleared out within the scope of root canal therapy. Here, one will have to rely on the body’s own power to resorb and heal. In case of focus formation caused by a dead tooth, some therapists suggest apicoectomy, the surgical removal of the root apex from the side, that is, buccally. Following this, the therapist can retest whether or not the tooth still has focal activity. Unfortunately, the newly created scar in the bone may also develop into a focus.

It should be emphasized that not every dead tooth is a focus and, hence, not every devitalized tooth must be removed. Differential diagnosis will help to make the proper decision.

Root Remnants in the Jaw Dental Fractures

Sometimes tooth extraction can be complicated. Very long and curved roots have a tendency to fracture in the apical region. Especially devitalized teeth are very brittle and hard like glass, resulting in fractures of the crown and/or roots. Splintered fractures call for a very careful wound inspection. However, it has often been found that, after dental fracture due to tooth extraction, the attending dentist apparently has omitted the surgical inspection as well as the radiological control of complete root removal (Fig. 4). Reossification of the bone defect is often regular and forms a line of demarcation around the denatured dentin of the root remnant. The demarcation line consists of inflammatory infiltrates containing histiocytes and granulocytes, partly also lymphocytes and plasma cells, and must be regarded as the expression of a permanent conflict between a foreign body and the body’s defense mechanism. If, however, the lumen of the root canal had already been colonized by bacteria, chronic infections are to be expected. If the root remnant was already filled with a medicinal paste for root canal filling, toxic effects must be considered. In certain cases cysts may develop (see p. 23f.).

An Example from My Practice Tooth Remnant — Eczema

Several years ago, a 60-year-old woman came to see me because of an obscure extensive skin rash and edematous swellings of her limbs. The symptoms had manifested themselves in a matter of

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Fig. 4 Root remnant underneath the bridge (from: 13).

days. Physical examination and the usual laboratory tests did not yield any conspicuous findings. There was a complete dental prosthesis of the upper jaw—the only support being a devitalized remnant of a tooth (right canine), actually only a root stump with a metal root pin inserted. During testing, this stump was the main field of disturbance. It was removed, and the skin rash subsided. Here again, it is interesting to note the relationship with the feedback system of kidney and bladder: the swelling of the limbs subsided as well.

As a rule, root remnants should be removed. They almost always appear as a focus during testing. Experience shows that the focal activity of a root remnant in the jaw may be weak upon initial testing but tends to intensify over time.

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Displaced Teeth and Impacted Wisdom Teeth Displaced teeth are predominantly wisdom teeth that remain impacted in adults; they are displaced in the jaw, fail to erupt, and are often not fully developed. However, not every impacted wisdom tooth is a focus; this needs to be established by testing. Transverse position of an impacted wisdom tooth may damage, for example, the root of the second molar because of osteoblastic activity. Wisdom teeth have a close relationship to the feedback system of the heart (irregular heartbeat) and to the psyche.

Foreign Bodies Filling Material

Foreign bodies are usually residues of amalgam or other filling material that became embedded into the extraction wound during a complicated tooth extraction. Particles broken off from the fillings of neighboring teeth or retrograde amalgam fillings torn off during the extraction may get into the wound. Preventive measures are thorough wound inspection and subsequent control by radiography. The practice of inserting amalgam fillings immediately after a tooth extraction in the same session is still common today because of time constraints, but it should be absolutely discouraged. Likewise, remnants of cast material pressed into an ulceration of the gum, or forgotten threads especially in the region of the wisdom teeth, may cause focal activity by means of local defense reactions. Foreign bodies need to be removed from the jaw bone and gum whenever possible (amalgam deposits in the gum are clearly visible as dark blue-gray spots).

Cysts in the Jaw Region Formation of a cyst is always linked to the presence of epithelial cells. These cells may have become scattered during embryonic development (dysontogenetic cysts) or displaced into deeper tissue by trauma (traumatic cysts), or they appear in glandular or excretory duct epithelia (retention cysts). Cysts are cavities lined by epithelium. They may be located in the bone or in soft tissue, are filled with liquid, and undergo a slow and intermittently expansive growth.

Radicular Cysts and Residual Cysts

Radicular cysts usually develop at the root apex following devitalization of the pulp (e. g., as a result of deep caries). They are easy to verify on the radiograph (Fig. 5). When a tooth is extracted, such a preexisting cyst is sometimes left behind by mistake. The former radicular cyst then turns into a residual cyst which may continue to grow in an expansive and, thereby, destructive manner. It is therefore important that the tooth socket (alveolus) is cleaned out by fraising after extraction of a tooth with a radicular cyst.

Follicular Cyst

A follicular cyst develops from a tooth follicle (e. g., at the follicles of the erupting permanent teeth in the deciduous dentition). The enlargement of the gingival pocket of an impacted wisdom tooth

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Fig. 5 Radicular cyst (from: 13).

into a follicular cyst can damage the root of the neighboring tooth and usually results in extensive focal activity.

Chronic Gnathitis Following Tooth Extraction or Surgery Toothless stretches of the jaw as a result of traumatic, pathological, or artificial loss of teeth are always suspected of having focal activity. After all, prior to tooth extraction, there has usually been an inflammation in the region of the root apex (apical periodontitis) due to chronic or acute pulpitis (see p. 18f.).

Residual Osteitis

If the wound cavity is not meticulously cleaned of inflamed tissue, bone fragments, and small concrements (amalgam particles, filling materials), chronic gnathitis (osteitis of the jaw) will inevitably develop during wound healing. In focal medicine this is called residual osteitis. The body attempts to protect itself against this nonhealing, chronically changed region by encapsulating it and holding it in check, because it is perceived by the body as foreign. All these activities consume energy and lead to focal activity.

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A tooth that needs to be removed is usually surrounded by inflamed tissue. This tissue often remains after tooth extraction and can sometimes be removed only by scraping or fraising of the wound cavity. As mentioned earlier, an amalgam filling at another site (or any other treatment which could introduce small particles into the fresh wound) should not be inserted during the same session. Other causes of chronic gnathitis may be residual cysts (see above) or root remnants. A fresh tooth extraction may be followed by osteitis with the risk of developing into chronic osteomyelitis. These conditions are clinically conspicuous and are therefore easily identified without special focal diagnosis. In the case of chronic osteitis, however, the inspection often deceptively shows absolutely no irritation from the outside. It is sometimes, but not always, visible as a light area on the radiograph. If a toothless stretch in the jaw is found to be a field of disturbance during testing, this should definitely be followed up by thorough radiodiagnosis. Interestingly, chronic gnathitis (residual osteitis) is a condition not recognized by many of my colleagues with conventional medical training. A very thorough radiodiagnosis will sometimes assist in discovering a focus in the dentoalveolar region. For further information on this topic we highly recommend that dentists and nondentists alike refer to Härtel (13).

Diseases of the Marginal Periodontium Inflammatory diseases of the periodontium may also have focal activity. They may be induced by the following factors:

protruding edges of fillings (direct irritation of the gingiva), protruding edges of crowns (direct irritation, or stimulation through retention of food followed by bacterial colonization),

insufficient contact between fillings (food particles pressed be-

tween the fillings may permanently injure the gingiva and lead to bacterial inflammation; the alveolar bone underneath may be affected as well), irritation by foreign bodies (e. g., gold dust generated during the fitting of bridgework, amalgam particles embedded in the mucosa), pressure ulcer (e. g., caused by very tight placement of a bridge span onto the gingiva), concrement deposition (supragingival deposition of tartar followed by retention of soft plaque, usually due to lack of dental hygiene; the plaque is extremely rich in bacteria and provokes marginal periodontitis), protruding edges of prostheses, malocclusion and articulation problems, sensitivity to toothpaste and mouthwash, and sensitivity to incorporated dental materials.

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26 The Basics Severe inflammation of the gum (gingivitis) can lead to bone decay (caries) and thus to partial exposure of the root of the tooth, followed by inflammation of the marginal periodontium.

Interaction with Internal Organs

As mentioned earlier, there seem to be feedback systems and functional relationships between the teeth and certain regions of the body (see also pp. 248–251, Tables 10–13). This also explains why the reverse is sometimes observed: Symptoms related to the prostate may in turn render the front teeth susceptible to disease. While completely incomprehensible to patient and dentist, the front teeth thus may develop pulpitis or deep caries. In this context there may also be problems with wound healing. If a tooth does not calm down after root canal therapy or the wound does not heal after tooth extraction, this might be due to a primary disturbance of an organ which, in turn, may have disturbed the tooth a long time ago. Focus diagnosis can help also in cases like this.

The Link to Traditional Chinese Medicine Kidney Meridian

In addition to the above-mentioned possible focal activity of individual teeth on certain organs and their feedback systems, we find this general connection between the teeth and the feedback system of the kidney also in Traditional Chinese Medicine (TCM). If the Kidney Meridian is disturbed, tooth problems are more likely to develop, and a newly devitalized tooth resulting from this will gain focal activity and further weaken the system. A pregnant woman passes on a certain energy (Kidney Essence, or Kidney Jing) to the fetus. According to TCM, this alone may be the cause for frequent tooth problems during pregnancy.

Scars Acting as Foci Focal activity derived from scars is usually caused by measurable malfunction of a few cells within the scar tissue. These cells have lost their ability to actively repolarize (sodium–potassium pump) due to thermal, chemical, or physical damage and, therefore, create a significant potential for disturbance by continuous passive depolarization (17, 38). Usually these disturbances affect only one or two small sites in the scar but, as a rule, these are the ones that act as foci.

Continuous Depolarization

Every cell represents a tiny potassium battery of 40–90 mV. The potential collapses with every stimulus (depolarization). Normally, the cell recharges quickly (repolarization). The energy for this comes from oxygen metabolism. After exceedingly strong stimuli, or too many of them accumulating (chemical, physical, and traumatic stimuli leading to scar formation), the cell is often no longer able to repolarize on its own. The mostly depolarized cell is now vulnerable or diseased; it is no longer connected to all the information and can no longer perform its functions properly. However, the cell emits disturbing impulses by discharging rhythmically—

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and so a focal disturbance develops which can then disturb the weakest part of the body (site of the least resistance). Humoral pathways or overriding segmental connections (autonomic nervous system) are being discussed as transmitters of these disturbing rhythmical impulses. All scars, including internal ones, may act as foci. Scars that develop particularly often into foci include those that have healed by second intention, or were kept open artificially (drainage sites), or have formed a granuloma. Sometimes, however, even scars that have healed by first intention and are cosmetically perfect may have focal activity. As already mentioned, usually only one or two tiny sites of a small or large scar develop into foci, and these need to be located very precisely during examination of the site.

About 50% of All Foci When applying Bahr’s focus diagnosis (see pp. 46f., 101f.), it soon becomes clear that about 50% of all diagnosed foci are scars. Are Scars The following scars may have focal activity:

scars from drainage and laparoscopy, the navel (especially in children, but potentially also in adults), scars after tonsillectomy and strumectomy, scars after sterilization, transurethral prostate resection, vaginal or abdominal uterus extirpation, cesarean section, scars after appendectomy, and scars after episiotomy (ask the patient). In principle, every existing scar should be examined for focal activity.

The Navel As a Scar Focus

The navel (umbilicus) (Navel Point on the ear or Point CV 8 on the body) appears as a scar focus primarily in children. In focus diagnosis, the navel has also a second function. As the main point of energy, it may point to an intestinal focus (see p. 33f.). This disturbance is found primarily in the presence of skin disorders (psoriasis, neurodermatitis) and asthma, sometimes in combination with amalgam load and/or laterality disorders. Scars on the back of the thigh rarely act as foci, whereas scars from Pfannenstiel’s incision, strumectomy scars (see p. 31f.), or inguinal scars tend to have focal activity. The location of a scar may even affect several meridians at once.

Foreign Body Granuloma

Sometimes the focal activity of a scar is not caused by a disturbing electrical impulse or its position in the course of a meridian; rather, the focal activity originates from a foreign body granuloma formed around starch particles or talcum crystals derived from powdered surgical gloves. Today, surgical gloves no longer come powdered, but in older patients the possibility of harboring such a granuloma in old surgical scars still exists. Giant cells first surround the insoluble silicate crystals, and lymphocytes and plasma cells then infiltrate the area. The continuous irritation caused by undegradable material leads to changes in the homeostatic system, and these changes severely interfere with the entire feedback system.

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Scars Located on a Meridian Blockage of a Meridian

Fig. 6 Gallbladder Meridian.

Dosch writes: “We still do not know with certainty why ... one scar turns into a field of disturbance, while another scar does not” (8). Here, acupuncture may help to understand this better. Interestingly enough, we observe time and again that those scars that cross the course of a meridian tend to have focal activity. We find in the

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acupuncture practice that interruption or blockage of a meridian may result in symptoms along the meridian. It is very impressive that symptoms produced by such scar foci often occur exactly in regions along the affected meridian. Whether such a scar will turn into a focus will also depend on whether or not this local disturbance coincides with an overriding overall disturbance in energy (Defense Energy, or Defense Qi). This is illustrated by the following example.

Example: Migraine – Gallbladder Meridian

The search for foci in migraine patients frequently uncovers disturbances of the Gallbladder Meridian that may be caused by scars. Blockage of this meridian by a scar may result in blockage of the free flow of energy through the body (Congestion of Qi). The head regions typically described by a migraine patient as being painful during an attack show a surprising correspondence with the internal course of the Gallbladder Meridian in the head (Fig. 7). The pain is described as being located at the temples, above the ears, as a weight on top of the head, and at the insertions of the medial and lateral neck muscles (sternocleidomastoid muscle, splenius muscle of head). Most patients also report a feeling of strong pressure behind the eyes, often even a feeling as if the eye would be pushed out from behind (the Gallbladder Meridian runs to the eye and through the eye to the brain). This description corresponds exactly to the course of the Gallbladder Meridian in the head region (Fig. 6). When explaining where they feel the pain, these patients often follow the cranial course of

Fig. 7 Gallbladder Meridian, its course in the head

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30 The Basics the meridian with their hand, sometimes as far as to the anterior shoulder. When taking into account the meridian clock (Fig. 2, p. 10), it becomes obvious that the time of maximum energy flow through the Gallbladder Meridian is during the night between 11 p. m. and 1 a. m. The disturbance in energy develops mainly during this period; as a result, many migraine patients wake up with a migraine in the early morning hours.

If the symptoms (e. g., migraine) can be traced back to blockage of a meridian, elimination of the focus will be the only effective causal therapy. Fields of disturbance in the region of the Gallbladder Meridian may include, for example, surgically tended ruptures of the lateral ligament, lateral pelvic scars, and scars resulting from injuries to the shoulder joint. Every scar in the course of this meridian may act as a focus (but does not necessarily do so). Other influences, such as food allergies, may lead to migraine when the Gallbladder Meridian is weakened (see pp. 35f., 163f.). Likewise, psychological influences may have a specific effect (analogous to the coupling of gallbladder–worry according to the teachings of acupuncture, see p. 37f.). I like to explain to my patients the potential effects that a focal disturbance along a meridian can have on other regions of the body, or on the entire organism, by comparing the system of meridians to a mechanical system. Disrupting the energy flow in one of the tubes will disturb the entire system. If the energy is programmed to be available only at a certain time of the day, any trouble will occur exactly within this time frame (analogous to the period of maximum energy shown on the meridian clock). Initially, the disturbance of the system remains localized (migraine), but slowly the entire system will be affected because all meridians are part of a common, interconnected system. Another way of explaning this is by comparing the meridians to the electric wires of a house. If the proper cable is disconnected in the basement, the lights will go out upstairs.

Fresh Scars and Meridianitis Symptoms along the As already mentioned, the site where a focus causes symptoms Course of a Meridian usually has already been one of the patient's weak spots (constitutional, acquired), or it has developed later in response to external factors (disease, accident). In some cases there will be no acute or previously existing weak spot; rather, the symptoms develop during, or shortly after, surgical intervention precisely along the course of the meridian affected. The meridian reacts by irritation, and this is called “meridianitis.” Two examples should illustrate this.

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An Example from My Practice Strumectomy Scar – Stomach Meridian

Upon my advice, a 65-year-old patient had undergone strumectomy. She then reported that she felt a terrible pain in the left half of the face shortly after recovering from anesthesia. Focus diagnosis revealed a small field of disturbance where the fresh strumectomy scar crossed the Stomach Meridian. The pain

Fig. 8 Stomach Meridian.

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32 The Basics described by the patient lasted for three days while she was hospitalized and then subsided. This was regarded as a temporary irritation of the Stomach Meridian. As is often the case with unexplained pain, there had been a blockage in the flow of energy (the Stomach Meridian runs from the head to the feet) (Fig. 8).

Fig. 9 Large Intestine Meridian.

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Root Resection – Large Intestine Meridian

Again upon my advice, another patient underwent root resection (apicoectomy) because of focal activity of a devitalized fourth tooth of the left maxilla (24). Right after this intervention he used to wake up at 6 o’clock in the morning with a piercing pain in the right shoulder. The pain lasted for a few hours and subsided during the course of the day. This pattern repeated itself every day until the patient came to see me. Examination of the shoulder yielded an atypical finding. Both active and passive mobility were severely restricted, while the isometric function tests were without findings, even local palpation did not indicate any involvement of rotator cuff or acromioclavicular joint. There was some sensitivity to pressure in the region of acupuncture point LI 15 (lateral border of the shoulder). The site of pain was described as lateral and radiating into the lateral elbow (LI 14, LI 11) (Fig. 9). This obviously represented an irritation of the Large Intestine Meridian which runs from the index finger along the arm and across the shoulder, neck, and cheek to the upper lip, where it crosses to the other side and terminates at the contralateral wing of the nose (focal disturbance on the left side, pain on the right side). The end point, LI 20, lies in the region of the root apices of teeth 23 and 24, and surgical intervention had been at the latter tooth. The meridian clock even explains why he woke up early in the morning with pain in the shoulder (Fig. 2, p. 10). The pain has obviously been induced by manipulation at the dental focus, thus irritating the meridian running through this region. Follow-up treatment of the ear reflex zone of the tooth soon lead to complete freedom of pain.

Intestinal Dysbiosis Also, disorders of the gastrointestinal tract, such as intestinal dysbiosis or fungal infection, may have a focal effect on the body by maintaining disease processes. For more details on the physiological and pathophysiological basics of the gastrointestinal tract and its microflora, please refer to the current medical literature (11, 14, 21, 31, 39, 40, 43). In the following, only a few key features will be mentioned that are essential for understanding the relationships between intestinal dysbiosis and chronic diseases.

Vitamin Synthesis, Immune System

Symbiosis means living together (sym, together; bios, life). We humans have entered a symbiosis with enteric bacteria without noticing it. How this coexistence of different organisms for mutual benefit works may be illustrated by the following example from the animal kingdom: In the throat of large predatory fishes live small fish which keep it clean by feeding on parasites. The purpose and function of the symbiotic organisms in the human intestinal tract are far from clear, but two tasks seem to be certain:

intestinal bacteria produce vitamins that are essential for humans, for example, vitamin B1 and vitamin K, and

they are a component of the body’s defense system.

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34 The Basics The fecal flora of healthy humans contains up to 90% obligatory anaerobic germs, such as bacteroids, bifidobacteria, and others, as well as an accompanying flora of obligatory or facultatively aerobe germs, such as coliform bacteria, enterococcae, and lactobacillae. Normally, that is, in humans with eubiotic intestinal flora, the different germs each colonize specific parts of the small and large intestines. The intestine has a surface area of 300 m2 (for comparison, the surface area of the skin is 2 m2). The intensive exposure of the intestine to antigens through colonization by microbes and the confrontation with exogenous antigens, such as food components, toxins, and their metabolites, call for an efficient defense mechanism. For this purpose, more than 80% of the lymphatic system and, hence, of the body’s defense system are gathered in the intestinal tract to maintain a balance between the human host and the internal microbial environment. This alone may illustrate the immense importance of a functional intestinal environment for the body’s entire defense system. The usual therapies of conventional medicine often do not seem to take this fact into account. The following factors can upset the balance of this fine-tuned eubiotic environment:

poor nutrition (e. g., unbalanced food, processed carbohydrates), food allergens (see below), too much animal protein, too little fiber, long-term constipation, drug abuse (especially laxatives), antibiotics, which are indiscriminately effective also against the intestinal flora (though essential and desirable in case of disease), and permanent stress. Damage to the symbiotic intestinal flora causes a shift toward pathological dysbiotic microbes which then take over the position, but not the function, of their symbiotic predecessors. This may result in:

decreased vitamin synthesis, change in pH, retrograde migration of pathogenic germs into the small intestine and possibly into the pancreas and biliary ducts, and

favorable conditions for the growth of fungi, for example, Candida albicans.

Leakage through the Intestinal Wall

Antibodies of the IgA type protect the mucosa of the respiratory and intestinal tracts by lining them like an antiseptic coating. Dysbiosis causes, among other things, insufficient production of IgA and, thus, insufficient stimulation of T cells. The permeability of the intestinal wall for antigenic microorganisms (and also food antigens) is pathologically increased (leaky gut syndrome). Dysbiosis results in immunological reactions in the intestinal tract which lead, among other things, to the formation of toxic metabolites, such as ammonia, indols, phenols, scatols, cadaverine, putrescine, fusel alcohols, and aromatic or aliphatic amines (51, 52).

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Potential Foci 35

Fungal Growth

In addition, increased fungal growth produces mycotoxins. The increased permeability of the intestinal tract favors the uptake of these substances into the bloodstream. Among other activities, mycotoxins have cerebral effects, are highly allergenic, and act as liver toxins or carcinogens. For example, bronchial asthma can be induced and maintained by mycotoxins. (In this context, it is interesting to note the energetic connection of the meridian pair, Lung Meridian–Large Intestine Meridian, see p. 9)

From the perspective of focal diseases, a pathologically altered intestinal tract must be regarded as a field of disturbance. Apart from the inappropriate nutrition often associated with our modern civilized world, allergic reactions to food are a common cause for intestinal dysbiosis (51, 52).

Lymphatics of the Intestinal Tract

In addition to the consequences that food allergies have within the intestinal tract and around it, they can severely affect the lymphatics of the intestinal tract and thus lead to exhaustion of the intestinal immune system. As a result, other lymphatic tissues of similar embryonic origin must increasingly fulfill the defense function, leading to enlarged tonsils and pharyngeal tonsils (polyps). This is followed by frequent episodes of tonsillitis or otitis media and finally leads to the removal of the presumed culprit. As a rule, it is worthwhile checking for food allergies in the affected children. Elimination of the allergen(s) leads rather quickly, often within a few weeks, to regression of the functional hypertrophy of the lymphoid ring.

Gastrointestinal Allergy and Migraine It has been pointed out time and again that a thorough focus diagnosis is especially important in the case of migraine therapy.

Weakness of the Middle Burner

As already discussed in an earlier example (see p. 29), our acupuncture practice shows that a migraine is often caused by weakness of the Gallbladder Meridian (gallbladder migraine). Such a migraine typically begins in the middle of the night or early in the morning and is accompanied by headache along the course of this meridian (pressure behind the eyes, on the temples, on the skull, in the neck region). If this weakness is not caused by a scar focus located in the course of the Gallbladder Meridian, or a meridian energetically linked to it, then there is usually an overall disturbance of energy, such as the so-called weakness of the Middle Burner according to TCM. Furthermore, it is frequently reported that the migraine is more intense during menstruation, during a change in the weather, or in response to tension or relaxation—or it may even occur only in these instances. We know, however, that the “causes” reported by patients usually only trigger the migraine and that their weakening effects only enhance a preexisting weakness of the Gallbladder Meridian.

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36 The Basics A change in the weather and a drop in hormones during menstruation are both well tolerated by a patient without focal disturbances. Gastrointestinal allergies are another potential cause for a weakness of the Gallbladder Meridian; as mentioned earlier, they can act as a field of disturbance. Moreover, and sometimes independent of the true gastrointestinal allergens, certain foods may act as additional triggers—for example, cheese, red wine, chocolate, certain types of sausages, and canned fish. A very healthy and natural diet does not do any good if the patient is allergic to one of its components. In principle, it is very reasonable to change one’s diet in favor of wholewheat products. Hence, it seems almost ironic to tell a migraine patient that the intensification of his/her symptoms during the last half year is due to an otherwise sound nutritional decision and that the pain will be alleviated once wheat has been completely eliminated from the diet. In the presence of an intestinal focus, focus therapy should never consist only of passive treatment. I have made it a habit in my practice to make this very clear to the patient and to request active participation. For example, I do not like to use acupuncture in children for the sole purpose of adapting them to an improper diet.

Amalgam, Formaldehyde

In this context it should also be mentioned that chyme loaded with amalgam particles (as a result of normal chewing in the presence of amalgam fillings) may affect the intestinal flora, the permeability of the intestinal wall, and the lymphatics of the intestinal tract in a similar way as food allergens do (see pp. 34, 88). The same is also true for large loads of formaldehyde, solvents, and other chemicals.

Pulse Diagnostics

A therapist experienced in using the vascular autonomic signal (pulse diagnostics according to Nogier, see p. 101ff.) can test for food intolerance or food allergy in a very precise and reliable way by means of the five Focus Indicator Points. This is even possible in areas in which the conventional tests are no longer reliable.

Substance Intolerance Dental Galvanism

In the field of dental restoration there has been an increase in the use of various materials that are foreign to the body. This creates dental galvanism not only between different metals but also between portions of the same metal processed in different ways or portions of toxic metal set free by corrosion. These factors put a strain on the body and, among other things, destroy the healthy intestinal flora. Changes in pH disturb and alter the normal bacterial colonization of the mouth and intestinal tract. The resistance of the mucosa against toxic metabolites declines, and the disturbed permeability resulting from damage to the intestinal mucosa leads to autointoxication (leaky gut syndrome). For information on the toxicity of metals used for dental restoration, please refer to the medical literature (7, 48, 53). When discussing the pros and cons of using amalgam as dental material, it should be kept in mind that many of the serious studies that clearly

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Potential Foci 37

demonstrate the toxicity of this material have been carried out by medical or scientific researchers who often have nothing to do with naturopathy. These studies are not based just on the practical experience often put forward by naturopathic doctors, but on hard facts.

Toxic Mercury

Scientists at the Institute of Forensic Medicine at the University of Munich have demonstrated that the percentage of organic mercury derived from food is small in all organs studied (liver, kidneys, and brain), namely 5–8% of the total mercury found in these organs. By contrast, the percentage of inorganic mercury released from dental fillings is about 95% of the total. Furthermore, the correlation between the mercury load and the number of teeth filled with amalgam is highly significant (with an increased number of fillings, inorganic mercury may reach up to 99% of the total). These findings certainly should make us think twice (9). When an internationally recognized medical journal like The Lancet agrees to publish an article on dental amalgam as a source of mercury poisoning via direct nose-to-brain transport (2), it becomes clear that this issue can no longer be dismissed. This mechanism of intoxication affects not only the patient during removal of the fillings by drilling (mercury vapor) but especially also the dentist. The poison reaches the brain via the valveless venous system and the olfactory nerves (26–28). The mercury load of the mother can lead to intoxication of both fetus and infant (the concentration in the child’s kidneys is several times higher than in the kidneys of the mother). This fact is now as well established as the many other toxic mechanisms of amalgam (46). Unfortunately, the reality is that there is still no material that matches the properties of amalgam (in terms of expansion coefficient, plasticity, durability, costs, easy processing, etc.). However, this should not prevent us from discussing the undesirable and often disease-causing effects of this material.

Avoiding Implants

Whenever possible, one should avoid implanting metal parts into the body, because they may indirectly disturb the balance of electrolytes and create an electrogalvanic current. While it may not be possible to avoid joint replacements or surgical repair of accidental injuries involving metal wires and plates, the use of metal implants in dental prosthetics needs careful reassessment.

Other Potential Foci Mental Field of Disturbance

Many illnesses may also be maintained by a troubled psyche. The concept of a mental field of disturbance (mental focus) is well established in the field of focus diagnosis. It speaks for itself that sole reliance on our diagnostic procedures for foci is not sufficient for such a diagnosis. However, testing for such foci often provides valuable clues that might help the therapist to think along these lines and begin to talk about the issues involved.

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38 The Basics In practice it is good to know about the link between specific organs and certain emotions, for example:

gallbladder – worry, liver – anger, lungs – sadness, and spleen – anxiety.

An Example from My Practice Worry – Migraine

In my practice, I once had a patient who suffered from a so-called gallbladder migraine which remained resistant to therapy even after several treatments. A well-aimed question uncovered the true origin of her gallbladder weakness: she was extremely worried. Such an emotional condition weakens the Gallbladder Meridian which, in turn, causes an increased susceptibility to migraine, especially if the patient is predisposed to it.

Environmental Factors

Diagnosis and therapy of external fields of disturbance—such as toxic substances, geopathogenic factors, electromagnetic fields (“electrosmog”, recently increased by the use of cellular phones), radioactive and ionizing radiation—certainly also play important roles in the concept of a holistic therapy. However, they cannot be discussed here.

References 1. Bahr, F.: Systematik und Pratikum der wissenschaftlichen Ohrakupunktur für mäßig Fortgeschrittene. Self-published, Munich 1989 2. Bahr, F.: Systematik und Pratikum der wissenschaftlichen Ohrakupunktur für Fortgeschrittene (Stufe 3). Self-published, Munich 1994 3. Bergsmann, O.: Asymmetrische Leukozytenbefunde bei Lungentuberkulose. Wien. klin. Wschr. 77 (1965) 618–621 4. Bergsmann, O.: Herdwirkung in der Pulmologie. Therapiewoche 15 (1965) 1284–1287 5. Bergsmann, O.: Pathogenetische Aktivität der Störfelder. Der informierte Arzt 20 (1980) 41–48 6. Daunderer, M.: Amalgam – Klinisch-Toxiologische Stoffmonographien. Ecomed, Landsberg 1989 7. Daunderer, M.: Handbuch der Umweltgifte. Ecomed, Landsberg 1990 8. Dosch, P.: Lehrbuch der Neuraltherapie nach Huneke. Haug, Heidelberg 1989 9. Drasch, G., Schupp, I., Riedl, G., Günther, G.: Konzentrationen von anorganisch und organisch gebundenem Quecksilber in Nierenrinde, Leber und fünf Hirnarealen. Dtsch. Zahnärztl. Z. 47 (1992) 490–496 10. Glaser M.; Türk, R.: Herdgeschehen. E. Fischer, Heidelberg 1982 11. Greinwald, R.: Moderne Grundlagen für die mikrobiologische Darmtherapie. Erfahrungsheilkunde 5 (1991) 324–328 12. Gross, D.: Innervierte Strombahn, Gefäßzone, Quadrant und ihre Bedeutungen für die Therapie. Acta neuroveg. 30 (1967) 522–535 13. Härtel, H.: Bildatlas der Herddiagnostik im Kieferbereich. Haug, Heidelberg 1992

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Potential Foci 39 14. Irrgang, K., Sonnenborn, U.: Beziehungen zwischen Wirtsorganismus und Darmflora. Schattauer, Stuttgart 1988 15. Kellner, G.: Wirkung des Herdes auf die Labilität des humoralen Systems. Öst. Z. Stomatol. 60 (1963) 312 16. Kellner, G.: Nachweismethoden der Herderkrankungen und ihre Grundlagen. Therapiewoche 15 (1965) 1267–1274 17. Kellner, G.: Zur Histiochemie der Narbe. Hippokrates 36 (1965) 777–785 18. Kellner, G.; Klenkhart, E.: Zur Differenzierung der Serumjodometrie nach A. Pischinger (Elektrometrische Titration). Österr. Zschr. f. Erf. u. Bek. Krebskrankht. 25 (1970) 81–88 19. Kibler, M.: Segment-Therapie. Hippokrates, Stuttgart 1950 20. Klein, F.: Personal communication 21. König, H., Manz, W., Singer, U.: Einfluss auf Darmbakterien. Kassenarzt 18 (1991) 52–61 22. Krapf, H.: Vergleichende Studie über die Aufdeckung einer Kieferhöhlenaffektion mittels CT, Röntgen, Spiegelung an 750 Patienten. Medical Tribune, Nov. 20, 1990 23. Lechner, J.: Herd, Regulation und Information. Hüthig, Heidelberg 1993 24. Leriche, R.: Die Chirurgie des Schmerzes. Masson, Paris 1949 25. Nogier, P.: Lehrbuch der Aurikulotherapie. Maisonneuve, Sainte Ruffine 1969 26. Nylander, M., Aquilonius, S. M., Friberg, I., Gillberg, L., Lind, B.: Mercury distribution in human brain in relation to exposure from dental amalgam. Poster presented at the ISTERH Conference Palm Springs, California, Dec. 8, 986 27. Nylander, M.: Mercury in pituitary glands of dentists. Lancet 1 (1986) 442 28. Nylander, M.: Zahnamalagambedingte Quecksilbervergiftung durch direkten Nasen-Hirn-Transport. Lancet 3 (1989) 29. Perger, F.: Kompendium der Regulationspathologie und -therapie. Sonntag, Munich 1990 30. Pischinger, A.: Das System der Grundregulation. Haug, Heidelberg 1990 31. Reimann, H. J.: So hilft Kneipp bei Nahrungsmittelallergie. Orac, Wien 1991 32. Rossaint, A. L.: Ganzheitliche Zahnheilkunde. 3rd ed., Haug, Heidelberg 1991 33. Rost, A.: Verifizierung der Wirksamkeit der Neuraltherapie durch die Thermographie. Ärztez. Naturheilverf. 23 (1982) 713–719 34. Rost, A.: Objektivierung der Neuraltherapie nach Huneke durch die Thermographie. In: Freudenstädter Vorträge 1986, vol. 11, editor P. Dosch. Haug, Heidelberg 1987 35. Schiffter, R.: Neurologie des vegetativen Systems. Springer, Berlin 1985 36. Schmidt, H.-D.: Personal communication 37. Schmidt, J.: Neuraltherapie. Springer, Berlin 1988 38. Schoeler, H.: Zur elektrischen Untersuchung von Narben. In: Therapie über das Nervensystem, vol. 2, editor D. Gross. Hippokrates, Stuttgart 1965 39. Schulze, J.: Obstipation und Darmflora. Z. ärztl. Fortbild. 86 (1992) 121–126 40. Schütz, E.: Mikrobiologische Therapie von chronisch entzündlichen Darmerkrankungen (CED). Erfahrungsheilkunde 5 (1991) 328–334 41. Schwamm, E.: Thermographischer Bericht über das Infrarot-Symposium 1969 in Freundenstadt. Verlag für Physikalische Medizin, Heidelberg 1971 42. Schwamm, E.: Thermographische Störfelddiagnostik. In: Freudenstädter Vorträge 1974, vol. 2, editor P. Dosch. Haug, Heidelberg 1974

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40 The Basics 43. Sonnenborn, U.; Stobernack, H.-P., Proppert, Y.: Die Entwicklung der aeroben Darmflora bei Neugeborenen. Fortschr. Med. 108/21, 420/ 36, 424/42 (1990) 44. Stacher, A.: Die Wirkung der Neuraltherapie auf das Blutbild. Ärztl. Prax. 18 (1966) 827–829 45. Steinhäusler, F. et al.: Membrane resting potential (MRP) as indicator of cell transformation in human lung biopsy samples (preliminary report). 2nd International Workshop on Experimental Oncology. Madison, Wisconsin USA, May 29 and 30, 1981 46. Störtebecker, P.: Mercury poisoning from dental amalgam: a hazard to human brain. Störtebecker Foundation of Research, Stockholm 1985 47. Tilscher, H., Eder, M.: Therapeutische Lokalanästhesie, Hippokrates, Stuttgart 1989 48. Volkmer, D.: Amalgamitäten. Energetik, Sulzbach 1992 49. Volkmer, D.: Eigener Herd, Goldes wert. Energetik, Sulzbach 1993 50. Voll, R.: Kopfherde. Med. Verlagsges., Uelzen 1987 51. Werthmann, K.: Enterale Allergien. Haug, Heidelberg 1986 52. Werthmann, K.: Kinderallergien – Erkennen und Behandeln durch individuelle Diät. Sonntag, Regensburg 1989 53. Ziff, S.: Amalgan – die toxische Zeitbombe. Hübner, Waldeck 1985

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Test Procedures for Focal Disturbances The Role of Ear Acupuncture in the Testing for Foci Around 1950 Paul Nogier, a physician from Lyon, France, discovered that the external ear represents a reflex area onto which all organs of the body are projected (48, 49). He noticed that some of the patients in his practice had strange scars at a specific site on the auricle. When questioned the patients reported that they had been treated for lower back pain by a lay healer. The respective site on the ear had been cauterized by means of a red-hot iron pin. As a result, the back pain had subsided or even disappeared altogether.

Reflex Localizations

Nogier followed this up and was successful in reproducing the method in many patients with lower back pain, initially by cauterizing and later by pricking the observed site on the ear with an acupuncture needle. The site in question was located on the antihelix where it intersects the ascending helix and was, obviously, a reflex localization of the lumbosacral transition (L5/S1) (Fig. 10). Nogier then had the brilliant idea that other parts of the body might be projected onto the auricular surface as well, thus creating a reflex map on the ear. In patients with lower back pain clinically localized in the region of the lumbosacral transition, he observed that the al-

Fig. 10 Reflex localization of the L5/S1 transition on the ear.

Fig. 11 Reflex localization of the vertebral column on the ear.

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42 The Basics ready known ear point for the L5/S1 region was very sensitive to pressure. This tenderness was absent in healthy individuals. He then examined systematically in many patients the pressure sensitivity of points along the antihelix and thus found that this region represented the entire vertebral column in an inverted form (Fig. 11).

Pressure-Sensitive Reflex Points

At first the research into the ear reflex zones was pursued only via the increased pressure sensitivity of reflex points. After a while Nogier discovered that points found due to their tenderness also proved to have a different temperature than their normal surroundings as well as an increased or decreased skin resistance. Hence, the points could be detected by electrical measurements. This made it much easier to determine which reflex point belonged to which body region or organ, since data collection was now objective and no longer depended on the cooperation of the patient.

Electric Point-Finders

Point-finding devices, see pp. 60ff., 68f. were developed which not only measured the difference in skin resistance between a point and its surroundings but could also indicate the degree of change. Following this intensive research, Nogier collaborated with Bahr (Bourdiol produced the drawings) to develop detailed reflex maps of the lateral and medial surfaces of the auricle. These maps are still in use today and represent the foundation of auriculotherapy, the treatment by means of ear reflex zones. Nogier observed that only those reflex points were particularly sensitive to pressure, or changed electrically, that represented an area of pain or an area of pathological change in the body (e. g., osteoarthritis). He did not find any pressure-sensitive or electrically altered points in a completely healthy person, where the surface of the ear was electrically neutral. This meant that an organ or joint would produce a corresponding point on the ear only if there was a pathological change.

Only a disturbed structure (e. g., a painful joint) will have an active, electrically altered reflex point on the ear. Today, this fact still forms the essential foundation of every diagnosis via reflex zones on the ear, no matter whether one is searching for the ear point corresponding to a painful joint or for a field of disturbance. The following is valid for focal disturbances:

Auricular Representation of Disturbing Scars

Only a structure with true focal activity will have an active corresponding point on the auricle. Identification of these active reflex points represents an important opportunity to assess various suspect structures of the body (scars, maxillary sinuses, etc.) for their focal activity. When searching for foci this means that out of several suspect scars only the truly disturbing one will have an electrically altered reflex point. Scars without focal activity do not have a corresponding point on the auricle. It is possible that several scars or inflammatory foci have focal activity at the same time; if this is the case, they

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are each represented by a corresponding active (electrically altered) point.

Example: Disturbing Scar – Ear Point

If a scar on the lower leg has no focal activity, there will be no altered point in the Lower Leg Zone on the ear (see p. 222). However, if the patient has a disturbing scar following surgery in the pelvic region, an active point will definitely be present in the Pelvic Zone on the ear, thus indicating a focal activity. Interestingly enough, one can even distinguish between the focal activity originating from the scar in the abdominal wall and that originating from the internal scar, because the reflex localizations for the abdominal wall and, for example, the uterus are located at different sites on the auricle.

Auricular Diagnosis and Therapy

Based on the reflex cartography and the knowledge about ear reflex zones gained so far, Bahr not only developed the diagnosis of foci mentioned above but also the systematic use of ear acupuncture for diagnosis (auriculodiagnosis) and therapy (auriculotherapy) as it is taught today by the German Academy for Acupuncture and Auriculomedicine in Munich (see p. 232ff.). The scientific basis for ear acupuncture has been described in numerous publications (1–71).

Focus Therapy via Ear Reflex Zones

A field of disturbance can be diagnosed as well as treated via the ear reflex zones (see p. 77ff.). In addition, not only foci but also the various diseases maintained by them can be successfully treated or alleviated by means of ear acupuncture: all kinds of painful conditions (especially functional pain), headache and migraine, bronchitis, asthma, gastrointestinal disorders, allergies, susceptibility to infections, irritated bladder, prostate disorders, many functional disorders, singultus, fertility and hormonal disorders in both men and women, addictions, and insomnia. Absolute preconditions for focus diagnosis and therapy and also for symptom-oriented ear acupuncture are a correct diagnosis via the corresponding zones on the ear and a clean treatment method. (For this reason, studies are more difficult to conduct than drug tests— the therapy depends entirely on the training of the therapist.)

Medical History of the Patient, Preliminary Examination

It speaks for itself that, following a thorough medical history, every patient should undergo physical examination and, if necessary, also the usual diagnostic laboratory tests and imaging procedures prior to acupuncture treatment. One of the fascinating things about ear acupuncture is that it is possible to learn the methods within a relatively short time and that one is soon able to achieve surprising results.

General Remarks Regarding the Testing Conventional Medical Diagnostics

As mentioned earlier, the concept of a focus has been long established in the field of internal medicine and, in the case of certain illnesses, screening for foci is performed with the available methods. Unfortunately, a large proportion of existing foci that interfere with

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44 The Basics the healing process still escapes the common diagnostic methods of conventional medicine. An increase in alpha-2 globulins is known to be a sign of an acute inflammation and is often accompanied by a high erythrocyte sedimentation rate and an increase in beta globulins. An increase in gamma globulins indicates the chronicity of an inflammatory condition. Apart from this, immunoelectrophoresis (IgA, IgM, IgG) may yield pathological findings in the presence of a focal process. All these parameters, however, may only point in the right direction but can indicate neither the type nor the site of a focus. In many cases of focal processes, the findings are still within the normal range.

Grading of a Focus

Various medical “fringe groups” have been trying for years to develop testing methods better than the usual laboratory tests and other equipment-intensive diagnostic tools available today. Many of the detection methods developed so far are not very convincing. They often only indicate whether or not there is a focus, while some may also indicate which side or quadrant of the body is affected. They rarely provide information on the precise site of a focus, and they cannot establish prior to therapy whether or not an altered body structure (scar, dead tooth, etc.) has focal activity. None of these testing methods allows for grading of a detected focus or for the essential identification of the primary focus. Grading of a focus provides important clues about the intensity of a focal process, that is, how severely a patient is affected or what role the focus plays in the entire disease process. The most intense focus is the primary focus; it maintains the entire disease process. All other foci that may exist are secondary foci; they are supported by the primary focus which maintains their focal activity. They are of a subordinate nature and are not really responsible for the symptoms reported by the patient. If the primary focus is not found right away, or not at all, with the testing method applied, all therapeutic efforts will be temporary or not successful at all. In various publications one can find statements such as “80% of all foci are located in the mouth, teeth, and jaw region.” I often wonder about the matter-of-factness of these statements; after all, the author can only evaluate foci that he/she can detect by means of his/ her own testing methods. This clearly raises the question of how sensitive these testing methods are (e. g., scar foci commonly found in practice are either not considered or have not been detected).

Focus Diagnosis According to Bahr

The focus diagnosis according to Bahr described in this book, see pp. 46f., 54f. allows for a targeted search for foci. This is far more than the tentative search for a focus, such as the one carried out in neural therapy, for example. With Bahr’s focus diagnosis it is possible to determine the primary focus (the detection and elimination of which is crucial for therapeutic success) and to distinguish between active and quiescent foci.

Neural Therapy

As mentioned earlier, not every scar has focal activity—and of those that have, not the entire length of the scar will act as focus but only one or two points. Of course, if the trial and error treatment of all

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scars by neural therapy includes the one scar with focal activity (primary focus), then focal activity will subside and so will the symptoms of the patient. However, in order to eliminate the focal activity of a scar for good, it has to be treated several times at weekly intervals. If the primary focus remains undetected for lack of diagnostic possibilities, one is forced to treat repeatedly all scars present, that is, each scar has to be infiltrated individually. Some neural therapists therefore do not treat all potential scars in one session but treat them one at a time in order to recognize the primary focus by the result of the treatment. In principle, this is a good idea, but it may considerably delay the diagnosis and, hence, any effective treatment of the symptoms. After all, what is “a potential scar”? As outlined earlier, every scar can have focal activity.

Targeted Treatment of Scars

If the therapist is able to identify the one scar with focal activity among all other scars and to localize precisely the one or two disturbing points of this scar, the patient will be spared from having to undergo the uncomfortable infiltration of every scar present.

Detection of Dental Foci

Especially in the dental region, focus diagnosis often has far-reaching consequences, and it is particularly important here to reach a reliable diagnosis of the focus. Not every devitalized tooth is a focus that must be removed. Here, too much good is sometimes done as a preventive measure by needlessly removing non-disturbing teeth as well. It should be kept in mind that every gap in one’s teeth may disturb the balance in the mouth, teeth, and jaw region—not to mention the resulting invasive treatment of neighboring teeth required for fitting a bridge and the subsequent regression of the jaw bone. On the other hand, a devitalized tooth with focal activity is often not recognized as a focus, especially if it does not cause any symptoms. The focus diagnosis described in this book permits one to identify exactly the focal activity of individual structures in the mouth, teeth, and jaw region.

Foci Not Recorded in the Patient’s History

Frequently an existing focus cannot be uncovered by taking a detailed medical history, because the patient no longer remembers any disturbance, or is not aware of it, and because there are no signs of a focal disturbance. Examples include chronic inflammatory changes in the region of the maxillary sinuses or in the pelvic region, which often escape even the most elaborate conventional diagnostic tools. A targeted focus diagnosis can uncover focal disturbances not recorded in the patient’s history.

The Validity of Bahr’s Method

As described in this book, several important questions can be answered by focus diagnosis using the five Focus Indicator Points according to Bahr:

Does the patient have any focal disturbances? How many foci does the patient have? Where are these fields of disturbance? Which one is the most intense field of disturbance (primary focus)? Does a suspect structure of the body (scar, tooth, etc.) have any focal activity, and does it therefore participate in causing/main-

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46 The Basics taining the illness? (This is important, e. g., for deciding whether or not a dead tooth must be removed.) Which part of a scar acts as a focus? Are there any foci that have not been recorded in the patient’s history? Do certain body structures have the potential to cause disease? (This is important for prophylactic treatment.) Not only can foci be diagnosed in a targeted way but, above all, the procedure saves time, and the course of focus therapy can be monitored. By means of this method even internal foci can be treated without the need for deep infiltration (see p. 47).

Test Procedure for Foci According to Bahr— An Overview The following is a summary of two different methods of focus diagnosis according to Bahr. The reader then may come to his/her own decision regarding where to begin. The basic difference between the method for beginners (Level 1) and that for more advanced therapists (Level 2) lies in the sophistication at the advanced level. Here, the search for foci includes the use of Nogier’s pulse diagnosis based on the vascular autonomic signal (see page 101 ff.).

Focus Diagnosis for Beginners (Level 1) Diagnosis with the Point-Finder

In our auriculomedical training program, the beginner will first learn the reflex localizations of ear acupuncture. This is not difficult and can be learned in a few days because the reflex localizations of organs on the ear are arranged in a logical order. Every pathological process of the body manifests itself as an active (electrically altered) point or zone on the surface of the auricle. This point can be detected by means of a point-finder and thus made available for treatment, see p. 63ff. Basically, the beginner diagnoses disturbances by using the points and reflex zones of ear acupuncture. Examination of the ear reflex zones makes it possible to tell whether there are any foci present in the body and where they are, because only true, active foci produce a corresponding, measurable reflex point on the surface of the auricle (see p. 56ff.). The skills acquired at Level 1 will enable the beginner to check for focal activity and decide on further treatment. By using a small point-finder, regions suspected of being foci because of the patient’s history can be checked via these ear reflex zones. By using simple methods, the beginner already gets an opportunity to diagnose and treat foci (see p. 59ff.).

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Test Procedures for Focal Disturbances 47

More Advanced Focus Diagnosis (Level 2) Pulse Diagnosis

Level 2 is an introduction into the method of VAS control (pulse diagnosis, Nogier’s reflex, see p. 101ff.). This method makes the therapist independent of the point-finder and allows for grading of the foci detected through ear reflex zones according to their importance (using the five Focus Indicator Points according to Bahr, see p. 115ff.). The entire focal process thus becomes easier to evaluate. The primary focus can be identified in a very targeted way. The therapist no longer has to rely so much on the patient's memory (patient’s history), because the method also permits the detection of foci which are either unknown to the patient (e. g., in the dental region) or can no longer be recalled.

Improved Therapeutic Possibilities

Working under the guidance of VAS control, see p. 144ff., permits a more accurate treatment of the foci. For example, small sites of disturbance within a long scar can be accurately needled or infiltrated. The treatment of foci via ear reflex zones using acupuncture needles also becomes more precise, since the reflex points often measure less than one millimeter in diameter. A dental focus found via ear reflex zones can now be exactly assigned to the affected tooth. The correct application of this method and also various opportunities for practicing it will be discussed in detail below (see p. 232ff.).

Where to Start Focus diagnosis is possible via the method for beginners as well as via the method taught at Level 2 (VAS, five Focus Indicator Points according to Bahr). The ideal foundation for successful focus diagnosis and, above all, therapy is a combination of both methods: the detailed knowledge of ear reflex zones (Level 1) and learning the VAS control (Level 2). The advantages and disadvantages of both methods are summarized on page 48.

Therapy of Internal Foci

Knowing about the ear reflex zones offers another advantage when treating internal fields of disturbance. Not only can the focal activity of an internal focus be diagnosed via ear reflex zones, it can also be treated this way, see p. 77. This offers an excellent opportunity for a noninvasive and completely risk-free therapy, especially of foci that are difficult or impossible to reach (such as scars from tonsillectomy, chronically inflamed tonsils or maxillary sinuses, gynecological disorders, etc.). Such foci no longer require a sophisticated and by no means low-risk injection (as used, e. g., in neural therapy). In some cases treatment via ear reflex zones even represents the only possible therapy.

Preliminary Examination Is Obligatory

It speaks for itself that the specific search for foci described in this book must be preceded by the usual medical history of the patient, a detailed physical examination (both in general as well as specialist terms), targeted laboratory tests, and, if necessary, examination by imaging procedures.

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48 The Basics

Comparison of the Various Methods for Focus Diagnosis and Therapy Advantages of the Method for Beginners (Level 1) The findings are relatively easy to reproduce by means of a point-finding device. Knowing the auricular reflex zones provides the best access for treating internal foci. No need to learn VAS at this stage. Disadvantages of the Method for Beginners (Level 1) The therapist must have a good command of the auricular reflex zones because foci are diagnosed exclusively via these reflex zones. Accurate identification of the primary focus is not always possible. Precise assignment of dental foci (via Tooth Points on the ear) is not always possible. Foci not recorded in the patient’s history may not be noticed. Investment in a point-finding device. Advantages of VAS Diagnostics (Level 2) Establishing whether or not there are any foci at all. Determining the number of foci present. Establishing the primary focus. Localizing the foci in the body. Accurate assignment of dental foci (via Tooth Points on the ear). Establishing whether or not a scar or dead tooth has focal activity. Foci not recorded in the patient’s history will not go unnoticed. Initially, a good command of the auricular reflex zones is not essential. Even the nonacupuncturist is able to make an efficient focus diagnosis exclusively by using the system of Focus Indicator Points. (However, therapy via auricular reflex zones would be ideal if the therapist wants to treat internal foci without using deep infiltration.) No investment in a point-finding device. Perceived Disadvantages of VAS Diagnostics (Level 2) Application of the VAS must be learned and practiced. It cannot be emphasized enough that one should strive to learn the VAS method in any case. Apart from the focus diagnostics, this method offers a wide spectrum of other potential applications for the practice, for example, controlled neural therapy, controlled ear acupuncture, controlled body acupuncture, testing for food allergies (patients with allergies or neurodermatitis), testing for reactions to drugs (see p. 203).

References 1. Arens, K., Schumacher, J.: Diagnostische und therapeutische Möglichkeiten der Ohrakupunktur bei orthopädischen Krankheitsbildern. Orthop. Prax. 18/6 (1982) 446–454 2. Bahr, F. R.: Einführung in die wissenschaftliche Akupunktur. 6th ed. Vieweg, Braunschweig 1994 3. Bahr, F. R.: Einführung in die wissenschaftliche Akupunktur. Selfpublished, Munich 1991 4. Bahr, F. R.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für Fortgeschrittene (Stufe 3). Script, Braunschweig 1993 5. Bahr, F. R., Reis, A., Straube, E.-M., Strittmatter, B., Suwanda, S.: Skriptum für die Aufbaustufe aller Akupunkturverfahren. 4th ed. Self-published, Munich 1993 6. Baldry, P.: Acupuncture Trigger Points and Musculoskeletal Pain. Churchill Livingstone, Edinburgh 1989

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Test Procedures for Focal Disturbances 49 7. Bergsmann, O.: Objektivierung der Akupunktur als Problem der Regulationstherapie. Haug, Heidelberg 1974 8. Bergsmann, O.: Akupunktur und Bewegungssystem. Dtsch. Z. Akupunkt. 3 (1982) 69 9. Birkmayer, W., Danielczyk., W., Riederer, P.: Biogene Transmitter und Akupunktur. Haug, Heidelberg 1976 10. Bischko, J.: Einführung in die Akupunktur, vol. 1, 3rd ed., Haug, Heidelberg 1989 11. Bossy, J.: Formation réticulaire et acupuncture. Méridiens. o. B. (1981) 55–56, 73–93 12. Bossy, J., Prat-Pradal, D., Teulemollier, J.: Die Microsysteme der Akupunktur. VGM-Verlag, Essen 1993 13. Bossy, J., Godlewski, G., Maurel, J. et al.: Innervation and vascularization of the auricula correlated with the loci of auriculotherapy. Acupuncture & Electrotherapeut. Res. Int. J. 2/3–4 (1977) 247–257 14. Bourdiol R. J.: Eléments d’Auriculothérapie. Maisonneuve, Sainte Ruffine 1980 15. Chang, Ch. Y., Chang, Ch. T., Chu, H. T., Yang, L. F.: Peripheral afferent pathway for acupuncture analgesia. Scientia Sinica 16 (1973) 210–217 16. Dawood, M. Y., Ramos, J.: Transcutaneous electrical nerve stimulation (Tens) for the treatment of primary dysmenorrhea: a randomized crossover comparison with placebo, Tens and ibuprofen. Obstet. and Gynecol. 75 (1990) 656–660 17. Dung, A. C.: Die Rolle des Vagus bei der Gewichtsreduktion durch Ohrakupunktur. J. trad. Chin. Med. 14/3 (1986) 183 18. Durinjan, R.: Physiological basis of auricular reflexes to viscero-endocrine functions, acupuncture et electrotherapy. Res. Int. Journ. 8 (1983) 79–80 19. Eichner, H. et al.: Akupunkturbehandlung bei akuter Sinusitis bei Kindern und Erwachsenen. Akupunkt. Theor. Prax. 15/1 (1987) 6–15 20. Gaponjuk, V. P. J., Scherkovina, T. J., Leonova, M. V.: Differenzierte auriculäre Elektroakupunktur bei der Behandlung der Hypertension. AKU (Originalia) 21 (1993) 97 21. Gerhard, K.: Die Ohrakupunktur. Technik und Einsatz in der Gynäkologie sowie Ergebnisse bei Sterilitätsbehandlung. Erfahrungsheilkunde 39 (1990) 503–511 22. Gerhard, I., Müller, C.: Akupunktur in der Gynäkologie und Geburtshilfe. In: Naturheilverfahren in der Frauenheilkunde und Geburtshilfe, Editor F. W. Dittmer, E.-G. Loch, M. Wiesenauer. Hippokrates, Stuttgart 1994 23. Gerhard, I., Postneek, F.: Auricular acupuncture in the treatment of female infertility. Obstet. Gynecol. 69 (1987) 57–60 24. Gerhard, I., Postneek, F.: Möglichkeit der Therapie durch Ohrakupunktur bei weiblicher Sterilität. Geburtsh. u. Frauenheilk. 48 (1988) 154–171 25. Gleditsch, J.: Trigger-Punkt-Therapie bei funktionellen und entzündlichen Erkrankungen im Zahn-Mund-Kiefer-Bereich. Zahnarzt 28/11 (1984) 863–869 26. Gunn University of Washington: Treating Myofascial Pain. SG 56, Seattle WA USA 1989 27. Harrison’s Principles of Internal Medicine. 11th ed., McGraw-Hill, New York 1987 28. Heine, H.: Anatomische Struktur der Akupunkturpunkte. In: DZA 4/84 (73–93) 29. Heine, H.: Zur Morphologie der Akupunkturpunkte. In: DZA 4/87 (75–79} 30. Heine, H.: Morphologie der Ohrakupunkturpunkte. In: DZA 5/93 (99–103) 31. Jellinger, K.: Neuere biochemische Aspekte über Schmerzvermittlung und Akupunkturanalgesie. In: DZA 4/84 (77–93)

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50 The Basics 32. Kitzinger, E.: Der Akupunktur-Punkt. Maudrich, Vienna 1989 33. Krivorutskii, B.: Ia. Attachment for electroacupuncture of the external ear in treating smoking. Vopr. Kurortl. Fitioter. Lech Fiz. Kult. 4 (1986) 71–73 34. Kropej, H.: Systematik der Ohrakupunktur. Haug, Heidelberg 1977 35. Krüger, H., Krüger, C. P.: Auriculotherapie im Tierversuch. DZA 43 (1978) 22 36. Krüger, H., Krüger, C. P.: Grundlagen der Auriculotherapie bei Hund und Pferd. Akupunkturarzt 13 (1980) 7 37. Kubiena, G. et al.: Akupunktur bei Migräne (Follow-up-Studie). DZA 6/92, Haug, Heidelberg 1992 38. Kubiena, G., Meng, A., Petricek, E., Petricek, U.: Handbuch der Akupunktur. Orac Verlag im Kremayr und Scheriau 1991 39. Li, Q., Liu, Zh. et al.: A preliminary study on the mechanism of earacupuncture for withdrawal of smoking. J. trad. Chin. Med. 7 (1987) 243–247 40. Long, W. et al.: Clinical observation on 72 cases of obesity diagnosis and treatment with auricular point therapy. Intern. Symposium on Diagnosis and Treatment with Auricular Points. 16.–19.10.1989, Bejing, China 41. Long, W. et al.: Observation on the therapeutic effect of auricular point imbedding therapy in 92 cases of smoking withdrawal syndrome, Intern. Symposium on Diagnosis and Treatment with Auricular Points. 16.–19.10.1989. Bejing, China 42. Malven, P. W., Bossut, D. F. B., Diekmann, M. A.: Effects of naloxone and electroacupuncture treatment on plasma concentrations of LH in sheep. H. Endocrinol. 101 (1984) 75–80 43. Martin, G. P. et al.: The efficacy of acupuncture as an aid to stopping smoking. N. Z. med. J. 93/686 (1981) 421–423 44. Meng, A.: Die Veränderung der Schmerzwahrnehmung und Schmerzqualität bei chronischen Schmerzen durch Akupunktur. In: DZA 4/90 (82–84) 45. Milton, L. B., Culliton, P. D., Olander, R. T.: Controlled trial of acupuncture for severe recidivist alcoholism. Lancet June 24 (1989) 174 46. Mukaino, Y. et al.: Acupuncture therapy for obesity using ear needle treatment: Analysis of effectiveness and mechanism of action. Amer. J. Acupunct. 10/3 (1982) 270 47. Mukaino, Y. et al.: The effects of ear acupuncture on rats with hypothalamic obesity. World Congress on Scientific Acupuncture. Abstract, Vienna 1983 48. Nogier, P. F. M.: Lehrbuch der Auriculotherapie. Maisonneuve, Sainte Ruffine 1981 49. Nogier, P.: Praktische Einführung in die Aurikulotherapie. Maisonneuve, Sainte Ruffine 1987 50. Ogai, B. Ch. et al.: Effectiveness of acupuncture and berotec aerosol in bronchial asthma. Sov. Med. 9 (1986) 98–100 51. Oleson, T. D.: Auriculo Therapie Manual: Chinese and Western Systems of Ear Acupuncture. Health Care Alternatives, Los Angeles 1990 52. Pauser, G.: Die Akupunkturanalgesie. Der Akupunkturarzt/Aurikulotherapeut (1977) 31–34 53. Pauser, G.: Neurophysiologische und neuropharmakologische Untersuchungen über mögliche Mechanismen der peripheren Stimulationsanalgesie. Wien. klin. Wschr. 92 (Suppl. 113) (1980) 54. Pauser, G., Benzer, H.: Akupunkturanalgesie – klinische und experimentelle Ergebnisse der Wiener Schule. In: Kongreßbericht Akupunktur und Aurikulotherapie, Editor J. Bischko. Vienna 1975 55. Pennala, M. et al.: Primary effect of permanent ear acupuncture on appetite and ventricular feelings in 374 outpatients research. Nordic Acupuncture Soc., Acupuncture Seminar, Joensuu 1983, Finnish Acupuncture Ass., Espo 1984

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Test Procedures for Focal Disturbances 51 56. Pennala, M. et al.: Langzeitergebnisse in der Behandlung der Adipositas mit Ohrakupunktur (1200 Patienten). Akupunkt. Theor. Prax. 4 (1986) 69–77 57. Pert A. et al.: Alterations in rat central nervous system, endorphins following transauricular electroacupuncture. Brain Res. 224/1 (1981) 83–93 58. Pischinger, A., Heine, H.: Das System der Grundregulation. Grundlagen für eine ganzheitsbiologische Theorie der Medizin. 6th ed., Haug, Heidelberg 1988 59. Pohjola, R. T. et al.: Rationale behind acupuncture treatment of temporomandibular joint (TMJ) dysfunction. Akupunkt. Theor. Prax. 3 (1986) 237 60. Sadowski, H.: Weight-control in obesity: A simple, effective and practical approach. Amer. J. Acupunct. 10/1 (1982) 53–58 61. Schlehbusch, K. P.: Der heutige Stand der Grundlagenforschung in der Akupunktur. Ärztez. Naturheilverf. 5 (1982) 214 62. Seoane, M.: Vascularisation et innervation du pavillan de l’oreille. These, Méd., Montpellier 1974 63. Shen, E. H., Tsai, T., Lan, Ch.: Supraspinal participation in the inhibitory effect of acupuncture on viscero-somatic reflex discharges. Chin. med. J. 1 (1975) 431–440 64. Smith, M. O. et al.: Acupuncture treatment of drug and alcohol abuse: 8 years experience emphasizing tonification rather than sedation. Publication of the Substance Abuse Division, Lincoln Hospital, New York 1982 65. Steinberger, A.: The treatment of dysmenorrhea by acupuncture. Amer. J. clin. Med. 71 (1981) 3743–3745 66. Stux, G., Stiller, N., Pomeranz. B.: Akupunktur-Lehrbuch und Atlas. 4th ed., Springer, Berlin 1993 67. Travel, J., Simons, D.: Myofascial Pain and Dysfunction. The Trigger Point Manual. Williams and Wilkins, Baltimore 1983 68. Umlauf, R.: Beeinflussung des experimentellen Schmerzes beim Menschen durch Akupunktur. Haug, Heidelberg 1982 69. Umlauf, R.: Zu den wissenschaftlichen Grundlagen der Aurikulotherapie. Dtsch. Z. Akupunkt. 3 (1988) 59–65 70. Umlauf, R.: Zu den Grundmechanismen der Akupunkturwirkung. Haug, Heidelberg 1989 71. Vrbicky, K. W., Baumstark, J. S.: Evidence for the involvement of βendorphin in the human menstrual cycle. Fertil. Steril. 38 (1982) 701–704

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Part B Practical Application

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54 Practical Application

Learning and Mastering Knowledge Level 1 Focus Diagnosis by Means of Ear Reflex Zones As mentioned earlier, the beginner will diagnose focal disturbances by means of the points and reflex zones used in ear acupuncture. Through reflex connections, every pathological process in the body manifests itself as an active, electrically altered point on the surface of the ear. Hence, this point can be located with a point-finding device—and, therefore, ultimately be treated.

Essential Requirements Ear Map

Training for focus diagnosis by means of ear reflex zones begins with learning and memorizing the different focus-relevant localizations on the ear, namely, the projections of the body’s anatomical structures onto the front and back of the auricle. Without a thorough knowledge of these reflex localizations, it will be impossible to apply all diagnostic possibilities in one’s own practice. The most important focus-relevant localizations on the ear are listed at the end of this book (see p. 216ff.). A valuable tool for both learning and future reference is the large multicolored ear map (5) which illustrates the ear reflex zones. Even those colleagues who do not wish to use all possible applications of ear acupuncture will benefit from obtaining some practical training in addition to the theoretical education. This way, they can be sure to learn the method well enough to apply it in their practice (for detailed information on training opportunities, see p. 232ff.).

Ear Models

Rubber ears are a practical tool for getting familiar with the locations of reflex zones on the ear. They are available from various companies (see p. 235). Such ear models are a must for hands-on training courses, because they ensure that every participant can practice the precise localizations under supervision and guidance. They can also be of help when explaining to a patient where a permanent needle has been applied. Rubber ears are therefore a good investment not only for the entire training period but also for future use in one’s own practice. I am referring here not to the hard Chinese plastic ears with reflex points printed on them but to the soft and flexible silicone ears of natural size and skin color. Due to the special properties of the material, these ears withstand repeated needling and survive many years of practicing without showing signs of damage. It is recommended that one buys a pair of ears rather than a single ear, for some localizations are present on one ear only (e. g., the teeth of the right maxilla are represented only on the right ear).

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Level 1: Focus Diagnosis by Means of Ear Reflex Zones 55

Ear Stamp

A rubber stamp that can be used to reproduce the ear on paper will help to create illustrations that complement the notes taken when one is learning the techniques or during courses one takes. In addition, for each treatment of a patient, an ear chart should be kept in the patient’s records in order to document the active points found during examination. Initially, this can also be practiced with colleagues who volunteer as guinea pigs. Another important requirement for learning focus diagnosis is to have enough time for practicing. No course or book can be a substitute for regular practice on a patient. In the beginning, one should not shy away from treating patients for the sake of practicing, nor from telling the patient that this is the case. Many patients are grateful that one is trying out a new therapy for them. Figure 12 explains the symbols used for various types of acupuncture needles and points, respectively.

Fig. 12 Symbols for needles and/or ear points.

Gold needle/Gold Point Silver needle/Silver Point Steel needle Permanent needle Hidden point location

Grounding Electromagnetic Fields

Electromagnetic fields of varying intensities and frequencies are present everywhere, including in the examination room, and the human body picks them up like a living antenna. These fields can create interfering electrical potentials on the ear and may thus hinder examination with the point-finder. The situation is further complicated by electrostatic load on floor coverings and clothing due to charge separation. This calls for discharge through proper grounding—a grounding terminal at the examination site (i. e., a clamp on the ear) to keep resistance to draining stray currents as low as possible, and a grounding plug with an ultrasensitive safety fuse. Without grounding, examination of electrical potentials on the ear may become ineffective because of potential measuring errors.

Tips for the Practice

An electrician can install a grounding receptacle (shockproof wall socket). In an office at street level or in one’s own house, grounding can also be achieved by inserting a long metal rod into the earth, like the commonly used lightning rod. An electrical cord running from there is then hooked up to the grounding terminal on the patient. As an alternative, the plumbing system can provide ground connection. However, only supply pipes are suitable because modern drainage pipes are usually made of plastic. In principle, a polished spot on a radiator may also be used for grounding purposes as long as there are no plastic parts in the heating pipe system. By using a simple oscilloscope, an electrician can test whether or not a pipe

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56 Practical Application

Fig. 13 Proper checking for grounding.

system is suitable for grounding. Otherwise, one can use the grounding provided by the standard grounding receptacle mentioned above.

Testing the Grounding

Grounding should be checked now and then to make sure it is working. This can be done with a standard multimeter (an analog or digital voltmeter, available in hardware stores for about $ 40), with the switch being set to resistance (R or Ω). The device should register at least 10 MΩ of internal resistance to prevent a very high measuring current from blowing the ultrasensitive fuse of the grounding. To check for functional grounding, one lead of the multimeter (red or black) is connected with the terminal on the ear and the other lead with the grounding contact of the plug (contact on the left or right side of the shockproof plug) (Fig. 13).

How to Avoid Faulty Measurements

Beware of taking false readings. Connecting the leads to both grounding contacts of the plug results in mass-to-mass measurement and creates a false reading (short-circuit measurement). Even with a defective fuse, this leads to measuring a current flow by mistake. The same false measurement is obtained when connecting the leads to both limbs of the ear clamp (grounding terminal), even if the limbs are insulated from each other, for example, by the rubber ear.

Finding the Ear Points Visible Changes

Visual inspection of the auricle can uncover special features that may be important for treatment. Prolonged or chronic diseases can cause pathological changes in the skin of the ear, such as red dots,

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Level 1: Focus Diagnosis by Means of Ear Reflex Zones 57

scaling, swellings, and possibly nodular protrusions. These points should definitely be included in the examination for electrical changes. However, testing nodular alterations with the electrical point-finder may be difficult. In such cases, the patient should be interviewed about the body region corresponding to the region on the ear where the skin alteration has been found. It should be kept in mind that the ear relief is different in different patients and that even the dimensions of individual regions of the relief may vary in relation to one another. Hence, the relative sizes of individual reflex zones may also vary from patient to patient. The beginner has basically two options for locating altered (active) ear acupuncture points: the mechanical search with the pressure probe, which relies on the increased sensitivity of these points, and the search with the electrical point-finder.

Mechanical Search for Points Locating Points with the Stirrup Probe Some important acupuncture points can be found just by palpating the ear relief. At various sites there are small, invisible collagenous depressions where a stirrup-shaped ear probe gets stuck during examination.

Palpating the Auricular Surface

A stirrup probe essentially consists of a triangular loop of fine wire, with the apex of the triangle being fixed to a stainless steel handle (Fig. 14). The base of the triangle runs parallel to the ear surface during palpation (Figs. 15, 16). The stirrup probe is perfectly suited to palpating prominent notches on the auricular surface. Initially, either end of a large paper clip will serve the same purpose. However, the paper clip wire is not fine enough for locating points accurately.

Fig. 14 Stirrup ear probe.

The different contours of the antihelix (the reflex zone of the vertebral column) are clearly separated from each other, and the transitions are easy to find with the stirrup probe. Holding the handle between thumb and index finger, the examiner lets the fine wire glide over the ridge of the antihelix as shown in Figures 15 and 16 while pressing firmly with the handle. The palpating wire then gets stuck at each notch or contour change of the antihelix (Fig. 15).

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58 Practical Application

Fig. 15 Using the stirrup probe for locating the individual sections in the reflex zone of the vertebral column.

Fig. 16 Using the stirrup probe for locating Point Zero.

To avoid errors, the antihelix should be palpated in this way from bottom to top as well as from top to bottom. It is important especially in the beginning to practice palpation of the different antihelix contours with the stirrup probe in order to make sure that the individual reflex zones of the vertebral column are properly understood.

Palpable Points

The stirrup probe is also used for determining Point Zero and Darwin’s Point (on the helical brim). Point Zero (synonyms: Umbilical Cord Point, Solar Plexus Point) lies where the root of the helix merges into the ascending helix, and it is easy to find because of a palpable notch in the cartilage (Fig. 16). It is best to start palpating

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Fig. 17 1 Point C0/C1 2 Point C7/T1 3 Point T12/L1 4 Point Zero 5 Darwin’s Point

on the helix, to continue descending into the concha and then ascending in the reverse direction. This eliminates making any mistakes. Five points on the ear can be located with the stirrup probe and, hence, can be unambiguously identified by mere palpation (Fig. 17):

Point C0/C1 (Atlanto-occipital Joint Point), Point C7/T1, Point T12/L1, Point Zero, and Darwin’s Point.

Locating Points with the Pressure Probe Pressure-Sensitive Points

Active acupuncture points are sensitive to pressure. They can be located by palpating the surface of the ear. Pressure probes are well suited for this purpose. After having been touched repeatedly, an active acupuncture point becomes so sensitive to touch that the patient flinches (grimacing reaction, according to Nogier). It is also possible that the patient involuntary moves his/her hand or slightly lifts his/her legs. These signs indicate—even without any verbal reaction from the patient—that an active acupuncture point has been found. To achieve a consistent pressure, Nogier developed different pressure probes. A pressure probe consists of a metal rod with a rounded contact area of 1 mm2 at its tip; the rod sits inside a metal cylinder and is spring-loaded (Fig. 18). Modern instruments for detecting painful ear points allow one to apply a defined and reproducible pressure, for example, 120 g/mm2 when the rod is completely pushed in.

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Fig. 18 Pressure probe according to Nogier.

Such a pressure intensity is suitable for locating painful points and also points of focal disturbances. Other pressure intensities are only of theoretical interest; they will be discussed in the context of Knowledge Level 2 for better understanding of the techniques introduced in the corresponding courses. To locate points, one should hold the pressure probe perpendicularly to the skin, while lifting and repositioning it repeatedly, rather then drawing it across the surface of the ear. The examiner must be very patient and should try always to apply the same pressure with the instrument.

Subjective Factors

The technique of locating points mechanically might seem easy. It is, however, based on the sensitivity of the patient and, therefore, completely depends on his/her collaboration. The technique is time-consuming and prone to error due to many subjective factors. Altogether the results are certainly less satisfactory than those obtained with the electrical point-finder.

Locating Points with an Electrical Device The Point-Finder

Time and again, we are asked in our courses for beginners whether it is really necessary to purchase an electrical point-finder (a good device costs about $ 350). It is definitely a good idea to buy one. Of course, one could always locate the points by means of their sensitivity to pressure, as described above. However, the costs for the extra time required by this method will soon exceed the money invested in a point-finder. Furthermore, the lack of precision of the mechanical method will leave much to be desired in the long run.

Verification of Active Points

Theoretically, if the beginner is confident enough after taking the respective course, he/she could switch directly to the techniques presented under Knowledge Level 2. At this level the pulse method using Nogier’s reflex (vascular autonomic signal, VAS) is introduced. Application of this method offers several other important diagnostic options, thus gradually making the practitioner independent of the point-finder (see p. 101ff.). However, learning the new method is what makes the point-finder indispensable. Initially, all points that the beginner thinks he/she has detected with the pulse method can and should be verified by using the point-finder. The device thus provides an excellent control. It is likewise possible to practice the reverse by first locating the points with the pointfinder and then performing the VAS test at the marked site. It should be pointed out here that second-hand devices may be listed for sale in various acupuncture journals (for addresses, see p. 239). However, the supply of second-hand devices is small because

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even far advanced practitioners who have mastered VAS palpation often do not wish to part with their point-finder as their “objective assistant.”

The Basics of Locating Points Electrically An ear acupuncture point differs from its neutral surroundings on account of

an increased sensitivity to pressure, a different temperature, and an increased or decreased skin resistance. The latter feature forms the basis for performing objective measurements. A device that is supposed to locate points must be able to analyze skin resistances at various locations. Two types of device are used for this purpose: a simple detector that measures the electrical resistance of a skin point, on the one hand, and a device that can measure the potential difference between the resistance of the acupuncture point and that of the surrounding skin, on the other hand.

A Simple Detector

A simple detector is a single fiber (monopolar) electrode with an exploring tip that is retractable and spring-loaded. Sensitivity is controlled by means of a potentiometer while the patient holds the reference electrode (grounding electrode). There are different models, which are available from various companies. A major drawback of using a monopolar electrode for point measurement is the fact that skin resistance at the acupuncture point may change due to various factors. For example, perspiration reduces skin resistance so much that an artifact (such as a hair or sweat) can be mistaken for an active point. These changes often take place within a short time, possibly even during the course of the same examination. The absolute value measured with a simple detector at the acupuncture point may change so much that false data are obtained. There may still be a significant difference in skin resistance between the acupuncture point and the surrounding skin of the ear, but it cannot be measured with this simple instrument. The following factors have an effect on skin resistance:

hair, moist skin, thick horny skin, heat, macroclimate and microclimate, pressure of the electrode on the skin, duration of measurement, autonomic disposition of the patient, circardian rhythm, and menstrual cycle.

These factors do not change the fact that an active acupuncture point has a different skin resistance than the surrounding skin.

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62 Practical Application

Measuring the Differences in Potential

Instead of measuring the absolute value of skin resistance at the acupuncture point it makes more sense, and is far more convincing, to determine the difference between two skin resistances using a concentric (bipolar) electrode. Such differential measurements are not affected by variable parameters. The first such measurements on the ear are based on work by Niboyet (4). The principle of differential measurement is based on simultaneous measurement of the skin resistance at the acupuncture point (with a point-shaped electrode as exploring electrode) and the resistance of the surrounding skin (with a ring-shaped electrode as reference electrode) (Fig. 19). Measuring point and reference point are both located on the ear.

Ring-shaded sensor (reference electrode)

Point-shaped sensor (exploring electrode) Fig. 19 Concentric needle electrode for measuring differences in potential.

Readings are taken from the inner sensor (point-shaped electrode) to the hand of the patient and from the outer sensor (ring-shaped electrode) to the hand of the patient, using a bifilar cable. The device compares the two measured values with each other when the patient closes the electrical circuit by holding the grounding electrode in his/her hand (Wheatstone bridge circuit). If the inner point-shaped electrode is positioned exactly on the acupuncture point, the outer ring-shaped electrode automatically lies on the skin surrounding the point. The values measured by inner and outer electrodes then differ from each other, which is indicated by a visual or acoustic signal. A potentiometer is used to determine the value of the measured difference, that is, how prominent or active the ear acupuncture point is. If there is a powerful focal disturbance in the body, the corresponding point on the ear will be severely altered, whereas the point corresponding to a weaker focus will be less affected.

Gold Points and Silver Points

Some points exhibit a lower resistance than the surrounding skin and, hence, should be treated with a gold needle to compensate for the difference. They are therefore called Gold Points. There are other points which have a higher skin resistance than the surrounding skin, and these need to be treated with a silver needle. They are therefore called Silver Points.

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Procedure for Locating Points with the Electrical Point-Finder The surface of the ear should be free of oil and skin deposits, since these could interfere with the measurements. The skin can be cleaned with an alcohol swab. The ear must be dry by the time the exam begins.

Palpation for Gold Points

The switch of the point-finder is set to the position marked “+” or “G,” and the search for Gold Points can begin. The point-shaped electrode is positioned perpendicularly to the skin area to be examined and then pressed slightly (1–3 mm) into the ring-shaped electrode. Screening a zone of the ear is done by repeated palpation with the inner electrode: the point-finder is lifted slightly from the skin, moved laterally, and then pressed on the skin again. When an acupuncture point lies underneath the inner sensor (exploring electrode), this is indicated by a sound.

An Example: Pain in the Knee

In the case of pain in the right knee, one will search with the pointfinder in the triangular fossa of the right ear for the Knee Joint Point (see p. 222). Once this point has been located, the device will emit an acoustic signal. Points that represent a focal disturbance (Focus Points) are located in the same way. Pushing the point-shaped electrode deeper into the ring-shaped electrode than the recommended 1–3 mm is compensated for by the spring mechanism and does not cause false readings—as long as the inner sensor is not pushed through completely. Pressing too hard, however, translates into unnecessary waste of time during ear examination.

Applying the Electrode at a Right Angle

The measuring probe must always be applied perpendicularly to the skin surface. This ensures that the value measured by the pointshaped electrode and that measured by the ring-shaped electrode relative to the grounding electrode in the patient’s hand can be compared by means of the bridge circuit. While the practitioner is holding the measuring probe with the right hand, his/her left hand must support the ear from below. By gently pressing the thumb against the back of the ear, curved parts of the ear can be straightened in order to render the measuring surface as flat as possible. This will make it easier to position the electrode perpendicularly to the skin surface (Figs. 20, 21). Once in a while, the practitioner should make sure that the patient is still touching the grounding electrode (either a metal plate or a hand-held electrode), otherwise the circuit is interrupted and the points are sought in vain. Furthermore, good contact between the patient’s hand and the grounding electrode is essential.

Determining the Activity of a Point

Once the device sounds a signal, the activity of the detected acupuncture point is determined by turning the knob of the potentiometer. While doing so, the exploring electrode must not slip away from the detected point. The knob is turned towards lower sensitivity values until the sound st ops. For example, a numerical value of 3 indicates a more active acupuncture point than a value of 5 does. It is best to begin the examination with a medium value, for example, 6 (Fig. 22).

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64 Practical Application

Locating Silver Points

Fig. 20 Proper application of the concentric electrode: at a right angle to the skin surface (according to Bahr, 2).

Fig. 21 Wrong application of the concentric electrode: at a slanted angle to the skin surface (according to Bahr, 2).

To locate Silver Points the switch of the point-finder is set to the position marked “–” or “S.” Silver Points are always more difficult to find than Gold Points. Examination should therefore begin with a potentiometer setting of around 8 (very sensitive). A very active

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Metal plate (grounding electrode)

Measuring probe (exploring and reference electrodes)

Fig. 22 Point-finding device.

Silver Point will yield a slightly higher value than a Gold Point of comparable activity. In any case, locating Silver Points is irrelevant for focus diagnosis because points that indicate a focal disturbance are usually Gold Points. A continuous sound is a reliable indication that an ear acupuncture point has been located. If the sound is discontinuous, the measuring probe is only touching the margin of a point. By repositioning the measuring probe slightly, the point’s center may be hit, resulting in a continuous sound. Provided the reclining patient holds the potentiometer slightly above the level of his/her navel, the practitioner will be able to determine the sensitivity by turning the knob him/herself when the signal sounds. Initially, it requires some practice to continue to hold the measuring probe on the detected ear point with one hand, while turning the knob of the potentiometer with the other hand. Ideally, the latter is initially done by an assistant. After a brief introduction, most patients will be able to turn the knob so slowly that the practitioner is able to identify the precise value at which the sound stops. It is this value which indicates the extent of the change in skin resistance at the acupuncture point; it will later be compared with the values obtained for other located points. One should get into the habit of returning the potentiometer to medium setting (around 6) either immediately after having located a point or prior to every new search for points. Otherwise it will be impossible to measure further points.

Variations of the Differences in Potential

The ear acupuncture points may exhibit a strong potential difference in one patient and a weak differential potential in another patient. If no ear points are found when starting with a medium setting, the sensitivity of the potentiometer is increased by one or two values. If too many points are found, the sensitivity is reduced accordingly.

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66 Practical Application

Color Markings

Fig. 23 Imprint of the concentric electrode on the surface of the ear.

Once a point has been located and its activity determined, the measuring probe should not be removed right away. Instead, the concentric bipolar electrode is firmly pressed once more onto the skin as far as it will go. This produces a clear imprint on the skin, namely, a circle with a dot in the middle (Fig. 23). The center dot is then marked with a fine felt-tip marker so that it will still be visible when the needle is to be inserted. This is important because the imprint on the skin may disappear by the time all the other points have been located. Disinfecting the ear will remove the marking except for a tiny bit of color in the center of the acupuncture point. Green color has proved to be the best, for red is hard to see after disinfecting and black smears easily. The value measured for the located point should be recorded on the patient’s chart immediately after marking the point. If only a few points need to be treated, an acupuncture needle may be inserted immediately after locating the center of the imprint created by the electrodes. If several points need treatment, therapy should begin only after the diagnosis is complete in order to ensure that the search with the point-finder can be continued without being hindered by inserted needles. It also makes sense to compare the detected points first with one another. It is quite possible that one finds several Focus Points, of which only the two most active ones should be needled.

Sources of Error during Electrical Point Measurement The Ear Is Not Clean

Oil, skin deposits, scales, make-up, and sweat change skin resistance and distort the measured results. Hair spray forms a layer of resin and thus may have an insulating effect. False positive results are obtained when the ear is still wet from cleaning.

Drained Batteries

Some practitioners place an astonishing amount of confidence in how long batteries will last. It makes sense to provide the device with a sticker showing the date when the battery was replaced. The batteries need to be changed at least every four weeks if the device is used regularly. Many modern devices already have rechargeable batteries.

Losing Contact with the Device

When the patient lets go of the grounding electrode, the circuit is interrupted and differential measurement of skin potentials is no longer possible. This usually happens when the patient lifts his/her fingers from the metal plate of the point-finding device while making gestures during conversation.

Settings of the G/S Switch

In ear acupuncture, the wrong setting of the switch for Gold vs. Silver Points is a simple but frequent source of error. But it does not play a major role in focal diagnostics because the switch is always set to G. It is only mentioned here for the sake of completeness; if one forgets to switch back to “G” after having searched for a Silver Point, one will no longer be able to measure anything while searching for more Gold Points. Those who want to use the full spectrum of ear acupuncture should get used to first locating all possible Gold Points (e. g., Pain Points, Focus Points) and only then switching the

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setting to “S” for locating Silver Points. Prior to each treatment, one should check if the switch is in the proper position.

Potentiometer

Once a point has been located, its activity is determined by turning the knob of the potentiometer toward the lower sensitivity values. Forgetting to return the knob back to its original position will make locating further points impossible.

Incorrect Positioning of the Measuring Probe

The measuring probe must be positioned at a perfect right angle to the surface of the skin. When applied in a slanted position, it will not provide a clean reading of the difference in potential (see p. 63). To provide an ear surface as flat as possible, the ear is slightly supported from behind with the thumb or it is slightly stretched at the margin.

Incorrect Pressure of Ideally, the inner electrode should not be pushed in for more than the Measuring Probe 1–3 mm. It takes practice to develop a feeling for the gentle but comprehensive movement over the ear surface.

Dragging the Electrode

The exploring electrode is guided across the ear surface in a palpating movement, that is, it is repeatedly repositioned and lightly pressed against the skin. Dragging the electrode across the skin leads to faulty measurements.

Dirty Electrode

When tissue debris and oil collect between the inner and the outer electrodes, complete electrical insulation is no longer guaranteed. For cleaning purposes, the outer electrode is retracted (Fig. 24), and tip and shaft of the inner electrode are wiped clean with an alcohol swab.

Body Posture

Errors such as slanted application or incorrect pressure of the measuring probe can only be avoided when sitting completely relaxed behind the reclining patient. Sometimes it helps to gently rest one's forearm on the patient’s head while locating the ear points.

Fig. 24 Pulling back the outer electrode using the index finger.

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68 Practical Application A relaxed body posture is essential for the techniques of the more advanced knowledge levels; it is therefore best to get used to it from the very beginning. Those who perform acupuncture on a regular basis should extend the legs of the treatment table so that they can perform the treatment while sitting upright.

Suitable Point-Finding Devices When faced with the variety of devices offered by different companies, it is good to know what the requirements are for a device that is suitable for measuring potential differences:

It must have a bipolar electrode. The exploring electrode (point-shaped electrode) must be very

fine (diameter less than 1 mm) because the ear points are very small. The electrode should not be too sharp to avoid irritation of the tissue to be examined, otherwise it will yield false measurements. The electrode must be gently spring-loaded to guarantee that the practitioner always applies the same pressure. The inner and outer electrodes need to be loaded by springs of different strengths in order to account for the different application surfaces of the inner and outer electrodes (rugged ear surface). The shaft of the inner electrode must be insulated up to the tip. It is often necessary to measure at locations on the ear that are covered by skin flaps. It is therefore essential that the shaft of the electrode has no conducting contact with other parts of the ear apart from the point to be measured, as this would yield false readings. There must be a knob for regulating the sensitivity of the potentiometer so that even the finest differences in potential can be recorded on the ear.

The ideal device should meet all these conditions. Most models also include a control lever that allows for switching measurements from Gold Points to Silver Points. More expensive models automatically indicate during measurement whether the point is a Gold or Silver Point. However, the simpler version with the G/S switch is completely adequate because Focus Points are usually Gold Points. Even if the device is intended for later use in ear acupuncture, there is no reason to get the more expensive version.

Treatment with the Point-Finder

Some models include an additional part for treatment. Once a point has been located, it can be treated by means of the exploring electrode with a weak interrupted electrical current (6 mA, frequency 1.14 Hz) by pushing a button. As such a device is far more expensive, one should consider what type of patients one may need to treat without needles. As a rule, these are children up to age 10. It is not worthwhile using such a weak current in adults, since the effect of needles is far more intensive.

Treating Children with a Laser

I would not recommend that a pediatrician performs all treatments with the therapeutic part of the point-finder; the results could be disappointing. If one frequently treats children, investing in a laser

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will be better in the long run, because it is far more cost-effective. Treatment with a laser beam is almost comparable to needle therapy, especially in children. Furthermore, a laser gives the therapist a multitude of other helpful therapeutic and diagnostic options (for information on how to use a laser, see p. 178ff.) (1). Of course, the advantage of a point-finding device with a therapeutic part is that such a small device allows for making house calls or using it for diagnosis—and, in the case of children, also for therapy—while traveling (do not forget the grounding).

Preliminary Examination Handedness

Due to the chiasm of cerebral pathways, the dominant hemisphere in right-handed persons is the left one and in left-handed persons the right one. Unambiguous diagnosis of laterality (handedness) is of particular importance for those therapists who use the entire spectrum of ear acupuncture (including symptomatic therapy), because the localizations of many points depend on the handedness of the patient. However, the handedness should also be established when dealing exclusively with diagnosing focal disturbances.

The Dominant Ear

The rule applying to Organ Points also applies to Focus Points—they are always found on the ear of the same side where the focus exists in the body, independently of the handedness of the patient (e. g., the point for the appendix scar is on the right ear). For all medially located organs, however, the corresponding points on the ear are found as Gold Points on the side of the dominant hand—for the right-handed person on the right, for the left-handed person on the left. The ear on the side of the dominant hand is therefore called the dominant ear. The handedness of the patient must therefore be determined prior to locating the ear points corresponding to the foci. The statement “I use my right hand for writing” has no diagnostic significance, since true left-handed persons have often been trained to write with their right hand. It is better to ask which hand the patient uses to brush their teeth, to slice bread, or to thread a needle. The following simple tests allow for identifying a large proportion of undiagnosed left-handers:

When folding one’s arms, the right-handed person usually places the right forearm underneath the left forearm, with the right hand coming from below and resting on the left upper arm. The left-handed person does it the other way around. When clapping one’s hands, the right-handed person usually brings the right hand from above into the left hand. The lefthanded person does it the other way around (Fig. 25). At this Knowledge Level, the possibilities of recognizing a lefthanded individual are still limited to the above tests and a detailed medical history of the patient. They can point in the proper direction but do not provide absolute certainty. Unfortunately, the practice of retraining persons for the “correct” handedness is still quite common in Europe. It aims exclusively at

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70 Practical Application changing left-handedness to right-handedness, never the other way around. Hence, if a patient claims to be left-handed, this can usually be accepted without further testing, and the ear points corresponding to medially located foci can be searched for on the left ear.

Locating Focus Points on the Ear Focal Disturbances Usually Project As Gold Points

Ear points caused by focal disturbances (Focus Points) usually have a lower skin potential than the surrounding skin, that is, they are usually Gold Points. The ear is first examined in areas corresponding to potential foci reported by the patient; the right ear should be examined for foci lying on the right side of the body, the left ear for foci lying on the left side of the body, and the dominant ear for those located medially.

Asking the Patient About Foci

It happens time and again that an existing focus has not been recorded in the patient’s history. Either the patient has forgotten about a scar at a specific location or about a previous inflammation (e. g., scars following sterilization, or inflammatory affections of the pelvis), or the patient is completely unaware of any present or past changes in the body. It is therefore essential to ask very specific questions; even small scars resulting from insect bites or from vaccination may play an important role.

Fig. 25 Clapping. Right-handed person (above); left-handed person (below) (according to Bourdiol, 3).

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An Example from My Practice Scar – Migraine

Once I had a patient whose migraine attacks were solely caused by a hornet’s sting that became inflamed. The little scar was located on the lower leg exactly on one of the points of the Gallbladder Meridian; it therefore interfered with the flow of energy through this meridian. There is a strong relationship between the Gallbladder Meridian, which runs across the head and temple region, and headaches and migraines. The energy flow in the Gallbladder Meridian is quite often disturbed by scars resulting from surgical treatment of ligament ruptures of the ankle joint, or scars in the shoulder region. The therapist should therefore pay special attention to such scars when dealing with migraine and headache.

Checking for Common Focal Disturbances

It should become standard practice to check not only for all potential foci reported by the patient or uncovered by questioning the patient, but also for other commonly known potential foci. For example, a focus in the maxillary sinuses often does not produce any symptoms. A checklist will help to make sure nothing is left out. In practical terms this means that examination with the point-finder will always include the ear reflex zones of the maxillary sinuses, frontal sinuses, prostate, genitals, teeth, etc. Every focal process has a primary focus; it is the cause of the symptoms and sustains the activity of weaker secondary foci. The primary focus should be identified whenever possible, because the sole treatment of the secondary foci will not be sufficient. For this purpose it is essential to determine carefully the intesity of the focus by using the potentiometer knob. The value measured for a given point should be immediately recorded in the patient’s chart in order to be able to compare the values obtained for different foci.

The Special Case of Amalgam Amalgam Does Not Always Disturb

A special type of focus is the amalgam load of the body. One must be careful not to exaggerate this fact; not every patient with amalgam fillings suffers from amalgam load. However, amalgam may become a problem later in the life of an initially symptom-free patient once the amalgam fillings start to corrode. This process is further augmented when gold fillings or gold crowns are put in; they cause differences in potential between the different metals if amalgam fillings are still present. Measurements by Bahr have yielded potential differences of up to 300 mV. A dormant (masked) amalgam focus may be activated by the formation of a new focus, for example, a condition caused by an infection that is associated with persistent problems with the paranasal sinuses. In this case, the body is exhausting its potential for homeostatic regulation and immunological defense and is no longer able to compensate for a relatively harmless amalgam focus. Finally, severe diseases may develop, such as Crohn’s disease, which in our view might result from a special intolerance to amalgam. A severe amalgam load is often associated with problems of the maxillary or frontal sinuses. It is still unknown whether the effect

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72 Practical Application of amalgam provokes a focus in the maxillary or frontal sinuses, or whether both occur independently, yet still more frequently together than by mere coincidence.

Omega Point I

Omega Point I, which is located on the dominant ear as a Gold Point, is a Focus Indicator Point for amalgam load (Fig. 26). It would be unreasonable to rely on the methods of Knowledge Level 1 to reach a convincing conclusion about whether or not a patient has a high amalgam load. It is quite sensible and important, however, to keep in mind the possibility of an amalgam load and to examine Omega Point I for activity. In case the beginner does, indeed, suspect an amalgam load, confirmation by an experienced acupuncturist is essential. The removal of amalgam fillings is a considerable financial burden for most patients. Not only will the patient be disappointed when symptoms fail to improve after an ill-advised removal of fillings—the entire method of testing by acupuncture will fall into disrepute. Addresses of experienced acupuncturists may be obtained from the Auriculotherapy Certification Institute (ACI) (for address see p. 236).

Mental Fields of Disturbance Physical conditions, such as an irritable bladder, may be triggered or sustained by emotional problems. If a psychological basis of a disease is suspected in a patient, the therapist should search for active Psychotropic Points; the mental problems indicated by these points will be regarded as foci because of their pathological effect.

Master Omega Point This point is located as Gold Point on the right ear of a right-handed person. It is often associated with postherpetic pain, with the actual event dating back two to three years and without any local skin signs present. The patient nevertheless complains about pain in the region of the previously affected skin areas (Fig. 27).

Valium Analogue Point (Diazepam Analogue Point)

This point is found as Gold Point on the left ear of a right-handed person and is often associated with irritable bladder, or irritable prostate, respectively, without an organic or inflammatory origin (Fig. 28).

Depression Point (Antidepression Point)

This point is found as Gold Point on the right ear of right-handed persons. It is often associated with headaches and syndromes of the vertebral column (Fig. 29). Treatment of these Psychotropic Points can also play an important role in the therapy of somatic symptoms and, ideally, should be supported by ear or body acupuncture, phytotherapy, physiotherapy, and kinesitherapy. Of course, when uncovering a mental field of disturbance (mental focus), therapy should not be restricted to acupuncture alone.

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Fig. 26 Omega Point I.

Fig. 27 Master Omega Point.

Fig. 28 Valium Point according to Bahr.

Fig. 29 Depression Point.

Practical Approach at Knowledge Level 1 Conventional Diagnostics

Before treating a patient with ear acupuncture, the therapist should do the usual physical examination and consider all conventional aspects of symptoms in question. If there is any indication that further examinations may be needed, these should be carried out. In almost all cases, however, one will find that the patient has already run the gauntlet of conventional diagnostics and therapy so that only the records need to be studied once the clinical examination is complete.

Patient’s History with Respect to Foci

A thorough history of symptoms and potential fields of disturbance is taken prior to the ear examination. Even apparently insignificant details may be important, for example, migraine causing the patient to wake up repeatedly around two or three in the morning (i. e., after the peak time of the Gallbladder Meridian, suggesting Gallbladder migraine), lower back pain that appeared only after pelvic surgery (suspected focus in the scar), a chronological relationship between dental fillings and physical complaints (e. g., recurrent cystitis following a root canal treatment of the front teeth, or sleep disturbance following crowning of the seventh tooth). It is best to take a very detailed history about all potential foci. In addition, the checklist mentioned above will help to make sure that no other common focus is overlooked during examination. During ear acupuncture the patient should be lying on his/her back, with the physician sitting behind the patient. This is the best posi-

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74 Practical Application tion for the examiner to access both ears. Adequate lighting will help to locate and treat the ear points. It is not recommended that the patient sits, as the diagnosis required prior to treatment cannot be carried out properly. Any attempt to save time by making a quick (imprecise) diagnosis will take its toll by failing to yield a therapeutic success; this will also damage the reputation of the method. This is why I strongly advise against skipping the diagnostic phase and jumping right into treatment.

Positioning the Patient

The patient should remove glasses and jewelry. A rolled towel under the knees will make the reclining position more comfortable for older patients and those with back problems. It may seem banal, but the therapist should keep in mind that a reclining patient may get cold even at normal room temperature as the entire treatment time is usually about 30 minutes. Once the points are needled, autonomic reactions may enhance the chilling effect. The patient should therefore be covered with a light blanket once the examination has been completed, if not before.

Ear Map

In contrast to the way one is used to seeing the ear points in books and journals, the ears will be “upside down” while working on the patient. Apart from practicing on the inverted rubber ear, using a mnemonic aid during treatment will be helpful at least at the beginning. For this purpose, it is best to copy the large wall chart showing localizations on the ear (5) and cut out the individual illustrations. The small images thus obtained are placed next to the patient’s ear to be examined. Since the ears on these crib sheets are shown upside down, it is now possible to compare discretely the points found on the patient’s ear with those on the ear map. Likewise, if a specific zone on the patient’s ear needs to be located, it can be easily found by comparison with the ear on the map. Having the ear map hanging on the wall is more for decorative purposes than for information during treatment. Patients usually do not respond particularly well to a therapist who needs to consult books or wall charts before inserting the needle. Before the examination begins, it is essential to check that the grounding cord is plugged in or clamped to the radiator. Cleaning personnel have been known to unplug cords, or even the practitioner himself/herself may have removed the cord from the radiator when cleaning up the day before. Minor things like that can endanger the entire diagnostic procedure (see p. 55). Once the crib sheets have been placed next to the patient’s ears, with the checklist for focal disturbances near the treatment table and always visible, both auricles of the patient are cleaned with an alcohol swab. The skin should be dry by the time the examination begins, in order to avoid false readings.

Grounding the Patient

Next comes a detailed inspection of the auricle for red skin areas, swellings, scales, or ulcers. The patient is then grounded. For better contact with the skin, the ear clamp is briefly dipped into water and then attached to the lobule or another site on the ear. If the ground-

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ing clamp on the ear interferes with the examination, the lead can also be placed somewhere else, for example, underneath the shirt on the back of the patient, who will then lie on it. The lead will then have a slightly larger resistance, which is still acceptable for examination.

Locating a Point

The patient is then given the point-finding device to hold in his/her hand as described earlier (see p. 63), and the search for electrically altered, active acupuncture points can begin. It makes sense to start with the potential fields of disturbance indicated in the patient’s history. One will check the corresponding zones with the measuring probe and record the presence and activity of the acupuncture points found. If no acupuncture point is located in the zone for an appendectomy scar, for example, it must be assumed that this scar does not have a disturbing effect on the body. Finally, all other ear zones should be screened for active points that may indicate common foci. Initially, the checklist may be used for this purpose. Once located, the active point is marked with a fine green felt-tip marker (nonpoisonous and water-soluble) in the middle of the imprint of the measuring probe, and the measured value (sensitivity setting of the potentiometer) is immediately recorded on the patient’s chart. This is followed by searching for other active points. It is quite possible that a point is accidentally discovered that cannot be assigned to a focus. By comparing it with the ear charts, or by using the generally required knowledge about the ear reflex zones, it should be easy to assign the point to a specific site of the body—one probably has found a symptom point. In any case, even those practitioners who concentrate on diagnosing focal disturbances should screen the ear for symptom points once in a while. After all, the fact that the patient’s symptoms have been resistant to other treatment has usually been the motivation for a detailed search for foci.

Symptom Points

If the patient’s symptoms are caused by one or more focal disturbances—as is the case in a very high percentage of patients according to our experience—the corresponding Symptom Points are particularly active (high potential difference between the point and its surroundings). Just a few attempts at including these points in the treatment will usually suffice to convince the therapist of the purpose of the other possible applications of ear acupuncture. Not only can the focus, or foci, be eliminated this way, but the trouble spot in the body becomes stabilized at the same time. If left untreated, this spot will remain the site of disturbances with every new stress on the body. Once all active points have been located and marked, the diagnostic procedure is complete and needling may begin (see p. 144f.).

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Summary of Diagnostic Steps at Knowledge Level 1

Take a detailed medical history with respect to focal disturbances. Determine the handedness of the patient. Clean the ear surface with an alcohol swab. Ground the patient. Search for all potential foci indicated in the patient's history by screening the ear with the point-finder. Check also for all potential foci that are commonly found but have not been mentioned by the patient. Immediately mark all points once they are located and record the measured activity of each point on the ear chart.

References 1. Bahr, F.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für Fortgeschrittene (Stufe 3), zugleich Laserakupunktur und -reiztherapie sowie Einsatz von transkutaner elektrischer Nervenstimulation (TENS). Self-published, Munich 1995 2. Bahr, F.: Einführung in die wissenschaftliche Akupunktur: 5th ed., Vieweg, Wiesbaden 1992 3. Bourdiol, R. J.: Élements d’Auriculothérapie. Maisonneuve, Sainte Ruffine 1980 4. Niboyet, J. E. H.: Die Übereinstimmung des verminderten elektrischen Widerstands an punktförmigen Oberflächen und Hauptbahnen mit den Punkten und Meridianen, den Grundlagen der Akupunktur. PhD thesis, Marseille 1967 5. Nogier, P., Bahr, F., Bourdiol, F.: Loci auriculo-medicinae.

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Focus Therapy Via Ear Reflex Zones Therapeutic Principle The aim of every focus therapy is to eliminate the focus. Once a focus has been identified by using the diagnostic method described above, there are basically three different ways of treating this focus. Therapy aims at eliminating the disturbance caused by the focus or uncoupling the focal disturbance from the body’s regulatory functions. In principle, eliminating or manipulating the focus itself and thereby uncoupling its effects from the regulatory functions of the body can be achieved by the following measures:

needling the ear reflex zone that corresponds to the focus, infiltrating the focus itself with a local anesthetic, and treating the focus or Focus Point with laser, using specific frequencies.

Needling the Ear Reflex Zone That Corresponds to the Focus Because the surface of the ear is a relatively small and manageable area, reliable diagnosis and therapy of the focus is possible with some practice. Due to synapses in the reticular formation, inserting a needle precisely into the corresponding ear point has an intense effect on the focus itself and is certainly equivalent, if not superior, to infiltrating the disturbing scar. Usually the sole treatment of the ear reflex point of the focus is sufficient therapy. Only a few successive treatments are normally required to eliminate the focus completely. (This does not apply, however, to most dental foci.)

Access to Internal Organs

Not only do the ear reflex zones exhibit an active point for every pathological process, they also provide optimal access to all internal organs of the body, that is, also to foci not located on the surface of the body. However, the corresponding electrically altered ear points are small and require needling to be performed with the utmost precision.

Infiltrating the Focus with a Local Anesthetic Focal disturbances, especially scars, can be uncoupled from the body’s regulatory functions by intracutaneous, subcutaneous, or deep infiltration with a local anesthetic (e. g., 1% lidocaine) (Fig. 30).

See Also

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Breaking the Vicious Circle

The local anesthetic causes repolarization and stabilization of the neuronal cell membranes affected by the irritation, thus breaking the disease-causing vicious circle (12, 20, 21, 26, 28–32, 36, 37, 39).

Foci on the Skin Surface

Based on the active point found on the ear, the beginner can deduce the disturbing structure in the body (e. g., a scar resulting from appendectomy) and infiltrate this focus directly with a local anesthet-

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78 Practical Application

Fig. 30 Infiltrating a scar.

ic. However, this only makes sense if the disturbing structure has been identified with certainty (assignment based on the knowledge of ear reflex zones) and if the structure is located on the surface of the body. The beginner’s technique does not permit assigning an ear point that indicates a dental focus precisely to a specific tooth. Although the zones of the upper and lower jaws can be exactly located because of the clearly defined projection of the temporomandibular joint on the ear, the points corresponding to individual teeth lie only fractions of a millimeter apart. (Here, the VAS method permits a very precise assignment, see Knowledge Level 2, p. 101ff.)

Infiltration Alone Is Not Recommended

Once the decision is made to infiltrate, the entire scar must be infiltrated; this may be painful if the scar is large, long, or wide, and also time-consuming because infiltration usually needs to be repeated. Furthermore, all small spots left behind by suture material, or all deeper-lying parts of a scar, must be infiltrated as well to make sure the actual disturbing site will be included. Because of possible mistakes when identifying all parts of a scar, it is not recommended that peripheral infiltration is used as the only therapy to eliminate the focus. In all cases, the corresponding ear point should be needled as well. Using the VAS diagnostic method discussed under Knowledge Level 2, it will become possible to demarcate a very small disturbing site so precisely directly at the scar that a minimum amount of local anesthetic will suffice. Frequently, “dry needling” will be good enough (using an acupuncture needle instead of an injection needle) as long as the site is needled with precision. Therapy will thus be possible with the sole use of local acupuncture needles, or infiltration, respectively, or with the parallel use of ear acupuncture and peripheral needling (see p. 149).

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Needling the Ear Point

The beginner should definitely needle the ear point that corresponds to the focus, since this point is the exact representation of the disturbing site—be it the beginning or the end of a scar, or a small scar area with suture material, or a small drainage scar near the scar suspected of being the focus, or a deeper-lying site of the scar, which may or may not be accessible from the outside. Infiltration of scars and any uncomfortable, sometimes risky infiltration of organs (tonsillar poles, gynecological region, prostate, struma, etc.) essentially become obsolete through targeted acupuncture of the ear reflex zones. In cases of internal focal disturbances, any practitioner inexperienced in deep infiltration is left with the only option of using the ear reflex zones for treatment.

Laser Treatment Using Specific Frequencies This method is an excellent complement to precision needling of ear reflex points. It can also be used on its own (which is of special importance in small children). For more details, see page 178.

Scar Foci and Inflammatory Processes

Laser treatment may be used to eliminate or treat foci caused by scars or inflammation. Dental foci usually must be treated by a dentist. However, a thorough focal diagnosis prior to treatment is important—in many cases this will have indicated the need for dental treatment in the first place. Some foci can be eliminated with one or two treatments, while others (e. g., foci of the maxillary sinuses) need more treatments in order to reestablish normal function.

Summary The advantages of focus therapy by means of ear acupuncture are the following:

Precise diagnosis—not all suspected possible foci need to be included in the therapy.

Hence, treatment is less painful, more targeted, and therefore usually also more successful. Working with a small surface—it is often sufficient to needle a single point on the ear (e. g., the point corresponding to a scar). This may be important in the case of foci at sensitive sites of the body (such as toes, hemorrhoids, etc.), and treatment is usually also less painful. Internal foci (e. g., internal scars) can be accessed by means of the corresponding point on the ear. If the broader spectrum of ear acupuncture is used, the organs weakened by focal disturbances can be stabilized energetically by needling the ear (analgesic acupuncture, energetic acupuncture). To prevent remission one may stimulate certain Functional Points that have an energyelevating effect, since in most cases the body has suffered a loss in energy due to the focal process (see pp. 82, 155).

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Therapeutic Procedure Treat Only the Primary Foci

Once all ear points to be treated have been located by examining the ear with the point-finder, acupuncture needles are inserted for therapy. Out of all the points found that represent a focus (Focus Points), the two or three most active points are selected. All Focus Points are Gold Points and should always be treated with a gold needle. As already discussed in some detail, a low-energy point (decreased skin resistance) corresponds to a Gold Point and can be tonified by inserting a gold needle. A high-energy point (increased skin resistance) corresponds to a Silver Point and can be sedated by inserting a silver needle. However, this option is only considered if treatment of symptoms by acupuncture of ear reflex zones is to be performed in addition to focus therapy. It can be neglected in case of exclusive diagnosis and therapy of foci.

Gold Needles Are Better Than Steel Needles

The choice of needle metal is important, as differences in potential can be balanced depending on the position of the metal in the galvanic order. Gold needles are therefore more effective in focus therapy than steel needles. Because the needle insertion itself acts as an additional potent stimulus at the acupuncture point, steel needles do have some effect as well. It goes without saying that only sterile needles must be used. The sites marked with a felt-tip pen are cleaned with an alcohol swab while taking care that the markings are not completely wiped off. Holding the needle between thumb and index finger, the therapist inserts the needle with a quick stab exactly at the remaining small mark while twisting it slightly to facilitate insertion (Fig. 31).

Avoid Penetrating the Ear Margin

Fig. 31 Needling the ear according to Nogier

It is best to hold the auricle with the free hand or to pull it slightly outward at the lateral margin—in the same way as when locating the points with the point-finder—to prevent the insertion surface

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from slipping away. A finger placed behind the ear will provide some support for the needle. Caution: If the ear is very thin and flabby, a needle inserted into the margin of the ear may accidentally be pushed through the ear and into the therapist’s finger behind the ear (e. g., when needling the point representing a small scar on the little finger). When needling at the ear margin, it is best to pull the auricle slightly backward or to the side to provide a firm surface for inserting the needle.

Insert the Needle 1–2 mm Deep

The patient is asked to cough or exhale while the needle is inserted. The brief pain during insertion is thus perceived less intensely. At cartilaginous sites, the needle is inserted 1–2 mm deep so that its tip touches the cartilage. It may be inserted slightly deeper in cartilage-free parts of the ear. The cartilage must never be penetrated. It is sometimes easier to needle at a slight angle to prevent the needle from falling out prematurely. The marked area of a point located with the point-finder usually is big enough to accommodate two to three needles, and the beginner sometimes does not insert the needle at exactly the right site. It is possible to find the point of maximal sensitivity by gently palpating the small skin area with the tip of the needle prior to stabbing. The patient’s reaction usually indicates the proper site quite clearly. After gaining some experience with this method, one will find that the texture of the skin at this site is different, and the needle sometimes seems to fall right into place.

Leave Needles in the Ear for 20 Minutes

The needles remain in the ear for about 20 minutes. Immediately following the removal of the gold needles, permanent needles may be placed into the most important points. They should remain in the ear for about one week. The permanent needle should be inserted precisely where the gold needle has been inserted before (see p. 96).

Sieve Method If an area larger than a point is to be needled (e. g., the Zone of Maxillary Sinuses), several needles may be inserted next to one another. The needles may touch each other at the site of insertion or further up at their shafts.

Moxibustion The term “moxibustion” is composed of the Japanese plant name mogu sa (moxa in Latin) for mugwort (Artemisia vulgaris) and the Latin verb comburere (to burn). It means “burning of mugwort” over certain acupuncture points. Even more intense than simple moxibustion of an acupuncture point is heating the gold needle after inserting it into the point. Because moxibustion is always equivalent to stimulation of the acupuncture point, silver needles must never be heated. When using steel needles, moxibustion may result in a similar effect as inserting an unheated gold needle.

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Heating the Gold Needle

Only the handle of the needle is heated, and the needle conducts the heat to the acupuncture point. A cigarette lighter is used for this purpose, or even better, a pipe lighter (available in tobacco shops) where the flame comes out on the side. The advantage of a pipe lighter is that the flame can be better controlled without burning one’s fingers. The needle should only be heated to a level the patient can still tolerate. It is best to use the flame at intervals, that is, the flame is moved back and forth. The patient is asked to indicate when the needle is getting too hot. While bringing the flame close to the needle end with the right hand, the needle shaft is gently touched with a finger of the left hand. This way the therapist quickly notices himself/herself when the needling is getting hot. Because the flame can heat up the needle very suddenly, this type of monitoring can save the patient from uncomfortable sensations and even small moxa scars. Caution: Hairspray and artificial hair pieces may catch fire. Needles with plastic ends must not be heated because the handle is not heat-resistant.

Additional Ear Points for Focus Therapy If the therapist wishes to promote the success of focus therapy with little effort, he/she may needle the following points in addition to the Focus Points: the Prostaglandin E1 (PGE1) Point, which appears on the right ear as Gold Point (and corresponds to Confluent Point GB 41 of body acupuncture), and the Thymus Gland Point, which appears on the left ear as Gold Point (and corresponds to Confluent Point TB 5 of body acupuncture). Together these points have a strong antifocal effect, in addition to their analgesic and anti-inflammatory effects (Fig. 32).

Fig. 32 1 Point PGE1 on the right ear, 2 Thymus Gland Point on the left ear, both appearing as Gold Points.

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Thymus Gland Point

The Thymus Gland Point has a very powerful effect not only on focal disturbances but also on all other active ear points. After needling this point precisely, all other active ear points disappear temporarily, and subsequent attempts to locate points with the point-finder become unreliable. Therefore, and also with respect to the more advanced methods, it is best to make it a habit to always needle the Thymus Gland Point last.

How to Proceed in Case of Amalgam Load If Omega Point I is found as an indicator for amalgam load, the beginner should make every effort to have this confirmed by an experienced colleague. (The beginner must never advise the patient to have amalgam fillings removed on the basis of such a finding.)

Removing Fillings

Once an amalgam load has been confirmed, a thorough removal of the fillings should be recommended. Removal is followed by renewed ear acupuncture and other measures that should be left to the more advanced practitioner (amalgam elimination).

Alleviating Symptoms

If in doubt about the diagnosis, or in case the diagnosis has been confirmed but the patient is not able to have the fillings replaced right away, the beginner may also try various measures to alleviate the symptoms of the load. These measures partly belong to the field of ear acupuncture but are listed here for the benefit of interested colleagues:

Acupuncture of the ACTH Point and Omega Point I, both as Gold Points on the right ear; also the Thymus Gland Point as Gold Point on the left ear (Fig. 33). Administration of selenium; it forms harmless, insoluble complexes with free mercury components in the body.

Fig. 33 1 Omega Point I, 2 ACTH Point, 3 Thymus Gland Point.

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84 Practical Application Vitamins B3 and B6; they are used up faster during amalgam load. Zinc; most patients with amalgam load exhibit severe zinc deficiency, which causes an increased tendency to develop infections or allergies.

Mental Fields of Disturbance If there is reason to believe that the symptoms are caused by a mental field of disturbance, this should be first addressed by the physician. In severe cases, the patient should undergo concomitant psychotherapy.

Including Physical Symptoms in the Therapy

A patient whose symptoms are caused or sustained by emotional problems will always have somatic symptoms as well—and these can be treated. It is therefore worthwhile and important to treat the somatic symptoms (e. g., by body acupuncture, ear acupuncture, neural therapy, physiotherapy, chiropractic). Patients with emotional problems are often pushed aside in the regular medical practice when, in fact, the combination of targeted pain therapy and psychotherapy would be the ideal treatment. Moreover, surprising results can be achieved by including the Psychotropic Points in the therapy.

Needling Psychotropic Points

It may happen that a patient has severe focal disturbances, while conversation and ear examination uncover the existence of additional emotional problems which most likely contribute to sustaining the existing pain. In such a case one should always treat the foci and, in addition, any Psychotropic Points that have been discovered (possibly in combination with concomitant psychotherapy). Likewise, any patient with obvious mental problems should be examined for other focal disturbances. Severe foci make a patient more susceptible to his/her trouble spots, for example, low back pain or migraine. The patient would tolerate emotional stress far better without the effects of the severe foci. The burden under which, for example, the sore back suffers is literally taken away by eliminating the focal activity.

A Note Regarding Therapy in a Left-handed Person For the left-handed person the same rule applies with respect to Organ Points and Focus Points as for the right-handed: Organ Points and Focus Points are always found on the ear of the side where the affected organ is located in the body. This means that the location of the point is independent of handedness. However, if the median organs are affected as focus (e. g., prostate, umbilical scar, trachea), the corresponding Gold Point is found on the side of the handedness, namely, on the right side in a righthanded person, and on the left side in a left-handed person (see p. 69).

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Practical Tips for Therapy Patient Information Sheets

Patients ask a lot of questions, especially when they are confronted with acupuncture for the first time—and this is justified. To meet the patient’s need for information and to save valuable time, each new patient is provided with an information sheet, entitled “What is Acupuncture,” prior to treatment. The time spent in the waiting room is usually long enough to read the pamphlet; this will answer many questions in advance. (For patient information sheets, see p. 240ff.). Only those ear points are needled that have been located with the point-finder. A point which cannot be located—provided the correct technique is applied—does not represent a focus. Do not needle potential Focus Points on suspicion.

Securing the Ground The ground wire is usually very long and hangs loose somewhere between the treatment table and the examiner. If the therapist gets Wire caught with his/her foot or knee, the grounding clamp will pull uncomfortably on the patient’s ear. This can be avoided by fastening the last 3–4 feet of cable with an adhesive tape to a leg at head end of the treatment table, leaving about 2 feet of free cable between the ear clamp and the site of attachment. If the cable is then caught, it will primarily pull on the site of attachment. When using both gold and silver needles on the same ear (namely, when the therapist wants to include the treatment of symptoms by ear acupuncture), the needles should not come into contact with each other. In case they do cross each other, a swab or cotton ball is placed between them.

Vegetative Reaction–Elevation of the Legs

Intense autonomic reactions may sometimes occur during treatment. If the patient asks how many needles still have to be inserted, this could be a warning sign that a circulatory collapse is imminent—although this is rare. Elevating the legs will help immediately. Such sensitive patients should be treated initially only with the thinner steel needles. At the end of the session the therapist should check how well the needles are still in place. A needle that is still “working” is relatively immobile. It should be left in the ear for a little longer.

Measures Supporting the Therapy No kind of therapy, not even focus therapy, should be performed as a single, exclusive therapy. The therapist should welcome any measures that may stabilize the therapeutic success in the long run, and they should be used whenever possible. In particular, there are some measures that can be performed by the patient at home.

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Massage of Acupuncture Points by the Patient Experience has shown that the process of healing is promoted when the patient massages the ear points representing focal disturbances between two sessions of ear acupuncture. This is called acupressure. If the symptoms are to be treated by ear acupuncture as well, this applies also to the corresponding symptom points on the ear.

Acupressure of Body Points

A therapist who is familiar with body acupuncture will find it easy to show the patient the acupressure points that may be treated at home. The points are marked on the skin with a waterproof felt-tip marker (e. g., Staedtler lumocolor, extra fine), and the patient is informed that the markings cannot be washed off within the next few days. Any object with a rounded end, such as a pen or pencil, can be used for massaging the acupuncture points. I prefer to give the patient the sheath of a disposable needle. Massaging the acupressure point with an ointment containing 20% benzocaine has proved very effective; it may also be used by the patient at home.

Transcutaneous Nerve Stimulation Thymus Gland Point

In addition to the mechanical manipulation of an acupuncture point, electrical stimulation is also possible. It will be beneficial for the beginner to include this simple technique in the therapy. In all patients with a focal process, it makes sense to stimulate the highly antifocal Thymus Gland Point between individual sessions. This can be done by stimulating its corresponding body acupuncture point, Confluent Point TB 5, which is easily accessible for the patient (2 cun, or two widths of a thumb, proximal to the dorsal

Fig. 34 Stimulating Point TB 5 and Point PC 6 by means of transcutaneous nerve stimulation (TNS).

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wrist crease between ulna and radius, on the left forearm for the right-handed person). Electrical stimulation of this body point is carried out by means of two adhesive or rubber electrodes (each 32 mm in diameter) and a small electrical device for transcutaneous nerve stimulation (TNS) (1–4, 9–11, 13–15) (Fig. 34). The best effect is achieved with a frequency of 74.9375 Hz (thymus-specific frequency, according to Bahr) delivered by a TNS device in the same way as the already explored laser frequencies (e. g., TNS SM1 F, manufactured by schwa medico, see Appendix, p. 237). The device gives the patient the opportunity to use this special frequency at home in order to support the ear acupuncture treatment between the sessions.

Right-handed Person – Left Forearm

One of the two adhesive electrodes is attached to Point TB 5 on the left forearm (for the patient: “the site where you wear your watch”), while the other one is attached to Confluent Point PC 6 on the opposite (median) side of the forearm (Fig. 34). Point TB 5 is connected with the plus pole (red cable) and Point PC 6 with the minus pole (blue cable). All this applies to a right-handed person. For a left-hander, the electrodes are attached to the right forearm. Duration of stimulation is 20–30 minutes, once a day, if possible. The intensity of the stimulating current can be controlled by the patient—a mild tingling of the skin indicates when the individually correct intensity of the current has been reached. Experience has shown that using the TNS device in the way described above may have a slightly excitatory effect. To avoid sleeping problems, sensitive patients should therefore not use the device in the evening. In addition to the above-described stimulation of functional antifocal points, the patient may also use the TNS device for local pain therapy (e. g., in the case of a sprain or compression).

Renting a TNS Device

To support focus therapy, a TNS device may be prescribed for daily use. It may be provided to patients on a rental basis through their health insurance. In many clinics, the use and prescription of TNS devices for pain management is already standard medical practice. In some European countries, the insurance may pay the costs especially in cases where the diagnosis calls for pain management, provided the patient has been instructed by the physician in the proper use of the device and the effectiveness has already been demonstrated. If the transcutaneous nerve stimulator eases the patient’s pain, the device is prescribed for home therapy on a rental basis, initially for one month. The prescription must indicate the type of device, the diagnosis (related to pain or orthopedic problems, if possible; perhaps also circulatory problems), and the period for rent (always one month in case of the first prescription). The prescription form is then sent by the doctor’s office or the patient to the nearest distributor, who will deliver the device indicated to the patient. After one month, the rental period may be extended with a new prescription, this time for three months. This extended prescription is simply mailed to the respective distributor. This

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88 Practical Application may be repeated as long as necessary. (Sources of supply are provided in the Appendix, see p. 237) Devices are provided free of charge in the doctor’s practice for instructional purposes. Preliminary follow-up observations have shown that existing foci can be far better controlled under concomitant TNS therapy, and the therapeutic success therefore sets in faster as well.

Improving Muscle Balance and Stability It cannot be emphasized enough that it does not make sense to free a patient from back pain by acupuncture treatment, while leaving an existing instability at the lumbosacral transition untreated. Such instability is usually caused by insufficiency of the trunk muscles and concomitant shortening of other muscle groups, for example, the iliopsoas muscle.

Muscle Training

Without a minimum of consistent physical exercise of both abdominal and back muscles such a patient will be subject to another pain attack at the slightest strain or wrong movement. Likewise, a patient whose lower back pain is mainly attributable to an oblique pelvis will not remain pain-free for long after undergoing focus therapy without concomitant pelvic adjustment through appropriate footwear or insole support. The same applies to all symptoms related to the locomotor system. Joints should be stabilized by proper exercising of the muscles involved, and shortened muscle groups should be stretched. Stabilization of a knee joint, for example, calls for consistent training of the quadriceps muscles and cannot be achieved by acupuncture treatment.

Diet In patients with neurodermatitis and allergies, Point Zero (Umbilical Cord Point) is often found to be active, indicating an intestinal focus (see p. 27). This is frequently associated with allergies or intolerance against certain types of food and, as a rule, requires a change in the diet. If there really is an intestinal focus, focus therapy should never be a purely passive therapy (see p. 33f.). I have made it a habit to make this clear to my patients and to request their cooperation.

Allergens

The diagnostic methods of Knowledge Level 1 do not permit reliable testing for allergens. The therapist must therefore rely on his/ her knowledge of certain types of food that often cause intolerance. These usually include milk (while other dairy products may be tolerated), citrus fruits, raw onions, hazelnuts, walnuts, and wheat. It is common knowledge that a low-fiber diet—consisting essentially of refined carbohydrates, white sugar, red meat, and, possibly, alcohol—is counterproductive to the treatment of allergies or neurodermatitis. For a successful therapy it is essential that the patient’s gastrointestinal tract is cleansed concomitantly with the

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acupuncture treatment (probiotic therapy and, possibly, Candida clean-up) (16, 18, 19, 22, 23, 27, 33–35, 40, 41). Especially in this context, it is worthwhile to learn the VAS method and other techniques. Allergenic food can be precisely identified using the VAS method. Likewise, the medication one intends to use for intestinal cleansing can be tested for suitability and tolerance.

Problems during Therapy No Improvement of Symptoms Symptoms should improve during the first session of the treatment or shortly thereafter. Some patients react with a distinct improvement only after two days, others may need two to three sessions before improvement sets in. If the symptoms do not change at all, or only very slowly, this may have the following reasons:

The ear point for the primary focus has not been found. In that

case, the ear needs to be reexamined for a very active Focus Point. The Focus Point has not been needled precisely enough. The point must be located and needled again, possibly with two or three needles. It is helpful to make use of the point’s pressure sensitivity, as described earlier: once located, the point is palpated with the tip of the needle until the patient feels a distinct sharp pain. The needle is inserted right there. Not enough has been done to treat the symptoms. In many cases, elimination of the focus alone will be very effective. But one should also take care of the body’s current weak spot, namely, the site of the symptoms (e. g., using body acupuncture, ear acupuncture, neural therapy, physiotherapy, chiropractic). There are severe anatomical changes; for example, an acetabular fracture that healed in the wrong position, or scar adhesions in the abdomen following surgery. Here, focus therapy can only ease the symptoms. The symptoms are maintained by emotional problems (the Psychotropic Points should be located and needled, possibly in combination with psychotherapy).

The Focus Cannot Be Eliminated Has the Primary Focus Been Overlooked?

From one session to the next, all Focus Points found during the first examination should become less and less active as measured with the potentiometer. In the ideal case, an initially very active Focus Point should no longer be detectable after about five sessions. However, if this point shows the same activity in every session, the primary focus may have been overlooked, or there is yet another powerful focal disturbance. In such a case, the patient’s history should be reviewed during the third session at the latest to make sure nothing has been forgotten, and the ear should be reexamined.

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Ear Inflammation Due to a Permanent Needle In general, inflammation due to a permanent needle is rare. Clean working methods and a thorough instruction of the patient are essential for prevention. It may happen that a well-intentioned patient keeps the permanent needle in the ear despite some minor pain. Such pain, however, usually indicates an inflammatory reaction—which does occur in rare cases. The site is then disinfected and treated with one of the naturopathic anti-inflammatory agents routinely employed by many therapists. In rare cases, the inflammation may be so severe that antibiotics become necessary. Especially when dealing with the auricle, there should be no hesitation to use them, not even in a naturopathic practice. (Personally, I have seen such a case only once in my practice.)

Positively No Needling

If a point exhibits even a very minor reddening, it must not be needled until it has healed completely. Likewise, no area bearing a mole, small pustule, sebaceous cyst, or eczema should ever be needled. Therefore, any acupuncture point at such a site cannot be included in the needle therapy.

The Use of Laser

In the latter case, the advantage of a laser device is obvious: aseptic, contact-free therapy without a needle. Treating such an inflamed site with the proper laser frequency (see p. 178) means simultaneous treatment of both the local inflammation and the acupuncture point that is located underneath it. When working without a laser and the point to be treated has to be excluded from needle therapy for one of the reasons listed above, one may try to treat the corresponding point on the other ear with a silver needle.

Example: Treating the Other Ear

Point C7 in the Cervical Spine Zone should be needled as Gold Point on the right ear. If this site cannot be used for one of the abovementioned reasons, a silver needle may be inserted into the corresponding point on the left ear. Even though the effect is not exactly the same, some influence on pain perception can be achieved by this means.

Condition after Otoplasty After surgical correction of an ear (otoplasty), the reflex pathways are interrupted at the site of incision. Lateral to the scar (towards the margin of the ear) the auricle can no longer be used reliably for diagnosis and therapy. Since in most cases an incision has been made only on the back of the ear (medical side of the auricle), the reflex pathways of the front of the ear (lateral side of the auricle) are intact and can still be used for diagnosis and therapy. When searching for focal disturbances, the scar on the ear must be included in the search (for focus-relevant localizations on the ear, see p. 216f.).

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Uncertain Handedness At Knowledge Level 1 handedness cannot always be determined with certainty. A focus located in the middle of the body may then be treated on both ears with steel needles.

Initial Aggravation For the sake of completeness it should be mentioned that the symptoms may become worse during or immediately after the first needling. The aggravation of symptoms may last 24–48 hours, and the healing phase is usually initiated then. If the medical history suggests that the patient is especially sensitive, only thin steel needles should be used initially. It is better to save the effect of gold and silver needles for later. If there really is an initial aggravation, the patient should be informed that aggravation is a sign that the body is responding to acupuncture and that continuation will be worthwhile.

Unconscious Conflict An initial aggravation lasting for days is most likely the result of neurosis. Experience has shown that ear acupuncture itself does not trigger major disturbances. It can, however, uncover a conflict previously unknown to the patient. I remember a patient who came to see me because of unexplained vertigo that was resistant to conventional medical therapy. In the night following the first ear acupuncture treatment she started sobbing uncontrollably for no particular reason—according to her own statement, she had never cried before. The vertigo was eliminated within a few sessions.

Fear of Needles Thin Steel Needles

Fear of needles is common not only among children—even strong men in the prime of life may be affected. There are really only two options: if available, a laser device is used (see p. 178ff.), or the patient is introduced to needles step by step. The patient may agree to have a “test needle” first. Very fine steel needles are ideal for this purpose, possibly also body acupuncture needles with a guiding tube. Such thoughtfulness usually motivates even the most anxious patient to allow further needles to be inserted. In most cases, thicker needles can be used already during the next session. I have been using laser devices for quite some time in my own practice, but I rarely restrict therapy to laser treatment because of an adult’s fear of needles. The ear points need to be treated one by one with the laser beam, and this takes up far more time than needling does.

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Summary of Therapeutic Steps at Knowledge Level 1 Needle the most active Focus Points (gold needles). Possibly also infiltrate the focus at its periphery with a local anesthetic. If necessary, needle Functional Points or points with antifocal effect, for example, Point

PGE1 (corresponding to Confluent Point GB 41) and Thymus Gland Point (corresponding to Confluent Point TB 5). Always needle the Thymus Gland Point last. Needle Psychotropic Points, if necessary. If necessary, stimulate the Thymus Gland Point by treating Point TB 5 of body acupuncture with transcutaneous nerve stimulation (TNS, see p. 86). After removing the needles, a permanent needle may be inserted at one or two important points. Other measures supporting the therapy (see p. 85f.).

The Course of Therapy If the assumption proves correct that a patient's complaints are maintained by foci, the symptoms should already improve during or after the first treatment. Of course, the chances that this will happen are all the greater the more intense the concomitant measures to control the symptoms (even if these measures had no effect at all prior to focus therapy). As a rule, treatment takes place at weekly intervals. Ideally, the initial symptoms will improve from week to week so that the patient becomes more and more stable.

No Focus After Four to Six Sessions

The Focus Points found in the beginning should become less and less active as measured with the potentiometer. Step by step, the values decrease. After a few sessions, the points can no longer be detected; the focus is silent. Now, the diagnosis is: “free from focal disturbance.” It usually takes four to six treatments before a focus becomes silent; it should not take longer. However, the symptoms will not improve if the primary focus has been overlooked. Often the other foci that may have been found cannot be permanently silenced either. After the first treatment, the patient will often remain free of symptoms for one week. At the end of the week, however, the symptoms reappear—time for the next treatment. The patient should be informed of such a possible outcome prior to the first treatment. It is also possible that the symptoms disappear immediately, although the focus or foci are still present in a weakened form. In this case, the treatment must be completed so that the success of the therapy is not jeopardized.

Masked Depression

It is certainly possible that a distinct, more or less severe focal disturbance has been found and none of the symptoms has changed after three correctly performed treatments of both symptomatic points and Focus Points. At this point at the latest, one should carefully reexamine the Psychotropic Points. It is also recommended that the patient’s history is reviewed in more detail—a masked de-

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pression frequently manifests itself, for example, in the form of lower back pain. In this case, the characteristic symptoms (lack of energy, sleep disturbance, lack of motivation, sadness, apathy) need to be unearthed by questioning the patient. If the therapy is not successful, the patient should be referred to a nearby colleague experienced in focus therapy (for contact details, see p. 239).

Long-Term Effect

It is difficult to predict—and varies from patient to patient—how long the once severe, now completely treated focus will remain silent. It may never surface again in one patient, or if it does, only in a weakened form, while another patient needs to undergo a new round of treatments every six months.

External and Internal Stresses

According to our observations, the clinical effects of a focus on the patient, as well as the patient’s tendency to develop new focal disturbances or to reactivate an old, already treated focus, depend very much on the internal and external conditions, namely, on the patient’s lifestyle. External stresses (chronic exposure to toxins, nicotine, food, stress, poor working conditions, social environment) and internal stresses (inability to deal with stress, emotional problems, physical overload, lack of sleep, etc.) can activate the foci. On the other hand, there are those (usually healthy volunteers examined for training purposes) who exhibit a severe focus, but they do not experience any clinical effects. Reviewing the lifestyle of these individuals usually reveals favorable life circumstances with respect to diet, workplace, stress level, etc. These people are often in excellent physical shape, which is certainly also related to genetic factors. However, if such a person is exposed to less favorable life circumstances and is then injured (second strike), he/she becomes predisposed to developing chronic pain.

Therapy of Silent Foci

The therapist therefore should have the good sense to treat existing foci prophylactically, even though they do not (yet) cause symptoms. It should be noted in this context that even a “harmless” focus may unexpectedly develop into a more severe focus at any time.

Notes Regarding Acupuncture Needles There are different types of acupuncture needles: reusable gold and silver needles and gold- and silver-coated disposable needles. Both types have advantages and disadvantages, and each therapist must decide for himself/herself which type to use.

Disposable Needles Advantages

The coated disposable needles come in a plastic case and individually wrapped. They are available in the following sizes: 0.4 mm, 0.8 mm, and 1.0 mm in diameter. Thinner disposable gold needles are also available without individual plastic cases. However, needles for the ear should not be thinner than 0.4 mm. The advantages of disposable needles are obvious:

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94 Practical Application minimum amount of work involved guaranteed sterility no special storage requirements.

Disadvantages

However, there are clear disadvantages that should not be ignored:

far more expensive moxibustion is not possible due to the plastic handle not environmentally friendly. Recently, two companies have begun offering disposable needles with metal handles. Because the gold coating is relatively thick, these needles can be sterilized several times, and the metal handle is suitable for moxibustion. (Sources of supply: schwa medico, Disposable Needle, Gold Special; asia med, Acupuncture Needle, Goldcoated, No. 21; for contact details, see p. 237)

Reusable Needles Reusable needles are available from various companies. They are usually 0.4 mm (fine), 0.6 mm (medium), and 1.0 mm (thick) in diameter. Because they are made of massive gold alloy these needles will last many years, provided they are properly cared for.

More Gold Needles Than Silver Needles

When purchasing needles one should take into account that far more gold needles than silver needles will be used. Gold and silver needles should be purchased at a ratio of 5:1. (Of course, the same ratio applies when purchasing disposable needles.) After each use, the needles—gold and silver needles separately—are placed into a jar with a suitable disinfectant solution. This will remove any remains of skin and blood and will also prevent the risk of infections associated with keeping used needles in the open air. The jar should have some cotton wool at the bottom to protect the needles from being bent at the tip. Suitable disinfection agents must be free of formaldehyde but still effective against bacteria (including tubercle bacillus), fungi, and viruses (including HBV and HIV).

Checking Needle Tips for Hooks

After sitting for several hours in the disinfectant, the needles are removed from the solution using a forceps. They are thoroughly rinsed with distilled water and placed on tissue paper for air drying. Prior to sterilization, each needle must be checked for hooks at their tips. This is best done by drawing the needle tip over a piece of smooth fabric while turning the needle. That way, any hook will be heard as well as seen. Another procedure is to examine several needles together under a microscope, which takes less time. Checking the needle tip with the fingers is unsuitable. If a needle has a hooked tip, insertion into the ear will be painful, and the hook may even create a small wound when the needle is removed. Hooks must therefore be avoided whenever possible. If a hook has been found, the needle tip can be straightened on a piece of frosted glass. For this purpose, the needle is held at its shaft with the tip relatively flat to the glass surface (at an angle of about

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30°). Using gentle pressure, the needle is then turned, with the tip describing a circle on the frosted glass surface.

Needle Sharpening

Needles that have become blunt can be sharpened in the same way. (The insertion of a blunt needle is far more painful than that of a sharp needle.) It is important, however, that the needle tip does not become too thin because this will favor hook formation. Plates of frosted glass are available from any glazier. Most needle manufacturers provide such a plate with the purchase of needles. Needles are sterilized, for example, by dry sterilization at 180 °C for 90 minutes. Gold and silver needles must be sterilized separately, otherwise the silver needles receive a gold coat due to ionic migration.

Sterilizing Needles in a Swab

For sterilization, several needles are inserted into a cellulose swab in such a way that only the handles are exposed. Storing needles in swabs has several advantages:

The cellulose of the swab turns brown during sterilization, thus indicating that sterilization has taken place. This prevents mixing up sterile and nonsterile needles. When removing a set of needles from the glass or metal container, the other needles will not be accidentally touched with the fingers. While working on the patient, a swab holding several needles can be safely placed next to the patient’s ear for a few minutes without compromising their sterility. Once in a while, one should use the service offered by some needle manufacturers to have the needles checked, polished, and sharpened. This service is usually quite affordable, and there is no risk that the needle tips become to thin.

Check the Sterilizer

Acupuncture therapists who use reusable needles may expect, somewhat unfairly, far more scrutiny regarding needle sterility than dentists or gynecologists receive for the sterility of their instruments. For this reason, checks for proper function of the sterilizer using test spore samples should be carried out more often than usual (Bacteriological Examination of Test Spores / Test Bacteria, carried out by the German Federal Institute of Health and Environment). In conclusion, the use of reusable ear acupuncture needles is certainly more economical than that of disposable needles. It is, however, associated with a lot of work. As compared to disposable needles, a clear advantage is that the metal handles are well suited for moxibustion. The plastic handles of disposable needles do not withstand the heat. Furthermore, practical experience seems to prove that the reusable gold needles have a more intense effect due to the gold alloy.

Permanent Needles Prolonging the Effect of Acupuncture

Permanent needles are sterile, disposable needles made of stainless steel. They are inserted into one or more important ear points after treatment with normal needles is complete in order to main-

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96 Practical Application tain the acupuncture effect for an extended period beyond the treatment. A permanent needle is only about 3 mm long. Its lower part consists of a conical arrow which prevents the needle from falling out (the insertion is about 1 mm deep). At the upper end the needle has a small round plate which is about 2 mm in diameter and 1 mm thick. It prevents the needle from sliding deeper into the tissue (Fig. 35). Fig. 35 Permanent needle.

The short needle comes in a transparent plastic case that is open at the end of the needle tip. Behind the needle is a small plunger. To apply the needle, the case is placed with the open end onto the selected ear acupuncture point. Because the needle tip, which is now pointing toward the skin, is clearly visible through the case, it can be inserted very precisely in a controlled manner (Fig. 36). Pressure applied to the other end of the case pushes the small arrow into the tissue until it is stopped by the plate. Because the needle protrudes only about 1 mm above the skin surface, it is hardly noticeable.

Range of Uses for Permanent Needles There are essentially two potential uses for permanent needles: A permanent needle is either inserted after treatment instead of a previously inserted needle, namely, exactly into the existing insertion canal, or it is inserted directly into the point located with the point-finder, without prior use of a normal needle. Especially in focus therapy, however, one will achieve a far better effect by first inserting a gold or silver needle.

Bleeding from the Insertion Canal

If the point intended for the permanent needle is bleeding from the previously inserted needle, it will block the view on the insertion canal. In this case, the bleeding is wiped off under gentle pressure, and the ear is slightly pulled back or to the side with the free hand. This causes the small hole to become oval so that the margins approach each other and the bleeding stops. This moment should be used to insert the permanent needle. No harm will be done by a needle not precisely placed into the insertion canal of the previous needle, but it will also do no good. The

Fig. 36 Inserting a permanent needle into an ear acupuncture point.

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patient will have suffered in vain the pain of insertion, and the permanent needle will have been wasted.

Covering the Permanent Needle After inserting the permanent needle and waiting for the site to dry off completely, the top of the needle is covered with one of the small, round adhesive patches accompanying the permanent needle package. One should avoid touching the patch. It is best to use a fine forceps to pull it off the support.

Shaping the Patch

Fig. 37 Hat-shaped patch to cover a permanent needle without applying pressure.

In some regions of the ear it is difficult to make the patch stick properly. In this case, a cut is made from the margin to the middle of the patch using fine scissors. This will result in better, long-lasting adhesion. A flat patch attached to a permanent needle in the cartilaginous region of the ear (e. g., in the Zone of the Vertebral Column) may cause too much pressure for the underlying needle. This may lead to pain and intolerance in the long run. It can be prevented by cutting the patch as described above and moving the free ends on top of each other to form a little hat (Fig. 37). If the protective patch comes off or gets dirty when the patient is at home, it can be replaced by a piece of adhesive bandage cut out in the appropriate shape. Patients need to be informed about this, so that they will not run from one drug store to the next in search of small round patches.

Allergy to Adhesive Bandages

In case of allergy to adhesive bandages, one may first try the original patches for permanent needles as these are made of nonirritant material. Should intolerance still occur, round patches may be cut out of hypoallergenic material.

Stimulation of the Permanent Needle To make the permanent needles fully effective, they have to be stimulated. This is performed with the small permanent magnet that is contained at the end of the plastic case of the permanent needle. The small dipole magnet is black.

Turning the Magnet

The best effect is achieved by holding the magnet close to the needle (or gently touching it) and then turning it quickly back and forth between two fingers. This acts like a small generator and produces a very weak electric current that enhances the effect of the needle. The faster the rod is turned, the more effective the stimulation. The small case with the magnet will rest better in the hand when pulled apart—once the needle has been inserted—and reassembled in reverse order. This creates a small handle to hold on to the magnet. Even better may be the idea of a colleague who, in her practice, inserts the case with the magnet into an empty sheath of an injection needle. I have introduced this technique in my practice and find it especially handy for older patients (Fig. 38).

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Fig. 38 Magnet for a permanent needle, with its handle lengthened by a needle sheath.

Leave the Patch on the Needle

The effect of the magnet penetrates the patch. Therefore, the protective patch remains on the needle while using the magnetic needle stimulator. Patients need to be informed about this so that they do not think they should remove the patch for stimulation. The stimulation may be repeated several times during the day without reservation, each stimulation lasting for about 15– 20 seconds per needle. In addition, it may be used every time the symptoms occur for which the patient has received the permanent needle (e. g., pain, urge to smoke). It is recommended that the patient be provided with an information sheet (see p. 244) describing the stimulation of permanent needles and other important aspects.

Other Systems of Permanent Needles A metal applicator for permanent needles is an alternative to the disposable plastic case described above. The permanent needle is pulled out of its holding case by means of a magnetic applicator rod which attaches to the upper needle end so that the needle comes to sit in the tip of this rod. The applicator is then placed on the ear point in the same way as the transparent needle case described above, and the needle is pushed into the ear by pressing the plunger. There are two important reasons why this system should not be used:

The therapist cannot see the tip of the permanent needle in the metal case. It is therefore not possible to insert the needle tip precisely into an already existing insertion canal or into an ear point marked with a felt-tip marker. The applicator needs to be sterilized after each patient because it may come into contact with blood and tissue fluid leaking out when the needle is inserted. If one intends to treat several patients in succession, this system easily becomes impractical and uneconomical.

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Level 1: Focus Therapy via Ear Reflex Zones 99

Essential Equipment To be able to diagnose and treat effectively, the beginner should acquire the following basic equipment:

A pair of rubber ears, pins. An ear stamp for the preparation of special charts to be enclosed in the patient’s records. Possibly a stirrup probe. Complete grounding (self-made or prefabricated). A point-finding device with concentric needle electrodes. A set of needles (initially, 20 reusable gold needles will suffice, or disposable needles according to use). A pack of permanent needles. Sterilizer (for reusable needles). Metal or glass containers for needle sterilization. Sterile swabs, alcohol, a fine forceps, a green felt-tip marker, possibly also a fine waterproof felt-tip marker.

References 1. Artner, F.: Trigeminusneuralgie. Fortschr. Med. 104, 711–714 2. Ashton, H., Golding, J. F., Marsh, v. R., Thompson, J. W.: Effects of transcutaneous nerve stimulation and aspirin on late somatosensory evoked potentials in normal subjects. Pain 18 (1984) 377–386 3. Atefie, K., Jenkner, F. L.: Thalamic pain. Schmerz 9/3a (1988) 221 4. Augustinsson, L.-E., Bohlin, P., Bundsen, P., Carlsson, C.-A., Forssman, L., Sjoberg, P., Tyreman, N. O.: Pain relief during delivery by transcutaneous electrical nerve stimulation. Pain 4 (1977) 59–65 5. Bahr, F.: Wissenschaftliche Laserakupunktur und Laserreiztherapie. Self-published, Munich 1987 6. Bahr, F.: Akupressur. Mosaik, Munich 1991 7. Bahr, F.: Ohrlokalisationen im Cavum conchae. Der Akupunkturarzt/Aurikulotherapeut, issue 2 (1992) 3–6 8. Bahr, F., Zeitler, H.: Akupunktur in der täglichen Praxis im Bereich der Ohr-, Körper- und Schädelakupunktur. Self-published, Munich 1989 9. Becker, R., Reuter, H.: Transkutane elektrische Nervenstimulation bei chronischen Schmerzen. Münch. med. Wschr. 126, 32/33 (1984) 937–938 10. Chung, J. M., Lee, K. H., Hori, Y., Endo, K., Willis, W. D.: Factors influencing peripheral nerve stimulation of primate spinothalamic tract cells. Pain 19 (1984) 277–293 11. De Mar, E. A.: The use of transcutaneous electric nerve block on traumatized muscles. Schmerz 9/3a (1988) 201 12. Dosch, P.: Lehrbuch der Neuraltherapie nach Huneke. Haug, Heidelberg 1989 13. Farina, S. et al.: Kopfschmerzen und HWS-Erkrankungen: Klassifikation, Behandlung mit TENS. Headache 26/8 (1986) 431–433 14. Fox, E. J., Melzack, R.: Transcutaneous electrical stimulation and acupuncture: comparison of treatment for low-back pain. Pain 2 (1976) 141–146 15. Francini, F., Maresca, M., Procacci, P., Zoppi, M.: The effects of nonpainful transcutaneous electrical nerve stimulation on cutaneous pain threshold and muscular reflexes in normal men and in subjects with chronic pain. Pain 11 (1981) 49–63 16. Greinwald, R.: Moderne Grundlagen für die mikrobiologische Darmtherapie. Erfahrungsheilkunde 5 (1991) 324–328

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100 Practical Application 17. Hoffmann, C.: Akupunktur in der Urologie. Der Akupunkturarzt/ Aurikulotherapeut, issue 2 (1992) 18–23 18. Hofman, T., Hanasz-Jarzynska, T.: Die Bedeutung von Nahrungsmittelallergien bei kindlichem Bronchialasthma. EAACI, Paris 1992 19. Irrgang, K., Sonnenborn, U.: Beziehungen zwischen Wirtsorganismus und Darmflora. Schattauer, Stuttgart 1988 20. Kellner, G.: Zur Histiochemie der Narbe. Hippokrates 36 (1965) 777–785 21. Kibler, M.: Segment-Therapie. Hippokrates, Stuttgart 1950 22. König, H., Manz, W., Singer, U.: Einfluß auf Darmbakterien. Kassenarzt 18 (1991) 52–61 23. Leonhardt, L.: Allergologie in der Praxis. Reihe Praxishilfen. Kirchheim, Mainz 1992 24. Niboyet, J. E. H.: Die Übereinstimmung des verminderten elektrischen Hautwiderstandes an punktförmigen Oberflächen und Hautbahnen mit den Punkten und Meridianen, den Grundlagen der Akupunktur. Dissertation, Marseille 1967 25. Permar, J.: Behandlung des therapieresistenten, postoperativen Schluckaufs mit Ohrakupunktur. Der Akupunkturarzt/Aurikulotherapeut, issue 2 (1992) 26. Pischinger, A.: Das System der Grundregulation. Haug, Heidelberg 1990 27. Reimann, H. J.: So hilft Kneipp bei Nahrungsmittelallergie. Orac, Vienna 1991 28. Rost, A.: Verifizierung der Wirksamkeit der Neuraltherapie durch die Thermographie. Ärzte. Naturheilv. 23 (1982) 713–719 29. Rost, A.: Objektivierung der Neuraltherapie nach Huneke durch die Thermographie. In: Freudenstädter Vorträge 1986, vol. 11, editor P. Dosch. Haug, Heidelberg 1987 30. Schiffter, R.: Neurologie des vegetativen Nervensystems. Springer, Berlin 1985 31. Schmid, J.: Neuraltherapie. Springer, Berlin 1988 32. Schoeler, H.: Zur elektrischen Untersuchung von Narben. In: Therapie über das Nervensystem, vol. 2, editor D. Gross. Hippokrates, Stuttgart 1965 33. Schütz, E.: Mikrobiologische Therapie von chronisch entzündlichen Darmerkrankungen (CED). Erfahrungsheilkunde 5 (1991) 328–334 34. Schulz, J.: Obstipation und Darmflora. Z. ärztl. Fortbild. 86 (1992) 121–126 35. Sonnenborn, U., Stobernack, H.-P., Proppert, Y.: Die Entwicklung der aeroben Darmflora bei Neugeborenen. Fortschr. Med. 108/21 (1990) 36. Stacher, A.: Die Wirkung der Neuraltherapie auf das Blutbild. Ärztl. Prax. 18 (1966) 827–829 37. Steinhäusler, F. et al.: Membrane resting potential (MRP) as indicator of cell transformation in human lung biopsy samples (preliminary report). 2nd International Workshop on Experimental Oncology. Madison, Wisconsin USA, May 29/30, 1981 38. Strittmatter, B.: Lokalisationen auf der Ohrmuschel. Der Akupunkturarzt/Aurikulotherapeut, issue 3 (1991) 10–24, issue 4 (1991) 8–21 39. Tilscher H., Eder, M.: Therapeutische Lokalanästhesie. Hippokrates, Stuttgart 1989 40. Werthmann, K.: Enterale Allergien. Haug, Heidelberg 1986 41. Werthmann, K.: Kinderallergien – Erkennen und Behandeln durch individuelle Diät. Sonntag, Regensburg 1989

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Learning and Mastering Knowledge Level 2 101

Learning and Mastering Knowledge Level 2 Focus Diagnosis under Vascular Autonomic Signal Control Overview At Level 1, all points are located with the point-finder (a concentric needle electrode, Wheatstone bridge) based on their disturbed charge distribution. Level 2 is an introduction into pulse diagnosis, namely, the method of monitoring the vascular autonomic signal (VAS, Nogier’s reflex). Here, the electrically altered points are found by means of the VAS, which can be induced by approaching such a point with a 3-volt hammer (Fig. 39).

A Targeted Search for Foci

The VAS method is independent of the point-finder and makes it possible, among other things, to locate foci in a more targeted way. Focal disturbances can now be ranked according to importance by using Bahr’s system of five Focus Indicator Points (see p. 115ff.). This makes the focal process more assessable, and the primary focus can be located with great precision. The therapist no longer depends on the accuracy of the patient’s memory when establishing the medical history, for this method allows one to find even those foci that are either unknown to the patient (e. g., dental foci) or have been forgotten. Even a Focus Point in the reflex zone of the teeth that has been found by examining the auricle can now be accurately assigned to the affected tooth. The correct identification of a disturbed tooth will then be the basis of any further (dental) treatment.

Fig. 39 3-volt hammer.

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Advantages of VAS Diagnostics

Using the five Focus Indicator Points according to Bahr, several important questions can be addressed using the diagnostic method described in the following chapters:

First of all, does the patient have any focal disturbances? How many foci does the patient have? Where are these foci? Which one is the most intense focus (primary focus)? Does a suspected structure of the body (scar, tooth, etc.) have any focal activity and does it therefore participate in causing/maintaining the illness? (This is important, e. g., when deciding whether or not a dead tooth should be removed.) Which part of a scar acts as a focus? Are there any focal disturbances that have not been recorded in the patient’s history? Do certain body structures have the potential to cause disease? (This is important for prophylactic treatment.)

Saving Time

The system of Focus Indicator Points not only permits one to diagnose foci in a targeted manner, but it also saves time. Moreover, the course of focus therapy can be monitored.

Improved Treatment Is Possible

If the foci are to be treated later by means of ear reflex zones, the VAS method allows the therapist to work far more precisely than before. Small spots of long scars can be needled or infiltrated at the exact site while monitoring the VAS. Treating the foci by needling the corresponding ear acupuncture points also becomes more accurate under VAS control. Since ear reflex points are often no more than one millimeter in diameter, focal therapy depends entirely on the accuracy of needle insertion. Skilled application of the VAS method of examination yields a distinctly higher diagnostic efficiency—and thus also a higher therapeutic efficiency—than the exclusive use of the point-finder. Although learning the VAS method seems to involve far more effort, the experienced therapist will be able to carry out examination much faster than with the point-finder. As mentioned earlier, even the nonacupuncturist who does not want to learn and use the ear reflex zones can use the VAS method for efficient focal diagnosis. He/she will exclusively use the system of Focus Indicator Points to find the corresponding fields of disturbance in the body. Later, however, when planning to treat internal foci without deep infiltration, aiming for therapy by means of ear reflex zones is more meaningful.

The best method for diagnosing foci is based on the combination of a detailed knowledge of ear reflex zones (Knowledge Level 1) with mastery of the VAS method (Knowledge Level 2).

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Level 2: Focus Diagnosis Under Vascular Autonomic Signal Control 103

The Vascular Autonomic Signal (Nogier’s Reflex) Discovery of the VAS In 1945, the French physician, Professor René Leriche, observed certain changes in the pattern of arterial pulsation while he changed the dressing after vascular surgery in the region of the femoral artery. When moving his hand across the dressing, the artery began to pulse visibly underneath the dressing. The phenomenon could be induced and observed repeatedly, but it was not further analyzed (see ref. 13).

Changes in Pulsation Nogier made similar observations in 1968. More or less by chance, he palpated the pulse while examining a patient’s ear reflex zones with a pressure probe. Every time he examined a pathological ear point with the pressure probe, he noticed a distinct change in the quality of the pulse. The pulsation felt harder. This change persisted as long as the pathological zone was stimulated. The pulse became weaker and normalized once he terminated the stimulation. The change in pulsation could be repeatedly induced by renewed stimulation of this zone. Nogier observed that only the stimulation of pathologically altered acupuncture points triggered a distinct change in pulsation and that this phenomenon could be used for diagnostic purposes (at that time he was still searching for pathological points with the pressure probe). He had thus found a diagnostic tool that was reproducible and independent of the patient. It is still used today, among other things, for locating pathological acupuncture points on the ear.

3-Volt Hammer

Shortly thereafter Bahr introduced the 3-volt hammer. By taking advantage of the electric phenomena described on p. 113ff., this tool can be used to locate or stimulate points without touching the ear. While monitoring the VAS, the therapist can work much faster and, above all, with more precision because unwanted information caused by touching the skin can be avoided.

Auricular Cardiac Reflex

Nogier initially assumed that the change in pulsation noticed when stimulating pathological ear points was a cardiac reflex, and so he called it réflexe auriculo-cardiaque (RAC), that is, auricular cardiac reflex (ACR). Today we know that this is a sympathetic, autonomically controlled skin reflex. Nogier later revised the name to vascular autonomic reflex (VAS). This physiological phenomenon can be employed for diagnostic and therapeutic purposes. It works in every person and has no tendency to wear out.

Nogier’s Reflex

Even though the original term chosen by Nogier is not correct, it is still commonly used. In 1994, at the International Congress of Auriculotherapy and Auriculomedicine in Lyon, Bahr suggested naming the reflex “Nogier’s reflex” in honor of Nogier. This proposal met with unanimous approval (6).

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104 Practical Application

The Basics The physiology of the VAS has been mostly solved, although not completely (1–4, 10–15). The following is a brief overview. To understand the phenomenon of the VAS, it is essential to recall vascular physiology and, in particular, the properties of the pulse.

Stationary Wave

The pumping effect of the heart creates a progressive (traveling) pressure wave along the walls of the large arteries. This pressure wave travels to the sites where large arteries branch into smaller arterioles. Here it meets with greater resistance and is therefore reflected back along its original path. The result is a stationary (standing) wave. The maxima (crests) and minima (troughs) of this stationary wave are usually felt as pulsation.

Propagation of the Pulse Wave

Because the impulse is transmitted from particle to particle, the speed with which the pulse wave travels along the wall of the artery (propagation velocity) is far greater than the speed of the blood flow (transport velocity). The two speeds must not be confused with each other: At a systolic flow rate of approximately 70 cm/s, the pulse wave reaches the arterioles of the foot within 0.2 seconds; by this time, the fluid particles of the systolic discharge that induced the pulse wave have only arrived in the descending aorta. The speed with which the pulse wave travels depends very much on the vessel’s elasticity and the relationship between wall thickness and radius of the vessel. The more rigid or thicker the wall, or the smaller the radius, the faster the wave will travel (9). For a better understanding, the special case of a stationary wave can be illustrated as follows: Two transverse waves with identical planes of oscillation, wavelengths, and amplitudes travel toward each other at the same speed. Figure 40 is a graphic representation of the superposition of the two deflections. The superposition is shown here at 12 successive snapshots, each following the next at an interval of T/12. The continuous line represents the sum of the two deflections, with the result changing from one instant to the next. A typical feature of the standing wave thus formed is that certain points stand still during the entire process. They are called the nodes (nodal points) of oscillation and lie at intervals of half a wavelength of the progressing wave. All points between two adjacent nodes oscillate in phase, that is, they all reach their maxima at the same time and pass through the position of equilibrium at the same time. However, their amplitudes differ, with the highest amplitudes observed at the points in the middle between two adjacent nodes. These points are called antinodes of oscillation. The points to the left and right of a node oscillate in antiphase, that is, when the positive deflection to the left of the node reaches a maximum, there is a maximum of negative deflection to the right. The point of the maximum deflection subsequently travels through the zero phase and then becomes a negative deflection, and so on.

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Fig. 40 Section of a stationary wave in 12 snapshots. Broken line : wave progressing toward the left; dotted line : wave progressing toward the right; continuous line : standing wave resulting from superposition of the two progressing waves (according to Dorn and Bader, 7).

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Interference

Stationary waves thus develop from the interference of waves propagating in opposite directions. The special feature of a stationary wave is that its spatial image does not travel—unlike that of the progressive wave—but forms nodes and antinodes which always remain at the same site, giving the impression of an inflating and deflating motion. This explains why the pulse is always palpable at a crest or a trough of the wave, both appearing at the same position, only at different times. This can be easily reenacted in practice: A strong pulse (e. g., the radial pulse) is located with the finger or thumb. Ideally, the palpating finger is placed longitudinally to the artery rather than transversely as is commonly done. The finger is then slightly moved in distal direction. Now one can clearly feel that the finger no longer rests on the maximum of the crest but on a “slope” (Fig. 41). The model in Figure 42 illustrates the progression of a stationary transverse wave: A sinusoidal curve rotating around its axis is projected onto a screen, showing the temporal distribution of the deflections at four designated moments of the stationary wave (Fig. 43). In the previous example, two identical transverse waves were traveling toward each other to create a stationary wave. A stationary wave is also formed when such a wave is reflected on a wall. For example, if a transverse wave enters a tube, it will be reflected at the tube’s end in such a way that an arriving crest returns as a trough and vice versa.

Reflection of Waves

This is very similar to what happens in the vascular system: Here, the waves come in from one side and are reflected at the end, which is represented by the resistance of the blood vessels. In the region of the terminal arteries and arterioles, this resistance amounts to almost 50 % of the total flow resistance. This huge increase in resistance is due to a decrease in the diameter of terminal arteries and arterioles, which is not fully compensated for by the increasing number of parallel vessels. Hence, this region corresponds to the reflection site in the above-mentioned tube model. A stationary wave with fixed nodes and antinodes is thus formed; frictional loss and attenuation are not taken into consideration for the sake of better comprehension. When the site of reflection shifts (or the length of the tube is altered), a new stationary wave is formed, with its nodes and antinodes lying at different sites than before. This fact is important for understanding the phenomenon of the VAS (see p. 103). The resistance that the arterioles offer to the pressure wave depends on the activity of the sphincters in the vascular wall. These sphincters are controlled by the autonomic nervous system and by local biochemical processes. Their activation leads, for example, to the reflex-like constriction or dilatation of arterioles and/or to the opening or closing of arteriovenous (AV) shunts and, thereby, to a change in peripheral resistance (the flow rate through AV shunts can oscillate between 0 and 100 % within a fraction of a second) (9).

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Fig. 41 Palpating the pulse at the crest or trough of the pulse wave.

Fig. 42 A stationary wave as the projection onto a screen of a rotating sinusoidal curve (according to Dorn and Bader, 7).

Fig. 43 Stationary transverse waves at intervals of one quarter of the period of oscillation, with arrows indicating the oscillation amplitudes (according to Dorn and Bader, 7).

New Stationary Wave Resulting from Vascular Constriction

The constriction of small arteries or arterioles, or the closing of AV shunts, has consequences similar to the shortening of the tube: the reflection site for the incoming pulse wave shifts. A new stationary wave is formed as a result, and the crests and troughs of the wave shift slightly, and with them the nodal points. This shift is clearly registered by the finger palpating the pulse. It is assumed that the VAS essentially represents this change in pulse quality. The hydrodynamic model cannot be applied without restrictions to the hemodynamic cardiovascular model, but it helps us to under-

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108 Practical Application stand the VAS. When considering how the VAS is generated in vivo, one should also take into account the reflection of waves, the different rates of wave propagation, and any attenuating processes. When considering the pulse wave, the following points may be ignored:

the rate of blood flow (as mentioned above, the blood travels much slower than the pulse wave)

the longitudinal wave generated in the column of blood. Both aspects do not seem to play an essential role in generating the VAS.

The Backflow Phenomenon

The phenomenon of backflow, however, should be included in the consideration. The corpuscular components of the blood tend to flow in the center of the vessel, while the plasma tends to flow along the wall (Fig. 44). If the AV shunts suddenly close, the wall of resistance thus created will not only cause the reflection of the pulse wave to flow backward but also the much slower column of blood. At first, the backflow positions itself separately over the inflow, as may be expected (Fig. 45). The corpuscular portion of the backflow therefore comes into closer contact with the vascular wall and thus contributes to the development of a distinct shift of the pulse toward the periphery, that is, to the generation of the VAS.

Triggering the VAS

A vasomotor change in tonus (and thereby also the VAS, or pulse reflex) can be triggered by minor stimuli, such as the light reflex from the Heine lamp or the manual or electrical stimulation of an acupuncture point on the ear. The pulse reflex (or change in pulsation) lasts only for a relatively short period of time, often only for a few heart beats. It is not only triggered by stimulation at an acupuncture point but also at every other body site by appropriate stimulation causing tonal changes in the sympathetic nervous system.

Reaction of the Autonomic Nervous System

The speed at which the VAS response to minor stimuli (resonance VAS) can be felt excludes a biochemical interaction. It is therefore most likely that this reaction is mediated by the autonomic nervous system. It is now possible to document the VAS, for example, with a pulse oximeter or by bidirectional Doppler ultrasonography (5). At present, however, these objective procedures are still very susceptible to interference and not yet suitable for daily use in the medical practice. Unfortunately, they are no substitute for the attentive palpation of the pulse. For more details on the scientific foundations of the VAS, please refer to the existing literature (1–4, 10–15).

Technique of Palpating the VAS A Partially Subjective Procedure

In contrast to the absolutely objective method of electrical point location, the VAS-controlled diagnosis represents a partially subjective procedure for point location, comparable to heart auscultation. Like the interpretation of the findings obtained by auscultation, ECG, or radiographs, the first thing to do is practice the test procedure,

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Fig. 44 The corpuscular components of the blood tend to flow in the center of the vessel, whereas the plasma flows predominantly along the wall.

Capillaries

Metarteriolar anastomosis

Arterio-arterial anastomosis

Fig. 45 Backflow running against the main flow in arterio-arterial anastomoses.

which consists of establishing a change in pulse quality. Some practitioners learn it during the first clinical training session, while others need more time (for information about training, see p. 236ff.). While examining the ear reflex zones (palpation, electrical examination, see below), the trained therapist will notice a distinct change in pulsation when stimulating an active ear point. The pulse reflex enables one to recognize minor changes, which are known as VAS rebound or VAS consequence. They are induced by minute mechanical, electrical, or optical stimuli, especially on the auricle.

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Fig. 46 Relaxed posture for monitoring the VAC (according to Bahr, 5).

Fig. 47 Palpating the VAS. On the left the physician’s hand; on the right the patient’s hand (according to Bahr, 5).

It is recommended that the following instructions regarding body posture, position of the thumb, and so on are followed strictly at least in the beginning. Even a thick horny layer at the tip of the palpating thumb can make diagnosis by VAS difficult.

Relaxed Posture While Sitting

It may seem banal to point out that the therapist should sit in a relaxed position. But the initial success—and therefore also the motivation to proceed with VAS palpation—may depend on such simple aspects. The patient should lie down so that both ears are within easy reach to the therapist who ideally sits behind the patient’s head. The right hand examines the surface of the ear (e. g., with the 3-volt hammer, see below), while the left hand palpates the patient's radial pulse (Fig. 46). The treatment table should be high enough to ensure that the therapist is really relaxed while examining the ear. The patient’s left arm should be supported by a small pillow. The examining hand or forearm should be supported during the examination of the ear. Any muscle tension may decrease one’s sensitivity for the VAS. The pulse should always be taken at the same site.

Palpating with the Pulp of the Thumb

Because the thumb has the largest representation on the sensory cortex, palpation is usually done with the pulp of the thumb. The pulp of the thumb is gently placed on the site used for palpating the pulse; this is done without exerting pressure while the pulse can still be felt. This eliminates the risk of confusing one’s own pulse with that of the patient. The therapist’s thumb should be placed longitudinally rather than transversely as is commonly done. While doing so the forearms of the examiner and the patient lie in the same axis. The phalanx of the thumb is flexed at 110–120° (Figs. 47, 48). Palpation is exclu-

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Longitudinal section through the wrist Fig. 48 The phalanx of the thumb is flexed at 110–120° (according to Bahr, 5).

Fig. 49 The surface area of the thumb used for palpating has an oval shape (according to Bahr, 5).

Styloid process of radius

Radial artery Site for palpating the VAS

Fig. 50 The best site for palpating the VAS (according to Bahr, 5).

sively performed with the distal portion of the thumb and not with the proximal portion of the pulp (Fig. 49). If, for some reason, the thumb cannot be used, the pulp of the index finger is used. The procedure described above applies here, too.

The Radial Pulse Is Best

The best site for palpating the VAS is the radial pulse on the descending portion of the apophysis of the styloid process of radius. When moving the thumb upward from the inside of the forearm toward the wrist, this site is found about two fingers wide before reaching the transverse crease of the wrist (Fig. 50). The pressure should be applied as lightly as possible to avoid pushing away the pulse reflex. When a VAS is induced upon stimulation of an acupuncture point, it appears to the palpating thumb as if the pulse becomes harder,

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112 Practical Application tenser, or of larger volume. Nogier described this impression as “a bump rising under the thumb.” If the VAS is felt as a weakening pulse, one should check the position of the thumb and correct it as necessary.

Concurring Results of Palpation

Experienced therapists will reach identical results when examining the VAS of the same patient. Studies carried out on this matter yielded test results that showed a high degree of concurrence (16).

Preliminary Exercises

It is recommended that the beginner practices the palpation of the mere pulse reflex prior to VAS examination of acupuncture points. For this purpose, a Heine lamp is well suited for shining concentrated light onto a skin area of the face. The light beam may also be directed, for example, to Point Zero on the ear. While doing so, one can clearly feel a VAS. The change in pulsation lasts for a few beats and then becomes weaker. The light is then removed, and the same process is repeated once the pulse has returned to normal. After long periods of practicing signs of fatigue may set in, and they can make it difficult to palpate the pulse. At this point it is best to take a break.

Sources of Error When Palpating the VAS Wrong Site

In my training courses I am often surprised where my fellow practitioners look for the pulse in their eagerness to experience the VAS. The site for palpating the pulse is the same as always, only the manner of palpating is slightly different (the same site of palpation as taught in medical school, but using the thumb). Basically, one should first locate the resting pulse at its best site and feel it for some time so that one is able to notice the difference of the VAS reflex.

Wrong Position When Palpating

It is important especially in the beginning to maintain the precise position recommended for the palpating thumb (see p. 111). To be able to feel the fine longitudinal shifts of the pulse wave, the contact surface must not be too large, and the examiner’s thumb and hand must lie in the same longitudinal axis as the patient’s forearm. Especially when initially practicing the VAS on patients, it makes sense to verify the located acupuncture points with the point-finder. Alternatively, one may first examine the ear for active points using the point-finder and mark them so that the VAS can then be practiced at the marked sites. (For examination with the 3-volt hammer, see below.)

False Expectations

Some practitioners are able to palpate the VAS reliably right after the first attempt. Others may have problems. Considering that children are able to feel changes in pulsation fast and reliably because they are unbiased, it is easy to understand that false expectations with respect to the intensity of the changes in palpation can interfere with learning the technique of VAS palpation. It is therefore essential to take practical training courses (see p. 236). Course participants are introduced individually to the palpation of

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the pulse. Here, they learn how to recognize the changes in pulsation through demonstration and through palpation in parallel with the instructor.

Too Much Pressure

Especially beginners tend to exert too much pressure in an effort to find an ear point. As mentioned above, the pressure should be very light so that the pulse reflex is not pushed away. A relaxed sitting position is therefore essential. Many beginners tense their shoulder and neck muscles while practicing, and this makes VAS palpation very difficult. It is important to make sure from time to time that one is completely relaxed.

Thick Horny Skin

A thick callus on the pulp of the thumb will interfere with palpation. It should therefore be carefully rubbed off with a pumice stone. Grinding is done transversely to the pulp of the thumb and is best carried out under water, because dry grinding stimulates renewal of the callus. The subsequent use of an urea-containing ointment will keep the skin soft. It has been observed time and again that the VAS can be felt only after grinding off the callus on the thumb.

The Electric Hammer (3-Volt Hammer) As already described in connection with the detection methods at Level 1, an active ear acupuncture point differs from its neutral surroundings by increased sensitivity to pressure, a different temperature, and increased or decreased skin resistance. The latter aspect is the foundation for objective measurement with the point-finder (see p. 60 ff.). As mentioned before, the VAS-monitored diagnostic procedure offers essential advantages (see p. 48).

The Ideal Detection System

Bahr introduced the electric hammer for point localization (Fig. 39, p. 101). This instrument meets all criteria required of a detection system for acupuncture points:

The points can be unambiguously located in a reproducible, precise, and easy way.

The needle metal to be used for therapy is clearly determined. The points can be located without being treated unintensionally (and thereby nonspecifically).

It is relatively inexpensive.

Charge The 3-volt hammer is a dipole probe, and the electric field between Displacement within its limbs is maintained by a battery (Fig. 51). Acupuncture points can be located by bringing its positive or negative pole close to the Acupuncture Point

area of skin to be examined, which is then systematically screened. Approaching the dipole hammer and its surrounding electric field results in a charge displacement within the acupuncture point— without actually coming into contact with it and without closing the circuit (Fig. 52). This process is called electrostatic induction. The extent of charge transfer (displacement quotient, dQ) depends on the electric field strength (E) of the dipole and, therefore, on the battery voltage (VB), on one hand, and on the distance (d) of the di-

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Fig. 51 Battery voltage of a 3-volt hammer.

Fig. 52 Charge transfer (influence) at an acupuncture point caused by an approaching dipole.

pole from the acupuncture point, on the other. According to Franke-Gricksch, the following simplified relationship applies (8): dQ is approximately E : d, and this is approximately VB : d. The displacement forces generated during this process can be compared to forces generated by bringing equal and opposite magnetic poles close together. This model explains three important phenomena which, so far, have been empirically found on the patient:

VAS Reactions Caused by the 3-Volt Hammer

The electric hammer triggers clear and intense VAS reactions, as the pathological point is put into a hyperpathological state by bringing the effective pole of the hammer near the point. By approaching a Gold Point (a site of low potential) with the positive pole of a 3-volt battery (3-volt hammer), the residual positive charge at this point is temporarily pushed toward the periphery, thus increasing the disturbed charge distribution even further, which finally triggers the VAS (Fig. 53). By approaching a Silver Point with the negative pole of a 3-volt battery (3-volt hammer), the residual negative charge at this point is temporarily pushed toward the periphery. Here, too, the disturbed charge distribution is further increased, thus triggering the VAS.

When bringing the electric hammer near the pathological point with the ineffective (“false”) side, the metal itself does not trigger an appreciable VAS reaction because the point becomes temporarily neutralized through the potential of the hammer (Fig. 54). If the electric potential of the hammer is too intense, false results may be obtained: approaching with the effective pole could lead to overstimulation of the point, while approaching with the ineffective pole could lead to “overadjustment” of the point. This

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Fig. 53 Charge distribution at an acupuncture point at rest and when approaching with the positive or negative pole of the 3-volt hammer.

Fig. 54 Approaching with the wrong pole of the 3-volt hammer causes temporary neutralization of the point.

could trigger a positive VAS reaction by mistake, and the wrong metal would be assigned to the point. So far, a battery potential of 3-volt has proved to be best in body and ear acupuncture. The model of Franke-Gricksch has proved to be valid or for more than two decades.

The Five Focus Indicator Points According to Bahr First Discovery: The Histamine Point

Nogier realized more than 25 years ago that the Histamine Point (synonym: Allergy Point 1) was often found to be an electrically active point in patients with a strong focal disturbance. This point is a Gold Point on the left ear (and a Silver Point on the right ear) in a right-handed person, while it is the other way around in a left-

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Fig. 55 Histamine Point (Allergy Point 1) in a righthanded person.

handed person (Fig. 55). From this Nogier concluded that an active (electrically altered) Histamine Point would indicate the presence of a major field of disturbance. He thus found one of the most important focus indicators known to us today—the first Focus Indicator Point. This was the beginning of discovering a kind of “alarm system” on the ear, which Bahr consistently pursued further. He noticed that some patients had focal disturbances without showing an active Histamine Point, and he recognized the significance of this finding: Foci of various degrees of severity should be associated with different Focus Indicator Points. Bahr searched for, and found, four other Focus Indicator Points, which he named after the substances with which he had discovered them. (For the principle of local resonance, see p. 130 f.) The already known Histamine Point proved to be the strongest Focus Indicator Point, that is, its activity indicates a very severe field of disturbance. All other Focus Indicator Points represent weaker foci, one slightly weaker than the next. Table 1 lists the five Focus Indicator Points in order of importance (Fig. 56). Table 1 The Five Focus Indicator Points Type 1 Type 2 Type 3 Type 4 Type 5

Histamine Point (synonym: Allergy Point 1), indicating an active toxic focus Endoxan Point (synonym: Allergy Point 2) Prostaglandin E1 (PGE1) Point Vitamin C Point Laterality Point (synonym: Ginseng Point)

Left ear Right ear Right ear Right ear Right ear

An active Focus Indicator Point of Type 1 (Histamine Type) indicates a very severe, toxic focus, a Focus Indicator Point of Type 2 a

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Fig. 56 Focus Indicator Points for a right-handed person: 1 Histamine Point (Allergy Point 1) 2 Endoxan Point (Allergy Point 2) 3 PGE1 Point 4 Vitamin C Point 5 Laterality Point (Ginseng Point)

severe but slightly weaker focus than Type 1, and so on, with a Focus Indicator Point of Type 5 indicating a very weak focus.

One Active Indicator Point–One Focus

A Focus Indicator Point usually points only to one focus. Thus, if two Focus Indicator Points are found, it can be assumed that there are also two foci. If any one of the Focus Indicator Points is active, the examiner is provided with the following information:

A focus is present. The focus is of a certain severity (Type 1–Type 5). An active Focus Indicator Point merely indicates that there is a focus of a certain degree of severity. It does not say anything about the type of focus or its reflex localization on the ear. These need to be assigned subsequently in order to find the responsible focus (see p. 125, cable method).

Handedness and Focus Indicator Points

The localization of Focus Indicator Points on the ear is strictly related to the handedness of the patient. The following rule is valid for the right-handed person: The Histamine Point appears as Gold Point on the left ear, all other Focus Indicator Points appear as Gold Points on the right ear (Fig. 56). The opposite is true for the left-handed person: The Histamine Point appears as Gold Point on the right ear, all other Focus Indicator Points appear as Gold Points on the left ear. (For tips as to how to determine handedness, see p. 69f.).

Foci on the Right Side of the Body Project Onto the Right Ear

The foci always project onto the ear of the same body side where the focus is located. For example: appendix, gallbladder, and right knee are represented on the right ear, while a scar on the left elbow and a scar from a left inguinal hernia are represented on the left ear.

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118 Practical Application In these cases, it is completely irrelevant whether the patient is left-handed or right-handed.

Focus Indicator Point Type 1: Histamine Point (Synonym: Allergy Point 1) On the Left Ear in a Right-Handed Person

A focus belonging to this Focus Indicator Point is referred to as an actively toxic focus. It is also known as Type 1 focus, or focus of the Histamine Type. The Histamine Point is identical with Allergy Point 1. It is located at the apex of the helix and can be found by flapping the auricle with two fingers from the side to the front: the point lies right at the tip of the folded ear. It is needled as Gold Point on the left ear in a right-handed person and as Gold Point on the right ear in a left-handed person (Fig. 55). While monitoring the pulse, the point can be located with the positive pole of the 3-volt hammer, namely, from above and outside as well as from below and inside the helical fold. One should search for the point from both directions—without touching the ear, if possible. One should keep in mind that all ear acupuncture points, including the points representing the focus on the body, can only be found if they are active, that is, electrically altered (as is the case when points are located with the point-finder). When we talk about having “found” a point, this always means that the change in pulsation (Nogier’s reflex) was induced by moving the 3-volt hammer towards the exact site on the ear (ear acupuncture point), or the exact site of a scar.

Corresponding Body To test one’s own diagnosis while searching for Focus Indicator Points, one may additionally test the corresponding body acupuncPoints ture points recently discovered by Bahr. If a Focus Indicator Point on the ear is active, then the corresponding acupuncture point on the body must also be active—otherwise it is very likely that one has made a mistake on the ear. These body acupuncture points are discussed together with the individual Focus Indicator Points.

Point LI 3–1

When finding the Histamine Point to be active, it is possible to test one’s own reliability by checking whether the body acupuncture point corresponding to the Histamine Point is also active, namely, Point LI 3–1 on the hand. It is located at the level of Point LI 3 on the radial side near the upper third of the 2nd metacarpal bone. In a right-handed person, it is found as Gold Point on the left hand (Fig. 57).

Point BL 40

Point BL 40 may also be used for counterchecking the Histamine Point on the ear. In a right-handed person, it is found as Gold Point in the middle of the left popliteal cavity (Fig. 58). Until recently, before Bahr discovered Point LI 3–1 on the hand, Point BL 40 was the only known point for counterchecking the Histamine Point. However, Point LI 3–1 is far easier to reach when sitting behind the head of the reclining patient.

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Fig. 57 Point LI 3–1, a body acupuncture point corresponding to Histamine Point 1.

Fig. 58 Point BL 40, another body acupuncture point corresponding to Histamine Point 1.

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Caution with Allergic Patients

When searching for a focus in this way, without further aids, there is one restriction on the validity of the Histamine Point as Focus Indicator Point. In an allergic patient, an active Histamine Point can also be interpreted as indicating an allergy rather than a focus; in some cases it may indicate both—the allergy and the focus. Anyone interested in this topic should therefore refer to the chapter on improved diagnostics by means of additional aids (see p. 166ff.), which describes how relatively simple measures can be used to make a decision regarding the validity of a point with multiple functions.

Focus Indicator Point Type 2: Endoxan Point (Synonym: Allergy Point 2) On the Right Ear in a Right-Handed Person

A focus belonging to this Focus Indicator Point is also known as Type 2 focus, or focus of the Endoxan Type, and it represents a relatively severe disturbance. The Endoxan Point is located in front of the ear at the level of the antihelix; in most persons, this is in the hair region. In a right-handed person, it is found as Gold Point near the right ear (Fig. 59).

Point PC 9–1

As mentioned earlier, the VAS is regarded as a general response of the body to small stress stimuli so that the mere bending of short, strong hairs can already trigger a VAS. Checking the Endoxan Point in the hair region with the 3-volt hammer may therefore yield a false positive result, especially when the beginner is still learning the VAS. It is therefore recommended that the corresponding body acupuncture point, Point PC 9–1, be examined for a countercheck. It is located at the level of Point PC 9 about 2–3 mm away from the ulnar angle of the nail fold of the middle finger. In a right-handed person, it is found as Gold Point on the right hand (Fig. 60).

Fig. 59 Endoxan Point.

Fig. 60 Point PC 9–1, a body acupuncture point corresponding to the Endoxan Point.

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Focus Indicator Point Type 3: Point PGE1 On the Right Ear in a Right-Handed Person

A focus belonging to this Focus Indicator Point is also known as Type 3 focus, or focus of the Prostaglandin E1 Type (PGE1 Type). Foci of this type are moderately severe disturbances and are often found in rheumatic patients. Point PGE1 is located on the back of the ear, on the lobule near the inferior attachment site of the ear. It is found as Gold Point on the right ear (Fig. 61).

Fig. 61 PGE1 Point.

Fig. 62 Point GB 41, a body acupuncture point corresponding to the PGE1 Point.

Fig. 63 Point TB 3–1, another body acupuncture point corresponding to the PGE1 Point.

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Point GB 41/ Point TB 3–1

The corresponding body acupuncture point is Point GB 41 on the dorsum of the foot, found as Gold Point on the right side (Fig. 62). Here, too, Bahr discovered in recent years another corresponding point on the back of the hand that is easier to reach when working with the reclining patient: Point TB 3–1. It is located between the 3rd and 4th metacarpal bones at the level of Point TB 3, distal to the middle of the metacarpal bones. In a right-handed person, it is found as Gold Point on the right hand (Fig. 63).

Focus Indicator Point Type 4: Vitamin C Point On the Right Ear in a Right-Handed Person

A focus belonging to this Focus Indicator Point is also known as Type 4 focus, or focus of the Vitamin C Type. It represents a relatively weak disturbance. The Vitamin C Point is located 2–3 cm above the apex of the ear. In a right-handed person, it is found as Gold Point on the right side (Fig. 64).

Point TB 1–1

It is sometimes difficult to monitor the VAS reflex because the point lies in the hair region. For this reason, one should countercheck by examining the corresponding body acupuncture point, Point TB 1–1. It is located at the level of Point TB 1 about 2–3 mm away from the radial angle of the nail fold of the ring finger and is found as Gold Point on the right hand in a right-handed person (Fig. 65).

Focus Indicator Point of Type 5: Laterality Point (Synonym: Ginseng Point) A focus belonging to this Focus Indicator Point is also known as Type 5 focus, or focus of the Ginseng Type. It represents a very

Fig. 64 Vitamin C Point.

Fig. 65 TB 1–1, a body acupuncture point corresponding to the Vitamin C Point.

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weak disturbance. Even such a focus should be treated because every weak disturbance may develop into a severe one under unfavorable conditions.

In Front of the Right Tragus in a RightHanded Person

The Laterality Point is located about 3 cm in front of the middle of the tragus in the cheek region and is found as Gold Point on the right side in a right-handed person (Fig. 66). It is one of those points that have multiple functions in ear acupuncture. It might indicate unstable laterality (oscillation), and this can be determined by means of simple aids (see p. 135ff.). In the context of diagnosing foci, however, it is of interest only as Focus Indicator Point.

Point LI 1–1

If a beard interferes with monitoring the VAS, the corresponding body acupuncture point, Point LI 1–1, may be used as countercheck. It is located at the level of Point LI 1 about 2–3 mm away from the ulnar angle of the nail fold of the index finger. In a righthanded person, it is found as Gold Point on the right hand (Fig. 67).

Jewelry and Wristwatches

In addition to scars and mild inflammations, a metal necklace may develop into a Type 5 focus in an already weakened patient, as they may shortcut superficial Yin and Yang meridians. It does not matter which metal the necklace is made of. The same applies to metal bracelets and watchstraps. (Metal necklaces and bracelets do not cause disturbances in a healthy person.) Even the oscillation of the quartz crystal in wristwatches may develop into a Type 5 disturbance. (The frequency of most quartz crystals is very similar to that of focus frequency A’; see discussion on the use of laser in ear acupuncture, p. 180)

Fig. 66 Laterality Point.

Fig. 67 LI 1–1, a body acupuncture point corresponding to the Laterality Point.

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124 Practical Application As most patients will understand, it is always the total of all disturbances that will tip the balance. Therefore, these minor disturbances should be eliminated as well. With very little effort they can be influenced by the patient himself/herself.

Locating the Focus Indicator Points Searching with the Positive Pole of the 3-Volt Hammer

The positive pole of the 3-volt hammer is used to examine the points described above for electrical activity in order to find any active Focus Indicator Points. For this purpose, the practitioner sits behind the head of the reclining patient because both ears are best accessed in this position. With the left hand, the practitioner palpates the (left) radial pulse of the patient, while screening the ear surface with the right hand for Focus Indicator Points using the 3volt hammer (Fig. 68). Examination with the hammer is best done without touching the ear. The Focus Indicator Points are found as Gold Points at the locations described—but only if they are active, in which case they indicate one or more focal disturbances. Especially when working with the VAS, the attempt to save time by performing a quick, and therefore usually inaccurate, diagnosis will take its toll (e. g., when the patient is sitting). The therapy will not be successful, and this not only wastes the practitioner’s time (and the patient’s money) but also damages the method’s reputation in the long run.

Diagnostic Procedure in a Relaxed Setting

It is therefore important to take enough time to examine the reclining patient in peace and without external disturbance. It goes without saying that grounding, sufficient light (no fluorescent light, no radiators), a pillow below the knees (to prevent discomfort in the lower back or knees), and a blanket (to keep the patient warm) are essential. Finding an active Focus Indicator Point definitely confirms the presence of a focus, the severity of which is indicated by the point.

Fig. 68 Examination of the Focus Indicator Points with the 3-volt hammer.

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This focus must then be located and treated. As mentioned earlier, an active Focus Indicator Point corresponds to a single focal disturbance. If more foci are present, more Focus Indicator Points will be found to be active. If a patient has four active Focus Indicator Points, one can expect to find four focal disturbances. In some cases, there may be more foci present in a given patient than the maximal number (five) of Focus Indicator Points. Here, several weak disturbances are collectively indicated as a Type 5 focus, that is, the Laterality Point may indicate more than one disturbance, especially when severe foci are also present.

Example: An Active Endoxan Point

The Endoxan Point has been found to be active. Conclusion: There must be a focal disturbance of the Endoxan Type (Type 2 focus). This means that there is a focus of moderate severity, as indicated by the Endoxan Point, and this focus must now be located.

Assigning the Foci Belonging to the Focus Indicator Points As mentioned earlier, the principal focus can be identified and subsequently treated by examining the five Focus Indicator Points on the ear (Bahr/Nogier) while monitoring the VAS. One can also determine if, for example, a scar actually has focal activity, and if so, how severe the disturbance is.

Cable Method After determining which Focus Indicator Points are active, the socalled cable method is used to check if one or more suspected foci correspond to this point. For this purpose, one needs a simple electric cable with about 1 cm of the insulation being removed at both ends. One bare end of the cable is placed on the active Focus Indicator Point, where it is kept in place by an assistant (or by the free hand of the patient). While monitoring the VAS and without touching the ear, the practitioner searches with the other bare end for a corresponding Focus Point on the ear surface. When the free cable end passes over the ear point representing the focus, this is indicated by a distinct resonance VAS (Fig. 69). The best (and, above all, time-saving) procedure is to guide the free bare end of the cable tangentially over suspected areas or over the entire ear while monitoring the pulse. This search is carried out with large, brushing strokes. Passing over the corresponding Focus Point triggers a distinct resonance VAS. Using the tip of the cable, the exact point is then located within the area found in this way (Fig. 70).

Local Resonance

The fact that a strong VAS can be triggered when the cable connects the active Focus Indicator Point with the focus (or Focus Point) belonging to it was initially a purely empirical observation made by Bahr. However, it led to the conclusion that the Focus Indicator Point and the focus belonging to it must have the same electromag-

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126 Practical Application

Fig. 69 The cable method: Searching for the Focus Point by establishing a connection with the Focus Indicator Point.

Fig. 70 The cable method: Accurate locating of the reflex point within the area identified.

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netic pattern of oscillation. This idea is corroborated by the phenomenon of local resonance, namely, by the fact that both Focal Indicator Point and the focus belonging to it, respond to the same substance with a resonance VAS (see p. 130f.).

Focus Point and VAS

Searching with the cable is quick and practical: only the connection of the Focus Indicator Point with the one Focus Point belonging to it will repeatedly trigger a distinct VAS. In this way, hidden foci are sometimes detected that have not been identified in the patient’s history. The procedure described is then repeated for all other active Focus Indicator Points.

Symptom Point and VAS

Because each Focus Indicator Point will point to a single focus, there will be only one ear point that triggers a very strong VAS. However, because symptoms are normally maintained by focal disturbances, it can happen that the Symptom Point belonging to the focus also responds with a resonance VAS. This fact does not pose a problem when searching for focal disturbances because the resonance VAS is much weaker here. Moreover, the patient’s symptoms are known because they were the motive for coming to the practice. It requires little effort to learn how to associate the source of the complaints (elbow, shoulder, knee, stomach, etc.) with a reflex zone on the ear. In the run-up to the search for focal disturbances, the practitioner may therefore “check off ” as a potential Symptom Point any point that triggers a VAS. It rarely happens that Symptom Point and Focus Point are found at about the same location on the ear, such as in the case of epicondylitis with a scar existing at the same site.

Checking the Therapy

The above scenario does not pose a problem when searching for a focus. One can easily test whether or not the Focus Point on the ear has been properly needled: the Focus Indicator Point corresponding to the focus will disappear for a short while. Thus, if the Focus Point belonging to the Focus Indicator Point has been needled, the Focus Indicator Point itself is no longer active for a short period of time, and this can be tested with the 3-volt hammer. If it can still be found with the positive pole of the 3-volt hammer immediately following needling, then one has not needled the proper point and must search again. In the present example (epicondylitis with concurrent scar at this site) it could be that the respective Symptom Point was needled instead.

Double-check with the Point-Finder

When still inexperienced in palpating the VAS, the Focus Point on the ear can be checked with the point-finder. However, this device works in a wider area. To locate the point more precisely one should practice VAS palpation. Furthermore, not all Focus Indicator Points can be located with the point-finder (namely, those within the hair region).

Example: Assigning a Focus Using the Cable Method

The patient’s history: Appendectomy, tonsillectomy. The Endoxan Point is found as the only active Focus Indicator Point. This means that only a single focus is present, but it must be a relatively severe one. The Endoxan Point is then marked with a green felt pen. The tip of one cable end is now placed on this Focus Indi-

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128 Practical Application cator Point (on the mark), and the patient or assistant is asked to hold it there. While palpating the pulse, the practitioner moves the other (free) end of the cable over the Appendix Point and the Tonsil Point on the ear. If a resonance VAS is triggered over one of these points, the exact point is located with the tip of the cable. At the point of maximal VAS, the cable end can be slightly pressed onto the tissue to create a small impression. This impression is then marked for future needle treatment using a pen with water-soluble ink (to prevent impregnation). However, if no resonance VAS is found at the locations indicated by the patient’s history, other reflex zones are routinely checked, such as those of the temporal sinuses, maxillary sinuses, navel, gallbladder, oral and dental regions, in males also the Prostate Point, and in females the points of the gynecological region. Even though the latter regions may not be specifically recorded in the patient's history, they sometimes disturb without the patient being aware of them. It is essential for this method of examination that the Focus Indicator Point remains properly connected and that this connection is checked once in a while. Screening with the positive pole of the 3-volt hammer will also trigger a resonance VAS, but a less intense one because there is no connection with the Focus Indicator Point. If the beginner does not want to diagnose and treat by means of the ear reflex zones, the cable can be used to connect the Focus Indicator Point on the ear (in our example, the Endoxan Point) directly with the potential foci on the patient’s body. Once the proper site on the body (e. g., a scar) has been found by checking for resonance VAS, the free cable end is passed over this region in order to detect the exact spot, which is usually very small. Here, too, it is important to make sure that the connection of the other cable end with the Focus Indicator Point is still intact. The spot located in this way is then marked (circled) for future needle treatment using a pen with water-soluble ink. If the focus does not lie on the body surface (e. g., an internal scar) or is difficult to access (e. g., a scar from perineotomy), both diagnosis and therapy of the focus have to rely on the ear reflex zones. Even in the case of superficial foci, this method is more elegant and, above all, much faster than searching for points on the body. The area to be screened is extremely small, and the entire body with all its disturbances is accessible for examination on the ear surface, almost like a “control panel”. Once the Focus Point corresponding to the Focus Indicator Point (in our example, the Endoxan Point) has been located, one knows the patient’s most severe and therefore most important focus. All other focal disturbances are secondary. The focus detected in our example is also called a focus of the Endoxan Type. This simply means that the Endoxan Point indicates that the patient has a relatively severe focus. Experienced acupuncturists refer to such a focus (e. g., a scar) as an Endoxan focus.

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The Focus Indicator Point originally found for this focus will later serve as a therapeutic control once the treatment is complete and also during the next session.

Other Applications of the Cable If a Focus Point has been found in the reflex zone of the teeth and jaws, one should try to find the corresponding structure in the mouth prior to needling the point found on the ear. Again, this is done with the cable. An assistant holds one end of the cable at the point located on the ear, and the practitioner searches with the other end in the mouth for the affected structure while monitoring the VAS (Fig. 71).

Fig. 71 Identifying a dental focus belonging to the Focus Point found on the ear.

Fig. 72 Clip-on cable attached to an already inserted ear acupuncture needle.

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130 Practical Application

Clip-on Cable

To avoid employing an assisting third hand one may also use a clipon cable (available in specialty stores). One end is carefully attached to the needle already inserted in the ear, while the other end is attached to a sterile acupuncture needle (Fig. 72). The blunt needle end can then be used to search for the affected structures in the mouth without contaminating the cable. This method allows for clean working in the oral region, and the cable can be reused right away. The clip-on cable may also be used to determine the point on the body that corresponds to an ear point which has already been needled. For this purpose, one end of the cable is clipped to the needle in the ear, while the other end is used to search for the corresponding site or point on the body. There is no need for an assistant, and the point can be found even after the needle has been inserted. However, the information becomes weaker the longer the needle has been in the ear.

The Phenomenon of Local Resonance Every acupuncture point has an electric field, and every electric field has an electromagnetic field. Even dead matter has electromagnetic radiation. Certain acupuncture points exhibit local resonance to specific substances. Their electromagnetic fields resonate with these substances.

Omega Point I and Amalgam

Fig. 73 Omega Point 1, a Focus Indicator Point for amalgam load, according to Bahr.

Omega Point I, the Focus Indicator Point for amalgam load according to Bahr (Fig. 73), was the first point mentioned in this book that exhibits local resonance with a substance (see p. 83). If a patient really has an amalgam load, Omega Point I is found to be electrically changed (into a Gold Point), to be sensitive to pressure as compared to its surroundings, and to respond to an approaching piece of

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Fig. 74 Mercury Indicator Point on the forehead, according to Bahr.

amalgam with a resonance VAS (local resonance). The same changes can also be found at the two corresponding control points for mercury load, namely, at the Mercury Indicator Point on the forehead (Fig. 74) and at Point CV 12, the Mercury Indicator Point on the body (Fig. 75). These corresponding body points offer a valuable opportunity for checking one’s own diagnosis. The same principle of local resonance may also be used for locating the Focus Indicator Points with the corresponding substances (in ampoule form) with which Bahr initially discovered them:

Type 1/Histamine Point: histamine, Type 2/Endoxan Point: cyclophosphamide (Endoxan, a cytotoxic alkylating agent),

Type 3/PGE1 Point: misoprostol (a synthetic prostaglandin E1 analog),

Type 4/Vitamin C Point: ascorbic acid, and Type 5/Laterality Point: ginseng. These substances can be purchased individually and then filled into ampoules. There are now also affordable sources of indicator ampoules (see p. 237).

Test Ampoules Trigger a Powerful VAS

Instead of using the 3-volt hammer, the Focus Indicator Points can be screened for a resonance VAS by using the respective substances. While monitoring the pulse, the practitioner approaches the point with the ampoule, or slowly moves the ampoule across the point without touching it. If the point is active, there is a distinct, very powerful resonance VAS (Fig. 76). If the point is silent (inactive), there is no VAS response when moving the substance across the point. Because of the specific information, the resonance VAS obtained at the Focus Indicator Point in response to the corresponding ampoule is much more distinct than when checking with the 3-volt hammer.

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132 Practical Application

Fig. 75 Location of Point CV 12 on the Conception Vessel.

The Focus Responds to the Test Ampoule

As already mentioned in connection with the cable method, the Focus Indicator Point and the focus itself seem to possess the same pattern of oscillation. For this reason the substance belonging to the Focus Indicator Point not only resonates with the Focus Indicator Point but also with the corresponding focus. Because of this fact,

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Fig. 76 Checking the Focus Indicator Points with an ampoule, taking advantage of local resonance. In this case, the Histamine Point.

the use of test ampoules has simplified the search for the focus in an ingenious way. For example, when searching for a focus of the Histamine Type, only the focus and its Focus Point on the ear respond to the histamine ampoule with a resonance VAS. This resonance VAS is specific for the oscillations of the Histamine Point and the focus indicated by it. Instead of using the cable method, which often requires an assisting hand, one can now move the ampoule belonging to a specific Focus Indicator Point over the ear surface and search for the area where a resonance VAS can be triggered. This is the reflex zone of the focus (Focus Point). Because the head of the ampoule is relatively wide, the local resonance is first used to determine the ear zone where the focus is represented. The exact point is then located with the positive pole of the 3-volt hammer while monitoring the VAS; it is then marked with a pen containing water-soluble ink.

Specificity for the Focus

One important advantage of the ampoule method is its surprising specificity for the corresponding focus. At no other point on the ear, not even if it has profoundly changed electrically (e. g., another Focus Point), will it be possible to trigger a VAS with the respective ampoule, as long as there is no resonance with this point. The resonance VAS at the corresponding Focus Point that can be triggered by the ampoule method is therefore even more obvious than the one obtained by connecting the Focus Indicator Point and the proper Focus Point with a cable.

Example: Assigning a Focus Using the Ampoule Method

The patient’s history: Appendectomy, tonsillectomy. First, each Focus Indicator Point is tested with the respective substance (indicator ampoule, see above). When the histamine ampoule approaches the Histamine Point, a powerful resonance VSA is triggered. This means that there is, at least, one focus and that this focus is a very severe one.

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134 Practical Application Instead of using the cable as described above, the histamine ampoule is now used to search for the corresponding Focus Point on the ear (e. g., in the reflex zones of tonsils and appendix) while monitoring the VAS (Fig. 76). If a powerful resonance VAS is obtained at one of these sites, the focus belonging to the Histamine Point has been found. The exact point is now located with the 3-volt hammer and marked for future needle treatment. If no resonance VAS is found in any of the ear zones that represent foci recorded in the patient’s history, it is best to check routinely the reflex zones of the temporal sinuses, maxillary sinuses, navel, gallbladder, and dental region; one should also check the Prostate Point in males and the points of the gynecological region in females, even if the latter foci are not recorded in the patient’s history. Once the reflex zone of a focus has been found, the exact point is located with the positive pole of the 3-volt hammer and then marked. (Needling is carried out later under VAS control.) If, however, no resonance VAS can be triggered with the ampoule (in the present case: histamine ampoule) neither at the site indicated by the patient’s history nor at any other site on the ear, there are essentially two potential reasons: Either the Histamine Point has been wrongly found to be positive (in this case, there will be no corresponding focus) or the focus searched for is located at a very different site and has been overlooked when searching by means of ear reflex zones (e. g., hidden ear localizations such as the reflex zones of the gynecological region, kidneys, urinary bladder, colon, or internal hemorrhoids). In such an instance, the Histamine Point is checked once again, perhaps also the Histamine Point on the hand (Point LI 3–1, see p. 118). If it is really active, the entire ear surface is now carefully screened. In many cases, a scar or a tooth with root canal treatment will be found which has not been recorded in the patient’s history.

Advantage of Using By applying the indicator substances, the search for Focus Indicator Indicator Substances Points as well as for the focus indicated by a Focus Indicator Points is made

easier (simpler to handle), much faster, more specific and, hence, more targeted.

Indicator Ampoules and Body Points

If, initially, one prefers not to diagnose and treat by means of ear reflex zones, one may also search directly for the foci on the body. This is done by monitoring the VAS and applying the indicator ampoule containing the substance belonging to the Focus Indicator Point that has been found to be active. The principle is the same as when searching for the Focus Point on the ear. Once the proper site on the body has been found with the ampoule, the exact point (e. g., a spot in a scar) is located with the positive pole of the 3-volt hammer and then marked (circled) for future needle treatment. However, if the focus does not lie on the body surface or is difficult to access, one has to rely on the diagnosis and therapy by means of

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ear reflex zones. This is another clear example of why learning the most important ear reflex zones is always worthwhile. The time invested in learning the ear points will be well compensated for in the long run by considerable time-saving during the diagnostic procedure. Furthermore, the efforts invested in the study of ear acupuncture will be rewarded by a higher rate of therapeutic success. Elimination of a focus may take place either by means of the corresponding point on the ear, or by body acupuncture or, in the case of scars, by direct needling of the affected spot in the scar (see p. 147).

Grounding Disturbance through Electromagnetic Fields

When searching for Focus Indicator Points, and also later when assigning the foci, the patient should always be grounded. The pulse diagnosis, which relies on detecting extremely delicate information, must not be disturbed by a multitude of electromagnetic fields of varying intensities and frequencies. These fields are present everywhere, also in the examination room, and the human body picks them up like a living antenna. Such disturbing potentials on the ear may hamper examination with a 3-volt hammer. (Furthermore, there are electrostatic charges on floor coverings and clothes caused by charge separation.) As mentioned earlier, functional grounding must be provided to dissipate these charges: a grounding clamp at the site of examination (namely, on the ear) to keep resistance to the dissipation of interfering currents as low as possible, and a grounding plug with an extremely sensitive fuse. Without grounding the electrical examination may become inefficient due to faulty measurements (for practical tips on grounding, see p. 55f.).

Preliminary Examination Prior to examining the patient for foci, one should make sure that there are no disturbances that could falsify the diagnosis or even make it completely impossible. First of all, it is important in this connection that laterality (handedness) is determined and oscillation is excluded.

Determining Laterality As already mentioned when discussing the Focus Indicator Points (see p. 115f.), the location of these points is strictly related to the handedness of the patient (this is also true for some other points of ear acupuncture). It is therefore essential to determine prior to performing a diagnosis whether the patient is left-handed or righthanded. Independently of the patient’s handedness, the points representing a focus (Focus Points) are found on the ear of the same side on which the focus is in the body (e. g., appendectomy scar on the right side). For all median organs, however, the corresponding point on the ear is found as a Gold Point on the side of handedness—for the

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136 Practical Application right-handed person on the right side, for the left-handed person on the left side. Here, too, it is therefore important to determine handedness. The test procedure described at Knowledge Level 1 already includes some tips on how to determine the patient's handedness (see p. 69f.). Asking which hand is used for writing is usually not helpful in cases of undiagnosed or reeducated left-handers, because they have been taught to use the right hand despite their predisposition. However, if a patient indicates the left hand as the writing hand or claims to be left-handed, one can usually rely on this statement without further checking. The means of identifying a left-handed person become more convincing and reassuring by using further aids, such as the 9-volt rod or even laser (see pp. 175, 178).

Obstacle to Diagnosis and Therapy: Oscillation Unstable Reflex Behavior

Normally, the same stimulus will always yield the same reflex response every time it is applied to the body—for example, the number of heart beats in response to the same pressure to the skin will always be the same. If a patient oscillates, the body will respond in a different way every time the same stimulus is applied, that is, an ear point can sometimes be found and sometimes not— the body’s reflex behavior is unstable. The cause is thought to be a disturbance in the transmission of impulses in the reticular formation. It may be triggered by the following factors:

Exogenous Factors

Static charges due to synthetic clothing and carpets, charges due to radio waves and TV waves (type A5 waves), as well as nearby power transmission lines, because the human body receives electromagnetic waves like an antenna (Fig. 77).

Endogenous Factors

Any strong focus may cause the patient to oscillate. Severe systemic diseases, such as rheumatoid arthritis, Crohn’s disease, or cancer may cause oscillation, because the general energetic condition of the organism is severely affected. Sometimes even the rush of daily life or performance anxiety are sufficient to make a patient oscillate.

Fig. 77 a Charge of the skin, demonstrated by means of an oscilloscope. The graph shows several overlapping sinusoid waves. b After successful grounding, only minor ripples are noticed near the baseline.

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Absolute Obstacle to If the body’s reflex behavior is unstable, as is the case with oscillation, the practitioner cannot rely on the examination results, in Diagnosis and other words oscillation becomes an absolute obstacle to diagnosis. Therapy

(Since oscillation also threatens the therapeutic result, it is also referred to as an obstacle to both diagnosis and therapy.)

If oscillation is present, it must be eliminated immediately. Otherwise the effectiveness of the diagnosis and, hence, also that of the therapy is at risk.

Examination for Oscillation Point Yin Tang

Examination for oscillation is carried out by using Point Yin Tang (synonym: Extra Point HN 3), which is the control point of the reticular formation (Fig. 78). In a healthy person, a VAS cannot be triggered over Point Yin Tang by approaching it with the positive pole of the 3-volt hammer (and a VAS response to the negative pole indicates a particularly stable or energetic condition of the patient). However, if Point Yin Tang can be found with the positive pole of the 3-volt hammer, that is, if a resonance VAS is triggered when the positive pole approaches, this indicates that there is oscillation (Fig. 79).

Master Point of Oscillation According to Bahr

The same is true for the highly important Master Point of Oscillation, near the ear (Fig. 80). It corresponds to Point KI 3 of body acupuncture and is the most sensitive indicator for oscillation. Point Yin Tang has a double function, though. Because it is also the Master Point of the nose, it may be found as a Gold Point by approaching it with the positive pole of the 3-volt hammer—if the patient has a common cold, thus simulating oscillation. In this case,

Fig. 78 Point Yin Tang.

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138 Practical Application

Fig. 79 Examination of Point Yin Tang for oscillation.

however, the Master Point of Oscillation is not found to be active. Any affection of the paranasal or maxillary sinuses should be treated immediately (gold needle in the Nose Point on the ear, Fig. 81) so that Point Yin Tang becomes available again as neutral test point for the subsequent, important checking for inversion and handedness.

Grounding

Examination for oscillation should be first performed without grounding. If oscillation is detected, the patient should be grounded and checked again for oscillation. When oscillation is no longer detected, the initial oscillation was caused by exogenous factors

Fig. 80 Master Point of Oscillation according to Bahr

Fig. 81 Nose Point.

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(see p. 136) and has been eliminated by grounding. If the patient still oscillates, oscillation may be assumed to be endogenous and its cause should be sought out. It is essential to ensure from time to time that the grounding is still intact. Defective grounding cannot dissipate exogenous oscillation and may give rise to the false conclusion that there is endogenous oscillation when examining under grounding conditions. The subsequent search for the supposed cause of oscillation would only waste a lot of time. (For tips on how to check the grounding, see p. 56) In case there is oscillation despite intact grounding, it must be eliminated so that subsequent diagnostic procedures are not jeopardized.

Elimination of Oscillation

There are basically two possibilities for eliminating oscillation: It is either suppressed for a short time, or the cause of oscillation is found and eliminated. The first option is easier to do. The second option is more difficult but is also more elegant.

Suppression of Oscillation Needling Point Yin Tang or the Master Point of Oscillation

Using the thumb and index finger of the left hand, a longitudinal skin fold is formed over Point Yin Tang (the long axis of the oval point lies longitudinally, measuring up to 1 cm). A steel needle is inserted while monitoring the VAS, and it is moved about 5 mm in caudal direction toward the nose, tangentially to the skin (Fig. 82). Alternatively, a gold needle may be inserted into the right Master Point of Oscillation or a silver needle into the left Master Point of Oscillation (in a right-handed person). If the handedness is not clear, a steel needle is used on each side.

Control

When the positive pole of the 3-volt hammer can no longer trigger a VAS response over Point Yin Tang (or the Master Point of Oscilla-

Fig. 82 Inserting an acupuncture needle into Point Yin Tang.

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140 Practical Application tion) after inserting a steel needle, oscillation has been eliminated and the examination may continue.

Method of Detecting the Cause of Oscillation Oscillation is usually caused by a particularly severe focus. Inserting a gold needle in the corresponding Focus Point (if one is able to find it) eliminates oscillation immediately. This can be tested by examining Point Yin Tang (or the Master Point of Oscillation) once again with the positive pole of the 3-volt hammer—now, a resonance VAS can no longer be triggered there. The problem, however, is locating this Focus Point on the ear. Although moving the positive pole of the 3-volt hammer over the ear will trigger a profound resonance VAS over the respective reflex zone, locating the exact point is not always reliable because of the existing oscillation.

Resonance to Articaine

The search for a focus that triggers oscillation is quicker and more clear-cut when one takes advantage of local resonance. The substance resonating with Point Yin Tang, or with the oscillation, is articaine (e. g., 5 % hyperbaric). This means that Point Yin Tang can be checked for activity by using a simple articaine ampoule instead of the 3-volt hammer (other local anesthetics, such as procaine, lindocaine, benzocaine, may be used in a similar way).

Gold Needle in the Reflex Zone of the Focus

If a distinct resonance VAS is triggered when approaching Point Yin Tang with an articaine ampoule, it clearly indicates that there is oscillation. The responsible focus also exhibits resonance with this substance. This means that, once the presence of oscillation has been confirmed, the reflex point of the responsible focus can be located by moving the ampoule over the ear surface. The VAS response is much more profound than when searching with the 3-volt hammer. Once the reflex zone of the focus has been located, a thick gold needle is inserted there as precisely as possible while monitoring the VAS. It is easy to find out whether or not one has actually hit the point of the responsible focus—just checking Point Yin Tang (or the Master Point of Oscillation) once more with the articaine ampoule or with the positive pole of the 3-volt hammer will provide the answer. No resonance VAS during examination means that oscillation has been eliminated by treating the responsible focus. However, if a resonance VAS is triggered when examining Point Yin Tang (or the Master Point of Oscillation) once again with the positive pole of the 3volt hammer, one most likely has needled the point of another focus. Or, perhaps, there was no true oscillation in the first place but rather a common cold (see p. 137f.). The search must be performed once again and, as mentioned earlier, the reflex zones of nose and maxillary sinuses should be checked as well.

Example: Eliminating Oscillation

Preliminary examination under grounding conditions suggests that there is oscillation. Provided the grounding was intact, this indicates endogenous oscillation. Both ear surfaces are now screened with the 3-volt hammer or with the articaine ampoule. If a profound resonance VAS is obtained over a specific reflex zone, one may assume that the focus responsible for it has been found. If a fo-

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cus at the corresponding site of the body was not prominent in the patient’s history, its location in the body must be deduced from its resonance zone on the ear (e. g., reflex zone of gynecological region or prostate). Or one could search for a specific site on a limb as indicated by the point found on the ear, because there could be a scar. A gold needle is inserted into the exact ear point, and Point Yin Tang (or the Master Point of Oscillation) is reexamined. If the positive pole of the 3-volt hammer no longer triggers a resonance VAS, oscillation has been successfully eliminated. This approach is also used as the initial therapy of choice if a common cold or an affection of the paranasal sinuses was responsible for the VAS response over Point Yin Tang (for differentiation, see p. 137f.), because Point Yin Tang is also the Master Point of the nose and diseases of the paranasal sinuses. A gold needle is inserted into the Nose Point or Maxillary Sinus Zone on the ear of the affected side (check by monitoring the VAS).

Articaine Ampoule Saves Time

We are often asked why it is not possible to search with a histamine or cyclophosphamide ampoule right away—after all, true oscillations are usually caused by severe foci, namely, those of the Histamine or Endoxan Type. This is certainly a valid point. However, because foci of the Histamine or Endoxan Type are most likely present, searching with the articaine ampoule will usually save time. The disadvantage is that the focus cannot be assigned before it is eliminated (but assignment is essential for assessing the strength of the focus). Caution: the Master Point of Oscillation sometimes indicates an extremely severe field of disturbance, that is, one that is even more intense than a focus of the Histamine Type. Any information that is more intense than a Histamine focus seems to be concentrated in this point. This means that one should not neglect the fact that an active Master Point of Oscillation must be silenced, otherwise one runs the risk of overlooking the primary focus, which is the most important one for therapy. In the event that the Master Point of Oscillation really indicated an extremely severe focus and has been silenced, the corresponding focus will reveal itself in the next session as a focus of the Histamine Type, and it will appear during subsequent treatments as focus of the Endoxan Type, PGE1 Type, etc., respectively.

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Summary of Diagnostic Steps at Knowledge Level 2 Of course, the specific diagnostic procedure described here should be preceded by a review of the patient's history, an extensive physical examination (at both general and specialist levels), specific lab tests, and, if necessary, examination by various imaging procedures. Only then can the search for a focus begin:

Take a detailed patient history of potential foci. Prepare the patient for examination (reclining position, a blanket, and a pillow under the knees).

Apply grounding. Determine the patient's handedness. Check for oscillation. If necessary, eliminate oscillation (either by needling the Master Point of Oscillation—Gold Point on the right ear, Silver Point on the left ear—or by locating and needling the point of the responsible focus) Determine the active Focus Indicator Points (3-volt hammer or indicator ampoules). Assign the corresponding foci (cable method or indicator ampoules). Treat the focus (see p. 144f.).

Advantages of Methods at Level 2 over Those at Level 1 When using the methods described at Level 1, searching for the exact focus may still pose some problems:

The practitioner mainly relies on the patient's history, i. e., any foci that the patient cannot remember will be overlooked.

The all-important primary focus may not be clearly identified. Searching with the point-finder is inaccurate at some ear points, because the ear surface makes it impossible to apply the measuring probe to a flat surface.

The corresponding point on the body cannot be clearly identified. Teeth acting as focal disturbances cannot be clearly identified. Needle insertion may not be accurate, because the imprint of the measuring probe allows for several insertions. The methods at Level 2 offer major advantages for diagnosis and therapy:

The Focus Indicator Points according to Bahr are used to determine whether or not there

are any focal disturbances. The number of foci can be determined. The primary focus can be clearly identified. The foci in or on the body can be located. Dental foci (Tooth Points on the ear) can be accurately assigned. It is possible to test if a scar or dead tooth represents a focal disturbance. Foci not recorded in the patient's history can be detected. It is possible to test whether a specific structure is making a person sick. The therapy can be monitored by means of the Focus Indicator Points. Laterality can be determined unambiguously. Oscillation that would hamper further diagnosis can be eliminated. The acupuncture needle can be inserted with accuracy. Subsequent improvement is possible using a second needle while monitoring the VAS .

It pays to learn the VAS. (For training opportunities, see p. 236)

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References 1. Ackerman, J. M.: The biophysics of the VAS: Its relationship to healing. Parts I and II. COHERENS – Intl. J. Integrated Medicine, Feb 1998 and Jan 1999 2. Ackerman, J. M.: Cases from clinical practice. COHERENS – Intl. J. Integrated Medicine 2 3. Ackerman, J. M., Lewis W. M. Integration of VAS technique with traditional western medicine techniques. Part III. COHERENS – Intl. J Integrated Medicine 1 (2000) 24–33 4. Agnes, M.: Toward an integral energy medicine model for understanding the vascular autonomic signal. Doctoral thesis, Holos University, Graduate Seminary, 2002 5. Bahr, F.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für mäßig Fortgeschrittene. Self-published, Munich 1989 6. Bahr, F.: Projektion der chinesischen Meridiane auf das Ohr. Lecture at the International Congress on Auriculotherapy and Auricular Medicine in Lyon, 27–29 May 1994 7. Dorn, F., Bader, F.: Physik, Oberstufe, Schroedel, Hanover 1983 8. Franke-Gricksch, N.: Die Untersuchung von Akupunkturpunkten mit verschiedenen Detektoren – das Elektrohämmerchen. In: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für mäßig Fortgeschrittene, editor F. Bahr. Self-published, Munich 1989 9. Ganong, W. F.: Lehrbuch der Physiologie. 4th ed., Springer, Berlin 1979 10. Ikezono, E., Ikezono, T., Ackermann, J.: Establishing the existence of the active Stomach Point in the auricle utilizing artery tonometry. Am J. Chinese Medicine 31 (2003) 285–294 11. Moser, M., Dorfer, L., Muhry, F., Messerschmidt, D., Frühwirth, M., Bahr, F.: Untersuchungen zur Physiologie des Nogierreflexes. Z. Akupunktur und Aurikulomedizin 2 (1998) 1–10 12. Nogier, P.: V.A.S., Stimulations lumineuses cutanées sur le lapin. Leur influence sur le taux d’amines vasopressives plasmatiques. Auriculomédecine 25 (1981) 31. 13. Nogier, P.: From auriculotherapy to auriculomedicine. Maisonneuve, Sainte Ruffine 1983 14. Nogier, P. Introduction practique á l’auriculo médecine–La photoperception cutanée. Editions Haug International, Brussels, 1993, 20–25; 27–37 15. Timoshevsky, S.: Metrological standardisation of pulse diagnostics methods by means of a new laser-electronic pulse sensor, VAS research and classification of observable pulse reactions. Proceedings of the International Symposium of Auriculotherapy and Auriculomedicine; Lyon, 2000 16. Vulliez, C.: Registrierung von RAC-Veränderungen (Doppelblindversuch). Lecture at the International Congress on Auriculotherapy and Auricular Medicine in Lyon, 27–29 May 1994

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Focus Therapy under Vascular Autonomic Signal Control Therapeutic Principle At Knowledge Level 1, the ear surface was screened with the pointfinder for active Focus Points once a detailed patient’s history had been established. These points were marked and then needled. As an alternative, the body region was deduced from the active reflex zone found on the ear and then infiltrated under the assumption that it was the focus.

Precision Therapy under VAS Control

By contrast, treatment of a focus at Knowledge Level 2 is performed while monitoring the vascular autonomic signal. Because the reflex points are often only a fraction of a millimeter in diameter, proper treatment of a focus greatly depends on the precision with which the needle is inserted, among other things. Such precision is now possible under VAS control and allows one to work with greater accuracy than at Level 1. The ear acupuncture points can be needled in their very center, and focal sites in long scars can be needled or infiltrated at the exact point. Even laser therapy, which will be discussed in a later chapter, becomes more effective under VAS control because it is more accurate (see p. 178ff.).

Combined Treatment of a Focus

Using the VAS method, a focal disturbance can be treated in different ways and thus uncoupled from the focal process:

needling of the ear reflex zone that corresponds to the focus, infiltration of the focus with a local anesthetic, dry needling of the affected focal site on the body. The ideal approach is the precise needling of an ear point combined with infiltration or needling of a focal site on the body.

Needling of the Ear Reflex Zone That Corresponds to the Focus Following disinfection of the ear surface, the tip of a gold needle is moved toward the marked point on the ear while monitoring the pulse. As repeatedly mentioned before, the therapist should sit in a relaxed position and support the hand that holds the needle (Fig. 83). This ensures that the needle is inserted into the exact point—which, after all, determines the outcome of the therapy. At a maximum of the VAS, the needle is inserted while turning it slightly.

Insert the Needle 1–2 mm Deep

If still inexperienced in palpating the VAS, the therapist may very gently touch various parts of the skin within a small area with the tip of the needle prior to insertion in order to find the location of maximal sensitivity. The patient usually indicates this point clearly

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Fig. 83 Supporting the hand that guides the needle.

and unmistakably. The patient is asked to cough or exhale during needle insertion so that the brief pain is felt less intensely. At cartilaginous sites the needle is inserted 1–2 mm deep, so that its tip touches the cartilage. It may be inserted slightly deeper in cartilage-free parts of the ear. The cartilage must never be penetrated. Once the needle has been inserted, one should check whether it is placed accurately, that is, in the very center of the electrically altered point. For this purpose, the positive pole of the 3-volt hammer is moved around the site of needle insertion (without touching it) while monitoring the VAS (Fig. 84). If a VAS can still be triggered somewhere, this means that either the needle did not exactly hit the center of the point, or the point or zone occupies a larger area than can be covered by insertion of a single needle. In such a case, another needle is placed directly next to the first one (Fig. 85) while still monitoring the VAS. The needles usually touch each other at the site of insertion (Fig. 86). Interestingly, when asked which of the needles was more painful, the patient often clearly indicates the last needle. Since we know that an electrically altered point is also sensitive to pain, the answer tells us which of the needle has been inserted into the very center of the point.

Removing the Needles

The therapeutic result depends greatly on the accuracy with which the needle is inserted, and this applies to the focus diagnosis as well. The instruction at Level 1 was to keep the needles in the ear for approximately 20 minutes. By monitoring the VAS, one can now determine exactly when they may be removed. For this purpose, the positive pole of the 3-volt hammer is moved near the end of the needle while monitoring the VAS. The hammer may gently touch

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Fig. 84 Checking with the 3-volt hammer whether the needle has been inserted accurately.

Fig. 85 Insertion of another needle under VAS control.

the end of the needle or come very close to it (Fig. 87). If this triggers a resonance VAS, it means that the needle is still “working,” that is, it should be kept in place. If no resonance VAS is obtained, the needle can be removed.

Inserting Permanent Needles

A permanent needle may be inserted into the ear point corresponding to the primary focus immediately after removing the gold needle. The permanent needle should remain in the ear for about one week. It is inserted as accurately as possible into the puncture site of the gold needle (see p. 96ff.). Further VAS control while inserting the permanent needle may no longer be possible, because the gold needle has already silenced the point, that is, the point has been optimally treated. The permanent needle is placed best if the puncture site of the gold needle has been hit precisely. The tip of the permanent needle has a larger diameter at its upper end than the gold needle and, thus, plugs the prepunctured hole completely if

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Fig. 86 Two needles inserted into the same point to achieve the optimal effect.

Fig. 87 Checking with the 3-volt hammer whether the needle should still be left in the ear.

positioned correctly. Secondary bleeding after insertion is therefore an indication that the permanent needle has not been inserted accurately.

Bleeding at the Insertion Site

Sometimes there may be secondary bleeding when removing an acupuncture needle from the ear. This does not matter as long as no permanent needle is to be inserted, but a bleeding puncture hole obscures the view so that the correct insertion of a permanent needle is no longer possible. Prolonged compression with a swab often takes considerable time for bleeding to stop. Bleeding can be briefly interrupted by first swabbing and then pulling the ear slightly to the side. This brings the edges of the hole closer together, and bleeding stops briefly. This is sufficient for the clean and correct application of a permanent needle. The ear is also stretched while inserting the needle. This method is particularly suited for puncture holes in the region of the lobule as well as in the lateral third of the auricle.

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Infiltration of the Focus With a Local Anesthetic The principle of infiltration and its scientific basis were already discussed in connection with the methods used at Level 1 (see p. 77).

Infiltration under VAS Control

The previously marked site of a scar is infiltrated, initially only superficially and then by going deeper at the marked site. While pushing the needle into the tissue, the pulse is monitored again to determine the optimal depth of insertion. Due to the negative charge of the local anesthetic, there are charge transfers in the middle of the altered tissue, similar to those observed in response to bringing the 3-volt hammer close to an electrically altered acupuncture point. Furthermore, the conductivity of the needle brings about equalization between the potential of the point and the potential of the skin surface. Thus, when the tip of the needle reaches the optimal depth (which is already filled with local anesthetic from the initial injection), this is usually indicated once more by a prominent resonance VAS. An additional small amount of local anesthetic is then deposited at this deep location.

Pain Management under VAS Control

Even though this book focuses primarily on the diagnosis and therapy of foci and not on the treatment of symptoms, it should be mentioned here—for the benefit of those who are interested—that the VAS may be used in a beneficial and time-saving manner for quick pain control during a regular visit. For example, trigger points (or blocked small vertebral joints, or a blocked sacroiliac joint) are searched for with the positive pole of the 3-volt hammer while monitoring the VAS of the properly grounded patient. These points are then marked. Subsequent infiltration is done as usual but at the optimal location as determined by VAS-monitored diagnosis. Here, too, the depth of insertion can be determined by monitoring the VAS—this is especially important for trigger points of the muscles. In this way, the VAS can be integrated into the daily routine of an ordinary practice, and the therapeutic results in pain management will improve substantially. Furthermore, up to 75 % of the local anesthetic may be saved, depending on how thoroughly the search has been conducted. This not only lowers medical costs but also the risk of allergic reactions. Of course, targeted infiltration also reduces the number of punctures by 50 %, which will be appreciated by most patients.

VAS-Supported Diagnosis of Tendopathies

It should be mentioned here that therapeutic local anesthesia (TLA) under VAS control may also be employed for a more targeted diagnosis. In the case of diffuse pain in the knee or shoulder, the affected structure can be precisely located by means of the 3-volt hammer and VAS monitoring and is then infiltrated on a trial basis. In many cases of presumed meniscopathy or arthropathy of the shoulder, the irritation does not originate from the joint itself. Rather, it is often an irritation of muscle insertions, such as a pes anserinus tendopathy at the knee or a supraspinatus tendopathy at the shoulder.

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If the patient indicates the cessation of pain after infiltration of an extraarticular structure, one knows the exact structure that is affected, thus saving the patient from joint injection and arthroscopy, and what further treatment is needed becomes clear.

Diagnostic TLA

When used diagnostically, TLA thus represents a unique opportunity for a reliable diagnosis of tendopathies (irritation of muscle insertions), which are rather common and ethiologically often incorrectly assigned to a joint. So far, this diagnostic tool cannot be replaced by any imaging procedure or laboratory test.

Dry Needling of the Affected Focal Site on the Body Acupuncture Instead In the same way that a specific site of a scar can be infiltrated, the affected site may also be treated by inserting a simple acupuncture of Infiltration needle (dry needling). This saves local anesthetic and not only reduces medical costs but also avoids the risk of allergies. However, it is essential for this method that one already has a good command of VAS monitoring. The tip of an acupuncture needle (thin gold needle) is moved close to the previously marked site (e. g., a scar) while monitoring the pulse. At the exact point that triggers a prominent VAS, the needle is inserted and pushed deeper into the tissue while turning it slightly. When the tip of the needle reaches the optimal depth, this is usually indicated once more by a prominent resonance VAS. The needle should remain there for about 15 minutes.

Combination of Methods Ear Acupuncture and Ideally, ear acupuncture and infiltration are combined also at Level 2 to take advantage of all therapeutic procedures: an acupuncture Infiltration needle is inserted into the ear point, and the affected site on the body (peripheral focus) is infiltrated or dry-needled. However, due to reflex connections, inserting a needle into the ear point will immediately neutralize the electrically altered site on the body. Hence, the body site can no longer be located by monitoring the VAS, and infiltration of the body site (or insertion of a dry needle) has to rely on the previous marking of the exact point. Infiltration (or dry needling) is then carried out at this marking.

Finding the Focal Site on the Body

A little trick allows for greater accuracy during infiltration of a body site, namely, the use of a clip-on cable (see p. 130). One end is carefully attached to the gold needle already inserted in the ear, and the other end is clamped to a sterile acupuncture gold needle. By moving the tip of the free needle close to the corresponding site on the body, the VAS—which is so important for the accuracy of needling— can be triggered again, although in a slightly weaker form than when using the 3-volt hammer (Fig. 88). In this way, also the second gold needle can be inserted under VAS control. The cable is

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Fig. 88 Searching with a clipon cable for the focus site on the body after needling the ear acupuncture point.

then removed, but it may also remain in place for the duration of needle treatment. Attaching the clip-on cable to the ear needle already inserted should be carried out with great care, otherwise the needle may fall out. Likewise, the cable should not be stretched when searching over the body with a needle attached to its other end, otherwise the ear needle may be pulled out inadvertently. For this method, thick acupuncture needles are unsuitable for ear points. Their conical tips are slightly wider, and they do not sit as firmly in the tissue as thinner needles do.

Sieve Method As already described with the methods used at Level 1 (see p. 81), several needles are inserted very close to each other if the reflex localization is not a point but a larger area (e. g., the Maxillary Sinuses Zone). The needles may well touch each other at the site of insertion or further up at their shafts. By monitoring the VAS, it is now possible to exactly demarcate the electrically altered zone. The insertion of a second acupuncture needle as described on page 145 is not regarded as the sieve method but rather as precision needling of a point that has not been needled accurately before.

Moxibustion Shorter Treatment Time

As already described at Level 1, one should take advantage of the therapeutic possibility of heating the already inserted acupuncture needle (gold needle, steel needle). The time required for the needle to remain in the tissue can be checked by monitoring the VAS. When doing so, one will find that moxibustion greatly reduces this time, that is, one will observe far sooner that a resonance VAS can

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no longer be triggered by touching the end of the needle with the 3-volt hammer. The method of moxibustion is described on page 81.

Monitoring the Therapy It will not be possible to eliminate foci, especially severe foci, in a single session. However, they will become less active from one treatment to the next—which will be recognized at the corresponding Focus Indicator Points. The last focus to cease activity is a Type 5 focus (it is indicated by the Laterality Point), which is then assumed to have been treated successfully. The corresponding area on the ear or body is then electrically neutral; the previously active points have been neutralized. Whether or not the proper point has been needled is recognized by immediate checking. Apart from this, the course of therapy should be monitored over a longer period of time.

Immediate Checking Immediately after needling the focus itself or its Focus Point on the ear, the corresponding Focus Indicator Point disappears temporarily, which can be checked with the 3-volt hammer (see p. 113). If it can still be found, then the ear point or the focus itself has not been treated properly. In such a case, one has to search again, using the cable or ampoule method (see pp. 125, 131). Furthermore, the Focus Indicator Point does not disappear if the proper focus has been found but the corresponding ear point has not been needled accurately enough (deviating by a fraction of a millimeter may miss the exact point on the ear). The Focus Indicator Point is therefore a good indicator of whether or not the focus or the corresponding ear point has been treated accurately enough.

Immediate disappearance of the Focus Indicator Point after needling the corresponding focus or its Focus Point on the ear indicates that the proper focus has been found and treated accurately.

Monitoring the Course of Therapy Ideally, the initial finding will improve from one week to the next (as a rule, treatments are performed at weekly intervals). There is a stepwise decrease in focal activity. For example, a focus of the Histamine Type will show up as an Endoxan focus at the next session, as a PEG1 focus at the following session, and so forth, until the focus can no longer be found because it is no longer active. The final finding will be: free of focal disturbances. Note: A focus indicated by the Master Point of Oscillation (see p. 137f.) usually turns into a focus of the Histamine Type by the next session.

Focus Becomes Less Active

An Endoxan focus—a focus of the Endoxan Type, assumed to be the most severe focus in the present example—will usually turn into a

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152 Practical Application focus of the PGE1 Type by the next treatment session. When searching for Focus Indicator Points, the Endoxan Point will no longer be found, but the PGE1 Point will be found instead. When undertaking once more a focus assignment (using either the cable or ampoule method), the same focus is found as during the previous examination. However, this focus now exhibits a lower level of activity, that is, it will be found with the PGE1 ampoule or with the cable connected to the PGE1 Point. It is recommended that, in every session, the foci be reassigned to the active Focus Indicator Points to check one’s own performance. Finding the same foci again, although less active, confirms the initial diagnosis. It also shows that the treatment is making progress and the foci are becoming less active. However, if one finds during the second session the same principle Focus Indicator Point as the last time (in the above example, the Endoxan Point), this may have several reasons:

The corresponding focus was not properly identified or assigned during the first session. If so, search again and identify the focus.

Though properly identified, the focus was not needled accurately enough. Search again and needle the exact point. Check for proper needle insertion with the 3-volt hammer and insert a second needle next to the first one, if necessary. The patient’s general energy level is very low (see p. 153).

The Relation between Individual Foci Continues to Exist

Rechecking the Focus Indicator Points and reassigning the foci during the next session makes it possible to monitor not only the course of therapy but also one’s own work. Interestingly, the interrelationship of active foci continues to exist from one examination to the next. When finding the Endoxan Point and Vitamin C Point during the first session, indicating the presence of two foci of Type 2 and Type 4, respectively, one will also find two Focus Indicator Points during the following session, but this time they indicate two foci of Type 3 and Type 5, respectively—provided the foci have been properly assigned and accurately needled. Thus, the relation between the two foci usually remains the same. Table 2 shows the entries on an index card for the first and second visits of the same patient. The card carries the imprint of a stamp showing the five types of foci, and the assigned foci have been recorded next to the respective focus types. It is recommended that one orders such a custom-made stamp and uses it on regular index cards.

Table 2 Findings of focus diagnosis at two successive treatment sessions Focus Indicator Point

Assigned focus Oct. 10, 1996

✓

Histamine Point Endoxan Point

Laterality Point

Assigned focus Oct. 17, 1996

✓

Appendix scar

✓

Gallbladder

✓

Histamine Point Appendix scar

✓

Gallbladder

✓

PGE1 Point Vitamin C Point

Focus Indicator Point

Endoxan Point PGE1 Point Vitamin C Point Laterality Point

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Other Foci Are Maintained by the Principle Focus

It is interesting to note that the relation between the foci found during the first examination continues to exist even when only the principle focus has been treated during the first session. In response to this treatment, the focus next in line also decreases in activity, which can be easily confirmed during the next session by checking the Focus Indicator Points and reassigning the foci. This fact impressively substantiates the notion that a primary focus plays the leading role in the focal process and maintains the activity of all other foci. In some cases, the focus may even improve by two steps prior to the next session, thus changing from a focus of the Histamine type into one of the PGE1 type. One can assume that the patient’s energy level is quite high in such cases. However, if a patient is exposed to additional heavy loads (such as professional or private stress, anxiety, insomnia, poor nutrition, climatic changes), there may be such a profound lack of energy that the existing focus is far more difficult to treat. In these rather rare cases, one may find during the next session that the focus shows the same level of activity as before, even though it has been properly assigned and accurately treated by needling or infiltration. A detailed psychosocial history of the patient will point out the stress factors. In these cases it is beneficial when the therapy includes some ear acupuncture points that help to stabilize the patient's energy level (see p. 154), in addition to general changes in lifestyle.

Course of Symptoms The course of the therapy is reflected by the course of the symptoms. If the symptoms have been maintained by the focus, the patient will often remain free of symptoms for a week after the first treatment, and then the symptoms will reappear by the end of the week—time for the next treatment. However, it could as well be that the patient becomes immediately free of symptoms, although the foci are still present in a less active form. Here, treatment should continue so that the therapy is not jeopardized. Patients, particularly those who come for focus diagnosis because of symptoms resistant to therapy, usually have their constitutional or acquired trouble spot at the site of complaints. The foci disturb this trouble spot, and eliminating them will ease the burden enormously, thus breaking or slowing down the chronicity of the condition. Every conscientious therapist should not only study the methods of focus diagnosis, but should really familiarize himself/herself with other possibilities of symptomatic treatment (e. g., ear and body acupuncture, infiltration methods; see p. 144).

Procedure in Case of Amalgam Load If the positive pole of the 3-volt hammer is able to trigger a resonance VAS over Omega Point I, this is regarded in most cases as an indication for amalgam load. The different ways of checking for amalgam load are described in detail on pages 83f., 130f.; further treatment supported by medication is discussed on page 83f.

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Better Therapy by Using the VAS

The most important improvement of diagnosis and therapy at Level 2 is the fact that VAS monitoring and local resonance make the checking of points far more accurate. Furthermore, any ear acupuncture points that are used concurrently can be needled far more accurately under VAS control. For VAS beginners it is nevertheless important that they have their diagnosis confirmed by an experienced colleague prior to advising the patient to have the amalgam fillings removed.

Additional Points for Focus Therapy As mentioned above, it does happen that during the next treatment session the focus is found at the same level of activity as before, despite proper assignment and despite accurate needling or infiltration. This usually means that the patient has a profound lack of energy. For such cases, two points are described below that are easy to find even by someone inexperienced in ear acupuncture:

Point Zero

Point Zero (Umbilical Card Point) corresponds to Point CV 8 of body acupuncture. Location: In a small cartilaginous groove slightly superior to the root of the ascending helix; found as a Gold Point on the right ear in a right-handed person.

Point GV 4

Point GV 4 on the ear. Location: On the back of the ear in the corner formed by the ear and the scalp, roughly in the middle of the ear; found as a Gold Point on the left ear in a right-handed person (Fig. 89). According to the teachings of Traditional Chinese Medicine, combining these two points has the effect of “stabilizing the Middle Burner” by elevating the energy level.

Fig. 89 Energetically stabilizing points: 1 Point Zero (Point CV 8), 2 Point GV 4

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Level 2: Focus Therapy Under Vascular Autonomic Signal Control 155

Two other points supporting the therapy have already been discussed with the methods used at Level 1:

Point PGE1

Point PGE1 corresponds to Confluent Point GB 41 of body acupuncture and is found as a Gold Point on the right ear.

Thymus Gland Point

The Thymus Gland Point corresponds to Confluent Point TB 5 of body acupuncture and is found as a Gold Point on the left ear. Together the two points (Fig. 90) have strong antifocal as well as analgesic and anti-inflammatory effects. As already mentioned, the Thymus Gland Point has a very strong effect on foci and on all active ear points. Once it has been accurately needled, all other ear points disappear for a while, so that any subsequent search for other points under VAS control is no longer reliable. For this reason, the Thymus Gland Point should always be needled as the last point of a treatment.

Mental Fields of Disturbance See comments on page 84 for details. If the Psychotropic Points of ear acupuncture (p. 72f.) are used concurrently, they can now be precisely located while monitoring the VAS.

Problems during Therapy See page 89ff. for details. The method of searching for foci must be adapted to the diagnosis under VAS control. If the instruction says that the foci must be searched for once again, this refers to the system of Focus Indicator Points, VAS monitoring, and other methods used at Level 2.

Fig. 90 Additional points for focus therapy: 1 PGE1 Point, 2 Thymus Gland Point

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156 Practical Application The therapy for a left-handed person is described on page 84. Practical tips regarding the therapy are provided on page 85.

Measures Supporting the Therapy The various methods for improving the therapy or for ensuring therapeutic success have already been discussed in detail in the context of techniques applied at Level 1. The various measures are described on page 86ff. and apply in the same form also to the methods used at Level 2:

massage of body acupuncture points carried out by the patient, transcutaneous nerve stimulation (TNS), improving muscle balance and stability through physiotherapy, and

change in diet.

Marking Body Acupuncture Points

An important aspect is that VAS monitoring makes it possible to determine in advance the exact points that need to be stimulated; this applies to the massage of body acupuncture points by the patient and to TNS. The points are marked on the patient with a fine permanent marker, so that it is easy to find them again when performing self-treatment at home.

Long-term Course of the Therapy The comments on page 93 apply here as well. It is difficult to predict whether, and for how long, the once severe and now inactive focus will remain silent—and is very different from patient to patient. The readiness to reactivate an old, already treated focus or to develop new focal disturbances depends very much on internal and external conditions, namely, on the patient’s lifestyle. Foci can be reactivated by external stresses (chronic exposure to toxins, nicotine, inadequate nutrition, stress, poor working conditions, social environment), and also by internal stresses (inability to deal with stress, emotional problems, physical overload, lack of sleep, etc.). The same is true for the clinical effects that a given type of focus (e. g., Histamine Type) may have on the patient with respect to developing an illness.

Prophylactic Treatment of Foci

Existing foci, even though they may not (yet) cause symptoms, should be treated prophylactically. A “harmless” focus of the Vitamin C Type, for example, may unexpectedly develop into a more severe focus at any time. The beginner should use every opportunity to be examined for foci, for example, during the practical training course (for details on training opportunities, see p. 236). Once a focus has been detected, competent treatment should not be postponed for long—the “second blow” will certainly come, even if it is only a common cold that may then become resistant to therapy.

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Level 2: Focus Therapy Under Vascular Autonomic Signal Control 157

Summary of Therapy at Knowledge Level 2 As mentioned, focus therapy depends on sufficient diagnostic procedures. This means, of course, that the first step prior to therapy must be a thorough search for foci.

Disinfect the diagnosed region on the ear or body. Needle the most active Focus Points on the ear while monitoring the VAS (gold needles). Perhaps, in addition, infiltrate the focus on the body with a local anesthetic while monitoring the VAS.

Dry needle the points on the body (e. g., a specific site of a scar) while monitoring the VAS.

Perhaps combine the above methods, maybe by including the cable method. If necessary, needle Functional Points, e. g., energizing points (Point Zero, Point GV 4),

antifocal points (PGE1 Point, Thymus Gland Point—always needle the Thymus Gland Point last). If required, needle Psychotropic Points. Check the therapy immediately after needling (proper assignment, accurate needling?) by reexamining the Focus Indicator Points. Check the long-term effect of the therapy in follow-up sessions: Reexamine the Focus Indicator Points and reassign the foci. After removing the needles, insert a permanent needle into one or two important points, if required. For other measures supporting the therapy, see page 85ff. For example, additional stimulation of the Thymus Gland Point on the body (Point TE 5 of body acupuncture) by transcutaneous nerve stimulation (TNS, see p. 86).

Essential Equipment To be able to diagnose and treat effectively at Level 2, the following basic equipment should be acquired:

Proper grounding. A 3-volt hammer. A pair of rubber ears, pins. An ear stamp for producing index cards for medical records. Perhaps a stirrup probe. A set of needles (see p. 93f.; 20 gold needles are sufficient initially, but in the case of disposable needles this depends on how many are being used). A box of permanent needles (see p. 95f.; they may be shared with a colleague). A sterilizer (for reusable needles). A metal or glass container for needle sterilization. Sterile swabs, alcohol, a pair of splinter forceps, a fine felt pen (green), perhaps also a fine permanent marker (felt pen with waterproof ink).

For those who also want to exercise the reflex localizations on the ear, or to check one’s own VAS diagnostic procedure, we recommended that they do not yet sell their pointfinder (Level 1).

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158 Practical Application

VAS Method: Case Histories from My Practice Focus Diagnosis under VAS Control

The following case studies should provide some insight into the practical application of the VAS method. They demonstrate in an impressive way how a long-running case history may come to an end thanks to the targeted diagnosis and therapy of a focus. Examination was carried out with the methods of vascular autonomic signal– (VAS-) controlled diagnosis. From the description below, even the beginner will easily recognize both the course and the causality. All he/she has to do is transfer to the point-finder what has been described for the VAS examination, namely, taking a detailed history of the patient, followed by a search for the potential focus on the surface of the ear.

Shoulder Pain Due to a Dental Focus A 56-year-old male patient visited me because of pain in the shoulder from which he had suffered for several years. Examination of the shoulder itself yielded an infraspinatus tendinopathy already associated with a strong restriction of movement (he could lift his arm only up to 45°). While searching for a focus, I detected that two teeth (Nos. 23 and 24) acted as relatively severe foci. The dentist considered both teeth as worth keeping; No. 23 was vital, while No. 24 was devitalized, and the radiograph did not reveal any pathological findings. Initially, I was not sure what to do. I therefore started with symptomatic therapy by ear acupuncture and then treated the remaining foci (right maxillary sinus, a scar from biliary surgery). The symptoms improved considerably, and the patient was able to lift his arm almost up to 90°, but he was not completely free of pain.

Free of Pain after Tooth Extraction

Since the two teeth that acted as foci were supposed to give support for new dentures, I advised him to have them removed—rather than waiting until they might become troublesome and the dentures would have to be replaced at a high cost. The dentist removed both teeth reluctantly. As the patient reported to me, each tooth was ulcerated at the tip of the root. But he also reported something else: Immediately after removal of these teeth, his shoulder was completely free of pain, and he was able to lift his arm far over his head.

Comment

In the case of dental foci, the therapist must make a decision as to how to proceed. Scars can be infiltrated under the assumption that they are foci; this is less promising in the case of teeth. Furthermore, teeth cannot be extracted “on suspicion.” It is especially important here that one is skilled in the methods of focus diagnosis. If in doubt, one should consult a colleague who is experienced in focus diagnosis.

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VAS Method: Case Histories From my Practice 159

Chronic Back Pain Due to Impacted Wisdom Teeth A 17-year-old female patient presented with intractable pain in the thoracolumbar transition. She had been suffering from this for a few years and was unable to go to school on a regular basis. She went for diagnosis and therapy to the university clinic and a clinic specializing in rheumatology. But neither bone scans, conventional radiographs, a neurological examination, nor magnetic resonance imaging (MRI) yielded any pathological findings. The clinical diagnosis was chronic thoracolumbar syndrome, caused predominantly by faulty posture and associated with muscular imbalance.

Resistance to Therapy

The usual therapeutic attempts, including numerous physiotherapy sessions, back pain exercises, local infiltrations, and nonsteroidal anti-inflammatory drugs did not result in any alleviation of symptoms. I started by subjecting the patient to neural therapy, but without much success. I therefore performed a focus diagnosis. There was a primary focus of the Histamine Type, which could be assigned to a dental focus on the right side. A secondary focus was also found, namely, a scar on the right elbow (Fig. 91).

A Tooth Sustained the Back Pain

Fig. 91 Projections of 1 a wisdom tooth (tooth No. 18) on the right side of the jaw, and 2 a scar on the right elbow

At first, I could not make sense of this finding because the patient took good care of her teeth and there was not a single filling. I asked her to bring me the panoramic radiograph from the dentist—it revealed four impacted wisdom teeth. When I searched again using the cable method, I was able to identify the focus by means of the

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160 Practical Application

Fig. 92 Projection of a wisdom tooth (tooth No. 28) on the left side of the upper jaw.

ear point detected: the focus was, indeed, the impacted wisdom tooth on the right side of the upper jaw (tooth No. 18). Subsequent removal of this tooth provided immediate freedom from pain. From then on, the patient was able to return to school without any problems, thus preventing termination of schooling. A year later, the young woman visited me again, complaining about severe vertigo that had forced her to rest for the last couple of days. This time, examination of the ear revealed a focus of the Histamine Type that could be assigned to the left side of the upper jaw (Fig. 92). Extraction of the tooth in question (No. 28) and follow-up treatment with local neural therapy resulted in complete and lasting freedom from pain.

Comment

Impacted wisdom teeth can cause severe symptoms. Even if they are not regarded as a focal disturbance when focus diagnosis is first performed, the above case demonstrates that they should be regularly examined for focal activity.

“Meridianitis” A 50-year-old male patient visited me and reported that he had suffered from pain on the left side of the abdomen for the last 30 years. This tearing pain was sometimes more severe, sometimes less severe, but it was always present. It was particularly pronounced around 8 o’clock in the morning. So far, none of the many clinical examinations, laboratory tests, and imaging procedures had uncovered the cause (he brought the results of these examinations with him).

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VAS Method: Case Histories From my Practice 161

Fig. 93 Projection of a focus in the left lower leg (war injury caused by a splinter).

I found the Histamine Point on the left ear as the only active Focus Indicator Point. When trying to assign a focus, I did not find a resonance VAS at any of the possible focal sites indicated by him (such as scars). Thus, I had to rely on searching for an unknown focus “blind-folded.” Finally, I discovered a point on the left ear in the reflex zone of the lower leg (Fig. 93).

Foreign Body in the Lower Leg

Only when asked about any scars in this region did the patient indicate that he still had a splinter underneath the skin on the anterior side of the left lower leg (a war injury). I checked the respective region on the lower leg with the histamine ampoule and, indeed, I observed a very prominent VAS reaction over a foreign body that could be clearly palpated under the skin. The foreign body was approximately 1 × 0.5 cm in size and was located almost exactly where one would locate Point ST 39 of body acupuncture.

Free of Pain after Inactivating the Focus

I normally include acupuncture treatment in my therapeutic concept and should have located and needled the respective Pain Point on the ear. In this case, however, the connection with the symptoms in the abdomen was so obvious that I did not do this. Instead, I only infiltrated the tissue around the splinter with lidocain to inactivate the focus (for notes on the action of local anesthetics, see p. 148). The patient immediately perceived a warm feeling in the lower abdomen and two minutes later was free of pain.

Energy Congestion

It is impressive that such a connection between focus and symptoms can be demonstrated so directly. I explained the connection to the curious patient by pointing out the course of the Stomach Meridian: it runs from top to bottom, from the face down over the anterior thorax, lower abdomen, inguinal region, and anterior sides

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162 Practical Application of thigh and lower leg to the foot (Fig. 94). During the peak energy flow through the meridian (around the time when the patient had more severe pain) there was energy congestion due to the scar. This congestion caused an excess of energy in his lower abdomen on the left side, where he obviously had his trouble spot. Excessive energy in the region of both striated and smooth muscles normally leads to muscle cramps.

Fig. 94 The Stomach Meridian.

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VAS Method: Case Histories From my Practice 163

Point ST 39

In addition, the importance of Point ST 39 itself did corroborate the connection with the symptoms in the lower abdomen: Its indications are, among others, enteritis, colitis, and dyspepsia. In addition, Point ST 39 has a direct effect on the small intestine as a hollow organ. After this first treatment, I pointed out to the patient that the symptoms might reappear and that this severe focal disturbance should be silenced step by step in further sessions. I also explained to him that one should wait and see whether the splinter still present could be completely silenced by infiltration with the local anesthetic or whether it should be removed after all.

Course of Therapy

During the next treatment session the region with the splinter presented as a focus of the Endoxan Type. After two more sessions I found this region to be only a focus of Type 5, which is a very weak focus. Removal of the splinter was therefore not indicated at that point in time. I suggested that the patient should see me again in six months to check up on the focus. However, the symptoms did not reappear for a few years after the first session. Three years later the patient reported that, in connection with his application for a pension, he went to have an radiograph of the lower leg with the splinter. When the radiologist palpated the splinter region because he had told her about it, the familiar pain in the lower abdomen resurfaced immediately. As I had advised him just in case, he visited his family doctor who infiltrated the splinter region again, and he became free of pain immediately.

Migraine Therapy—A 5-Year Follow-up In February 1991, a 35-year-old female patient consulted me because of migraine. She had been suffering from migraine attacks since 1980, and the pain occurred predominantly on the right side once a month. In the following years, the frequency of attacks increased to once a week, and the pain increased as well. The attacks were now associated with disturbed vision and speech, sometimes even with unconsciousness. A recent neurological examination did not yield any indication as to what might trigger these attacks. Recently, the attacks had been occurring twice weekly. Upon the advice of a physician she had her amalgam fillings removed and her electrolyte deficiency balanced (selenium, zinc, copper, calcium, and magnesium). These measures reduced the frequency, but they did not prevent the attacks completely. The patient knew that her attacks were triggered by high-pressure systems and certain foods, such as wine, champagne, chocolate, and hard cheese.

Two Foci: Appendix Focus diagnosis revealed one focus of the PGE1 Type (Appendix Scar and Gallbladder Point on the right ear) and another one of the Vitamin C Type (Gallbladder Point on the right ear). The two ear points were pierced with gold needles. Lasting freedom from symptoms occurred already after the first session. The total number of treatments performed was five.

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164 Practical Application Four years later, the patient reported that she had had mild headaches initially and a migraine attack over the past few days, the first in years. After the last treatment, I had advised her to see me immediately in case of beginning migraine symptoms. The remarkable thing was that the migraine now occurred on the left side for the first time. I found the Endoxan Point on the left ear as Focus Indicator Point, suggesting that there was a severe new focus. I screened the ear reflex zones for possible foci already known from the patient’s history, but nowhere did I get a resonance VAS.

A Scar as a Focus

By systematically screening the entire ear surface, I detected a point in the reflex zone of the left side of the thorax. The patient then remembered that an excisional biopsy of the left breast had been carried out a few days before the migraine attack occurred. Checking the ear point located by means of the cable method (connecting the ear point with the scar) confirmed my suspicion that this scar was, indeed, the Endoxan focus. The explanation for the reoccurrence of migraine was obvious: The scar on the breast was located so far to the left side that it disturbed the supply area of the Gallbladder Meridian (this patient suffered from a so-called gallbladder migraine with the characteristic symptoms, such as painful pressure behind the eyes, radiation of the pain over the temples and the skull, pressure sensitivity at the insertions of the neck muscles, waking up during the night or early in the morning; see also p. 29). As another Focus Point, I found the Gallbladder Point on the left ear. Even though the gallbladder is located on the right side of the body, this did not surprise me in this case. The left Gallbladder Meridian was disturbed, and the migraine did in fact occur on the left side for the first time.

Continuous Freedom from Pain

Needling of the two Focus Points on the left ear resulted in longlasting freedom from pain (last information as of January 1996).

Comment

This long-term follow-up demonstrates that patients with a trouble spot (in this case, the Gallbladder Meridian) can remain free of pain for a long time if the foci are silenced. Every new irritation of their trouble spot, like the new scar on the left breast, may cause the symptoms to reappear. I always explain this to my patients at the end of the first series of treatments so that they can interpret new symptoms correctly and use this as an opportunity to see me again.

Posttraumatic Migraine A few years ago, a 60-year-old female patient came to see me because of intractable, severe migraine attacks occurring almost daily. The attacks appeared for the first time after the woman suffered a severe direct blow to her right cheek from a defective automatic door when leaving a department store. She was unconscious for a short period of time immediately after this had happened.

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VAS Method: Case Histories From my Practice 165

Resistance to Therapy

Neither her family doctor nor the attending neurologist could come up with an objective finding. Physiotherapy, infiltration of the ganglia in the head region, and administration of psychoactive drugs did not help her. The last attending physician, the senior physician of the anesthetic division of a regional hospital, finally consulted me because he suspected a focal process that could not be diagnosed by clinical examination. Appendectomy and biliary surgery were recorded under previous illnesses. Orthopedic examination and manual therapy yielded the following findings: The patient had blokkages of the atlantoaxial joint and, as a result, counter blockages in the thoracic spine and lumbar spine. These spinal blockages were temporarily eased by skillful chiropractic, but they reappeared within hours. Focus diagnosis revealed the remains of a small hematoma over the right cheek bone, which probably was caused by the blow and which exhibited an extraordinary focal activity. By the time of first treatment, it seemed to have already been invaded by connective tissue and was palpable as a small nodule under the skin.

Huneke’s Phenomenon upon Infiltration

I infiltrated this site with a small amount of local anesthetic (0.2 ml of 1 % lidocaine). The mere infiltration of this small hematoma triggered an immediate reaction (“Sekundenphänomen” according to Huneke): Though still present when the treatment began, the headache disappeared immediately. A few more treatment sessions were required, and the patient has been free of pain ever since.

Comment

With respect to evaluating the blockages in the cervical spine, they certainly were the primary cause of the migraine attacks because the symptoms did improve after appropriate manual therapy. However, the patient had never before suffered from headaches and myogelosis of the neck muscles. The blockages in the atlantoaxial joint were certainly triggered for the first time by the heavy blow to the right cheek bone and were then sustained by the small focus over the cheek bone. The activity of this focus was responsible for the failure of all previous therapies. The proof for the existence of such a connection between symptoms and focus lies in the immediate and lasting freedom from pain following infiltration of the focus.

Compensation for Injuries Suffered

Once the acupuncture treatment was successfully completed after a few sessions, the patient’s lawyer asked me for a report so that he could sue for reimbursement of the treatment costs as well as for compensation for the injury suffered. Although the patient did have an identifiable and treatable condition (the focus), this finding could not be established by laboratory tests or other means that would provide an objective proof in court. Nevertheless, based on my report, the court granted her approximately $ 2000 as compensation for injuries suffered.

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166 Practical Application

Optimizing the Methods Tools to Improve the Diagnostic Procedure This chapter is intended for those who are interested in achieving diagnosis of enhanced precision. However, the beginner also may successfully integrate this knowledge into his/her own work.

One Point—Several Functions

As alluded to earlier (p. 113), some important points of ear acupuncture may have more than one meaning. In such a case, it may be difficult to differentiate unambiguously without further aids. The Histamine Point, for example, can act as Focus Indicator Point for a severe focus and as Allergy Point indicating an allergy in an allergic person. The Prostaglandin E1 Point can act as Focus Indicator Point for a moderately severe focus and as an antirheumatic point of ear acupuncture (corresponding to Point GB 41 of body acupuncture). The Laterality Point can act as Focus Indicator Point for a weak focus and as a point indicating disturbed laterality. If a potential focus is located at the same location in the body where the patient also has symptoms (e. g., a scar at the elbow with concurrent epicondylitis), it may become difficult to distinguish between Symptom Point and Focus Point and to come up with an answer when attempting to diagnose the focus by means of ear reflex zones.

The 9-Volt Rod

A simple but effective aid for differentiation is the 9-volt rod according to Bahr. This rod is a diagnostic tool used in ear acupuncture. However, it may also be used for pure focus diagnosis. It serves to enhance the vascular autonomic signal when searching over an active Focus Point. At the same time, any disturbing secondary information is suppressed, thus making it easier to locate the proper focus accurately. Even for the limited use of the 9-volt rod in focus diagnosis, some basic information is required, in particular, with respect to the “three tissue layers” according to Nogier.

The Three Tissue Layers Different Pressure Intensities

As already described in detail (p. 103ff.), Nogier discovered that pathologically altered ear points exhibit a pronounced sensitivity to pressure. In the 1950s and 1960s, he experimented with the pressure probe in order to quantify the pressure sensitivity of different ear points (Fig. 18; p. 59). While doing so, he discovered that different groups of pathologically altered points could be detected when pressure of different intensities was applied. Pain Points and Focus Points were sensitive to relatively intense pressure (110– 120 g/mm2). Other points, such as Organ Points or Psychotropic Points, could be located particularly well by moderate or gentle pressure.

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Optimizing the Methods 167

Three pressure intensities emerged which were helpful in locating different kinds of points. These points were located in different tissue layers of the ear, which Nogier called the deep, intermediate, and superficial tissue layers.

The deep and intermediate tissue layers are of paramount importance for focus diagnosis.

Deep Tissue Layer Points Representing the Cause of Disease

As mentioned above, Nogier called those points found when applying a strong pressure with the pressure probe (110–120 g/mm2) the points of the “deep tissue layer.” These are essentially the points representing the cause of a disease. They include Focus Points, which—apart from a few exceptions (Amalgam Indicator Point)—are always located in the deep layer, furthermore, some Organ Points, and sometimes also Psychotropic Points, which represent mental disturbances underlying a disease. A pressure of 110–120 g/mm2 corresponds to the total distance to which the spring-loaded tip of a commercially available pressure probe can be pushed in.

Intermediate Tissue Layer Focus Indicator Points

Nogier called those points that he found when applying a moderate pressure with the pressure probe (60 g/mm2) the points of the “intermediate tissue layer.” This layer contains mainly the Focus Indicator Points, which are so important for focus diagnosis. A pressure of 60 g/mm2 corresponds to half of the distance to which the spring-loaded tip of a commercially available pressure probe can be pushed in.

Superficial Tissue Layer Indicator Points for Heavy-Metal Load

Nogier called those points that he found when applying a gentle pressure with the pressure probe (1–5 g/mm2) the points of the “superficial tissue layer.” This layer contains mainly the Functional Points. They become important when the more advanced focus therapist wants to diagnose, for example, heavy-metal loads (e. g., the Omega Point I indicates a mercury load). A pressure of 1–5 g/mm2 can be best achieved by means of a needle probe, which contains a much softer spring. The punch area consists of a bundle of needle tips (Fig. 95).

Fig. 95 Needle probe according to Nogier.

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168 Practical Application

Examining the Tissue Layers Activating the Sympathetic and Parasympathetic Nervous Systems

Bahr discovered empirically that the above-described points of individual tissue layers can be located even better when the sympathetic or parasympathetic nervous system is stimulated on the ipsilateral or contralateral side of the ear examined. For this purpose, he initially used a 9-volt battery placed on the patient’s body. Today, we use the 9-volt rod. By using the 9-volt rod method the therapist no longer depends on the time-consuming palpation of the ear with pressure probe and needle probe. The points can now be searched for with the 3-volt hammer under VAS control without touching them. The VAS is triggered by the charge transfer described on p. 114. Furthermore, the examiner no longer depends on the cooperation of the patient, which sometimes can distort objective findings. Now, the person perceiving the information (VAS) is exclusively the examiner rather than the patient.

Differentiating between Points by Means of the 9-Volt Rod

Proper positioning of the rod allows the examiner to “select” the respective layer of the patient’s ear, that is, one is looking at an ear on which one will find, for example, only points of the deep layer. All active points belonging to the other layers (and being of no interest at this particular moment) are suppressed when the rod is applied. In this way, one can easily differentiate between the two functions of the same point.

Examining the Deep Tissue Layer By placing the positive pole of a 9-volt battery (9-volt rod) onto the patient’s arm or hand of the ipsilateral side of the ear currently examined (e. g., right ear—right hand; Fig. 96), the sympathetic nervous system is stimulated on the body side under exploration. This makes it possible to find with greater accuracy the groups of points belonging to the deep tissue layer (p. 167).

All points on the ear that represent foci (Focus Points) lie in the deep tissue layer (exception: Indicator Points for toxic loads). Thus, foci are easily found under VAS control when the patient holds the positive pole of a 9-volt rod in his/her hand on the side of the ear examined. At the same time, all other information (points of the other tissue layers), which might interfere with the search for Focus Points, is largely suppressed.

Examining the Intermediate Tissue Layer By placing the positive pole of a 9-volt battery (9-volt rod) in the hand of the contralateral side of the ear examined (left ear—right hand, right ear—left hand; Fig. 97), the parasympathetic nervous system is stimulated on the body side under exploration. Now, the groups of points belonging to the intermediate tissue layer

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Optimizing the Methods 169

Fig. 96 Searching for focal disturbances in the deep tissue layer on the right ear (a) and on the left ear (b).

Fig. 97 Searching for focal disturbances in the intermediate tissue layer, on the right ear (a) and on the left ear (b).

Fig. 98 Searching for focal disturbances in the superficial tissue layer.

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170 Practical Application (p. 167) can be easily found. In the context of focus diagnosis, these are the Focus Indicator Points. The Focus Indicator Points on the ear are all located in the intermediate tissue layer. Thus, they are easily found under VAS control when the patient holds the positive pole of a 9-volt rod in his/her hand of the side opposite to the ear examined. At the same time, all other information (points of the other tissue layers), which might interfere with the search for Focus Indicator Points, is largely suppressed.

Examining the Superficial Tissue Layer The 9-volt rod is held with both hands—the positive pole with the right hand, the negative pole with left hand—and this is done independently of the ear under exploration. This means that the righthanded person always holds the positive pole in the right hand and the negative pole in the left hand, no matter which ear is examined. “Right side” always refers to the right (dominant) hand of the righthanded person. For the left-handed person these instructions have to be adapted accordingly. The left-handed person holds the rod the other way round: the positive pole with the left hand and the negative pole with the right hand (Fig. 98). Proper positioning of the 9-volt rod “selects” the desired tissue layer of the patient’s ear (see Tables 3 and 4). The patient should always be grounded. Table 3 Examining the three tissue layers Layer

Ear examined

Position of positive pole of the 9-volt rod

Rule

Deep

Right ear Left ear

Right hand Left hand

Applies to both rightand left-handers

Intermediate

Right ear Left ear

Left hand Right hand

Applies to both rightand left-handers

Superficial

Right ear and / or left ear

Right hand and, in addition, negative pole in left hand (one-rod method; rod position is independent of the ear under exploration)

Applies to right-handers (use the reverse order for left-handers)

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Optimizing the Methods 171 Table 4 How to find Focus Points, Focus Indicator Points, and Functional Points by proper positioning of the 9-volt rod. The following examples are presented to check one’s own comprehension. Points searched for

Position of positive pole of 9-volt rod

Focus Points on the right ear of a right-hander (deep tissue layer)

Right hand

Focus Points on the right ear of a left-hander (deep tissue layer)

Right hand

Focus Points on the left ear of a left-hander (deep tissue layer)

Left hand

Focus Points on the left ear of a right-hander (deep tissue layer)

Left hand

Focus Indicator Points on the right ear of a right-hander Left hand (intermediate tissue layer) Focus Indicator Points on the left ear of a right-hander Right hand (intermediate tissue layer) Focus Indicator Points on the right ear of a left-hander Left hand (intermediate tissue layer) Focus Indicator Points on the left ear of a left-hander (intermediate tissue layer)

Right hand

Functional Points on the right ear of a right-hander (superficial tissue layer)

Right hand and, in addition, negative pole in left hand (one-rod method)

Functional Points on the left ear of a right-hander (superficial tissue layer)

Right hand and, in addition, negative pole in left hand (one-rod method)

Functional Points on the right ear of a left-hander (superficial tissue layer)

Left hand and, in addition, negative pole in right hand (one-rod method)

Functional Points on the left ear of a left-hander (superficial tissue layer)

Left hand and, in addition, negative pole in right hand (one-rod method)

Checking for Inversion Reversed Reflexes

The preliminary examination can be extended by including the identification of obstacles to diagnosis and therapy. The reversal of reflexes is called inversion. Normally, there is a parasympathetic tonus in the head and a sympathetic tonus in the body. The clavicular line marks the boundary. Blockage of the first rib disturbs the stellate ganglion, which lies underneath the head of the first rib. This results in sympathetic firing, which then causes a reversal of reflexes.

Inversion Caused by Severe Foci

Apart from the purely mechanical exogenous cause of a blocked first rib (lifting heavy weights, physical overexertion), severe focal disturbances may act as endogenous causes of inversion. Abnormal information originating from a focus can lead to overstimulation of the stellate ganglion, for example, via afferent fibers of the phrenic nerve (abnormal information in the C3/C4 segment, the origin of the phrenic nerve; intraspinal transmission to C8/T1 with irritation

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172 Practical Application of the ganglion). In many such cases this is also accompanied by blockage of the first rib (which is important later for treating the inversion). If one intends to use the 9-volt rod for focus diagnosis (or for ear acupuncture), there must be no reversed reflexes. If inversion does exist, peripheral use of the positive pole of the 9-volt rod induces oscillation in the patient. Normally, holding the positive pole of the 9-volt rod in the hand is thought to have a stimulating effect on the deep tissue layer and a stabilizing effect on the sympathetic nervous system. The points of the deep tissue layer (Focus Points) of the ipsilateral ear can then be located more accurately. However, if inversion exists, placing the positive pole of the 9-volt rod in the patient’s hand has an effect as if the patient were holding the negative pole, because the reflexes are reversed. As a result, the body’s stability becomes weakened, and oscillation occurs (see p. 136, unstable reflex behavior). In such a case, the 9-volt rod cannot be applied as usual, for holding the positive pole on the side of the inversion would cause iatrogenic oscillation—which would be an absolute obstacle to diagnosis because the reflex response to the 3-volt hammer would be permanently unstable. It is thus important to identify the inversion and then eliminate it. Inversion may occur either on the right or left side of the body, sometimes even on both sides. In principle, therefore, each side must be checked separately for inversion (two separate examinations).

Checking for Inversion on the Right Side The procedure is logical and simple: When checking for inversion, one takes advantage of the fact that peripheral use of the positive pole of a 9-volt rod would cause iatrogenic oscillation if inversion exists. The patient is grounded and asked to hold the positive pole of the 9-volt rod in the right hand. The practitioner then uses the positive pole of the 3-volt hammer over Point Yin Tang to see whether a VAS can be triggered, which would indicate oscillation. No VAS response to the positive pole of the 3-volt hammer means there is no inversion on the right side of the body.

Checking for Inversion on the Left Side The patient is grounded and asked to hold the positive pole of the 9-volt rod in the left hand. The practitioner then uses the positive pole of the 3-volt hammer over Point Yin Tang to see whether a VAS can be triggered, which would indicate oscillation. No VAS response to the positive pole of the 3-volt hammer means there is no inversion on the left side of the body. Point Yin Tang is used for checking both oscillation and inversion. The difference in the case of checking for inversion is that the patient has to hold the positive pole of the 9-volt rod in his/her hand.

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Optimizing the Methods 173

Oscillation Must Be Checked Prior to Inversion

Prior to checking for inversion one must first check for oscillation. This order is important because, during the test for inversion, oscillation is only triggered when the patient is holding the rod. In the event that oscillation already exists but is not eliminated prior to checking for inversion, no further information can be obtained by using the rod. When checking for oscillation and inversion, it does not matter whether the patient is right-handed or left-handed; the outcome is identical for both. If one wants to work with the 9-volt rod, the following applies: If inversion exists, it must be eliminated immediately—otherwise further diagnosis or therapy will not be possible.

Procedure in Case of Inversion Unblocking the First Rib

Since inversion is sometimes caused by blockage of the first rib on the side affected, one may first try to unblock the first rib. This can be achieved either by appropriate manual therapy (chiropractic manipulation) or by rotating the arm backward from below and up (with the opposite foot put forward).

Treating the Focus

If a severe focus is suspected as the cause of inversion, the focus should be identified and treated. We know from experience that inversion on the right side is mostly caused by a focus on the right side, while inversion on the left side is mostly caused by a focus on the left side. For example, one will first search for a Focus Point on the right ear if there is inversion on the right side, but on the left ear if there is inversion on the left side. Examination is performed in a similar way as during the search for a focus that sustains oscillation: Taking advantage of local resonance, one moves an ampoule with local anesthetic over the surface of the ear while monitoring the VAS (see p. 140). However, the examination must be carried out without the 9-volt rod. (Applying the positive pole of the 9-volt rod to the arm would cause oscillation in the patient because the reflexes are reversed.) To eliminate inversion, it will always be more rewarding to search first for a focus that causes inversion, especially because most inversions are caused by a focus. However, if such a focus cannot be found without further aids (particularly by the beginner), manual therapy or rotation of the arm should be tried because blockage of the first rib often accompanies inversion caused by a focus. (It seems that extreme stimulation of the autonomic nervous system leads to irritation of the stellate ganglion and, as a result, to blockage of the first rib.) If the beginner does not find the focus-causing inversion due to lack of experience, he/she may eliminate the inversion by manual therapy or by needling the corresponding ear points, thus making it possible to use the 9-volt rod afterward. Local points for unblocking the first rib are the Ganglion Stellatum Point (as Silver Point on the ear of the affected side) and the First Rib Point (as Gold Point) (Fig. 99).

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174 Practical Application

Fig. 99 Potential ear points for eliminating inversion 1 Ganglion Stellatum Point 2 First Rib Point

If there is inversion on both sides, it must be treated on both sides.

Monitoring the Treatment for Inversion Testing Over Point Yin Tang

Immediately after treating the responsible focus, or after needling the corresponding ear points, or after performing manual therapy, the test described on page 172 (positive pole of the 9-volt rod; Point Yin Tang) is carried out once again. Inversion has only been eliminated, when—with the positive pole of the 9-volt rod in the patient’s hand—absolutely no VAS response can be triggered over Point Yin Tang with the positive pole of the 3-volt hammer. Examination can now proceed as described on pages 168f., 124.

Determining Laterality Functional Points As discussed on page 133, the unambiguous determination of the Depend on Laterality patient’s laterality (handedness) is of utmost importance for the entire therapy. Whereas Organ Points are always needled on the side where the organ is located in the body (e. g., Appendix Point on the right ear, points of the Stomach Zone on the left ear), the ear on which Functional Points are to be needled clearly depends on the laterality of the patient. Hence, laterality should be determined whenever possible. Using two 9-volt rods, the laterality of the patient can now be determined much more accurately: In a right-handed person, a very stable laterality (”superlaterality”) can normally be achieved when the patient holds the positive pole of a 9-volt rod in the right hand and the negative pole of a 9-volt rod in the left hand (two-rod method; Fig. 100). In that case, it is not possible to find Point Yin

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Optimizing the Methods 175

Fig. 100 Checking for laterality with two 9-volt rods.

Tang with the positive pole of the 3-volt hammer (as a sign of great stability, it may be found with the negative pole). In the event that there are no two rods available for the examination, one may use the one-rod method described in Table 4 on page 171.

9-Volt Rod and Laterality

If a right-handed person holds the two rods in the reverse order (negative pole in the right hand, positive pole in the left hand), he/ she will start to oscillate (iatrogenic oscillation). One can take advantage of this phenomenon to determine handedness: If the patient happens to be a left-hander, peripheral use of the positive pole of a 9-volt rod on the right side and of the negative pole of a 9volt rod on the left side does not have a stabilizing effect—on the contrary, this arrangement will cause iatrogenic oscillation. In other words, it has the same effect as the “wrong” use of the rods in a right-handed person.

Procedure

The patient should be grounded. Independently of the assumed laterality, the patient may always hold the positive pole of a 9-volt rod in the right hand and the negative pole of a 9-volt rod in the left hand. In this case, the following applies:

The patient is a right-hander if no VAS can be triggered over Point Yin Tang with the positive pole of the 3-volt hammer (one might even find a VAS with the negative pole of the 3-volt hammer). The patient is a left-hander if a distinct VAS can be triggered over Point Yin Tang with the positive pole of the 3-volt hammer. To confirm the results of the examination, a countercheck is possible: The patient first holds the rods in the “proper” order and then in the “wrong” order, and Point Yin Tang is checked each time while monitoring the VAS.

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176 Practical Application

Preliminary Examination with the 9-Volt Rod Since the determination of laterality makes use of delicate electric and electromagnetic phenomena, it may only be performed once oscillation and inversion have been excluded. In the event that inversion exists, the use of the rods will distort the response over Point Yin Tang. Hence, the above-mentioned order in which the preliminary examination is performed will change with respect to two aspects:

Checking for inversion is done immediately after checking for oscillation.

Checking for laterality must only be performed once oscillation and inversion have been excluded (Table 5). Note: The patient is always grounded during the preliminary examination described in Table 5. Table 5 Preliminary examination using the 9-volt rods

Examination for

Use of 9-volt rods

Normal result for right-hander

Endogenous oscillation

No rods

Point Yin Tang does not respond to positive pole of 3-Volt hammer—no oscillation; Master Point of Oscillation does not respond to positive pole of 3-volt hammer (right ear in the right-hander, left ear in left-hander) 1

Inversion, right side

Positive pole in right hand

Point Yin Tang does not respond to positive pole of 3-Volt hammer—no inversion on the right side

Inversion, left side

Positive pole in left hand

Point Yin Tang does not respond to positive pole of 3-Volt hammer—no inversion on the left side

Laterality

Positive pole in right hand, negative pole in left hand (two-rod method)

Point Yin Tang does not respond to positive pole of 3-Volt hammer—right-handedness If this point is detected with the positive pole of the 3-Volt hammer—left-handedness

Strittmatter B., Verborgene Zahnstörfelder – häufiger Grund für “unerklärliche” Therapieresistenz in der Akupunktur. Der Akupunkturarzt/Aurikulotherapeut 1997 (1), 20–32 and 1997 (2), 3–12.

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Optimizing the Methods 177

Examination Procedure Any work with the 9-volt rod should be preceded by a detailed history of the patient, an in-depth physical examination (both in general and specific terms), targeted laboratory tests, and examination by imaging procedures, if necessary. Then:

Take a detailed history of focal disturbances. Prepare the patient (reclining position, cover with a blanket, knees supported by a pillow). Apply grounding. Check for oscillation. Eliminate oscillation, if required. Check for inversion. Eliminate inversion, if required. Determine the patient's handedness. Locate active Focus Indicator Points (see pp. 115ff., 170). Assign the corresponding foci or Focus Points (see p. 125). Therapy (see p. 144).

References 1. Bahr, F.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für mäßig Fortgeschrittene. Self-published, Munich 1989

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The Laser in Focus Diagnosis and Therapy Irradiation of Certain Points Triggers Resonance VAS

In the 1970s, Nogier experimented with light frequencies produced by a stroboscope. He noticed that certain clearly defined zones on the ear, and thus certain regions of the body, reacted to specific frequencies with the vascular autonomic signal resonance: The irradiation of pathologically altered ear points triggered a distinct resonance VAS. This discovery that ear and body regions resonate with certain frequencies provided the basis for developing the mature lasers used today for diagnosis and therapy in ear and body acupuncture.

Nogier Frequencies

Nogier discovered seven important frequencies to which the different ear zones reacted with VAS resonance (Table 6). He found different frequencies for the locomotor system, internal organs, neurological structures, etc. (Fig. 101). The most important frequency for focus diagnosis is frequency A.

Fig. 101 The seven resonance zones according to Nogier (from: 2).

Fig. 102 Divergent radiation of normal light and parallel radiation of laser light (from: 2).

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The Laser in Focus Diagnosis and Therapy 179 Table 6 Nogier frequencies Frequency A

Frequency of unrest and disorganization, resonance with the reticular formation, resonance with all focal disturbances

Frequency B

Nutritional frequency, resonance with internal organs

Frequency C

Mesenchymal frequency, related to the locomotor system (orthopedic frequency)

Frequency D

Frequency of laterality, related to the tragus

Frequency E

Frequency of spinal cord, resonance with spinal cord (motor and sensory portions)

Frequency F

Frequency related to the structures of the dental–maxillary region; also emotional frequency, related to the subcortical parts of the brain (such as diencephalon and mesencephalon, hypothalamus)

Frequency G

Psychosomatic frequency, related to the cortex and also to the eyes and maxillary sinuses

Bahr Frequencies

In 1983, Bahr discovered his own series of frequencies (Bahr frequencies 1–7, see Table 7). These are assigned to the tissue layers, thus providing some information on the position which a pathologically altered point takes within the entire disease process. They are used primarily for diagnostic purposes in ear and body acupuncture, but also for treating hidden dental foci. During further development of the procedures for using frequencies in diagnosis and therapy, laser light was soon included in the experiments. It proved to be the optimal carrier of these frequencies, because it is the purest light known.

Characteristics of Laser Light

Laser light consists of parallel radiation (all rays run parallel, in contast to white light where the rays diverge) (Fig. 102).

Laser light is monochromatic (in contrast to white light, all rays have the same wavelength).

Laser light is coherent (all waves oscillate in phase, with crests and troughs being always at the same positions) (Fig. 103).

Laser light is not only the carrier of the frequency applied, but it also has a biological effect on its own which has been well documented by extensive basic research (1, 3–5, 7–10, 13–21, 23, 26– 28, 30–39). Its effects include increased production of collagenous fibers, activation of fibroblasts and thus increase in the tensile strength of the tissue, and faster healing through the forced formation of new blood vessels in regenerating tissue. The principle of laser light is induced emission, which carries information of a biochemical and physical nature. The coherent laser beam seems to be particularly suited to influencing incoherences in a living organism. Meridians as well as ear reflex zones seem to be the preferred regions of selective and optimal transmission of certain frequencies (waveguides).

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180 Practical Application

Normal light

Laser radiation

Fig. 103 Phase difference of normal light and coherence of laser light (from: 2).

Today, we use Nogier frequencies based on laser light: A’–G’ (Table 7). Their effect on the irradiated ear zone is quicker and more intense due to their more frequent passages through the base line. Table 7 Frequencies used in ear acupuncture There is a complementary relationship between the Nogier frequencies and the Bahr frequencies. Frequency A represents the frequency of foci, i. e., it resonates with focal disturbances, diagnostically and therapeutically. However, application of this frequency to nondisturbing sites of the body causes the patient to oscillate. By contrast, frequency 5 is a healing, antioscillatory and tonifying frequency and, hence, represents the counterpart to frequency A. Likewise, frequency 7 (hidden dental foci, see p. 185f.) is the counter frequency to frequency F, since the reflex zone of the teeth is located in the resonance zone of frequency F. All other Bahr frequencies can be assigned to a specific Nogier frequency in a similar way. Original Nogier frequencies

Laser frequencies

Bahr frequencies

2.28 Hz

A’

292 Hz

9592 Hz

4.56 Hz

B’

584 Hz

4796 Hz

9.12 Hz

C’

1168 Hz

2398 Hz

18.25 Hz

D’

2336 Hz

1199 Hz

36.50 Hz

E’

4672 Hz

599.5 Hz

73.00 Hz

F’

9344 Hz

299.75 Hz

146.00 Hz

G’

146 Hz

149.875 Hz

Laser vs. Needle and TLA

At this point at the latest, the reader wants to know the laser’s advantages in comparison to needles and/or therapeutic local anesthesia.

Focus Therapy

Basically, foci such as scars and chronic inflammations may be treated with a laser beam. When applied properly, the laser can replace the needle or local anesthetic. This means that a focus can be eliminated without acupuncture needles or infiltration of a local anesthetic. Of course, dental foci, toxic loads, and anything else that is not accessible to therapy by needle or local anesthetic is excluded here as well.

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The Laser in Focus Diagnosis and Therapy 181

Children

A laser is essential for treating children, but it is also justified when treating adults who usually accept needle treatment. There may be areas on the ear where it would be impossible to insert a needle because of inflammatory irritation or the presence of a mole. Now, contact-free therapy is possible with the laser.

Two-Dimensional Treatment

It often happens that a point that has just been pierced with an acupuncture needle turns out to be larger and requires the insertion of additional needles in this zone in order to achieve the best therapeutic effect. The laser beam is more gentle on the patient. Sometimes, the sum of stimuli (needle plus laser) is more effective than the needle alone. Furthermore, there are many opportunities where laser light can be used outside of acupuncture and focus therapy, for example, in cases of cold sores, stasis ulcer, and stomatitis.

Focus Frequency

Frequency A for focus diagnosis and therapy is described first. However, the focus therapist will benefit from including the other frequencies as well. The following description of the potential diagnostic and therapeutic uses of laser light in focus therapy cannot and should not replace comprehensive textbooks or practical training (2, 6, 11, 12, 22, 24, 25, 29). The following provides a first overview of the possible applications and should stimulate further interest in this method.

Application of the Laser Basically, the laser beam can be used for both diagnosis and therapy.

For Diagnosis

For diagnostic purposes, the methods and equipment of Level 2 are ideally applied in addition to the laser, without any changes initially: VAS, 3-volt hammer, perhaps also the 9-volt rod, grounding, tissue layers, cable method. However, the laser can also be used on its own (although the information obtained may be less clear).

For Therapy

The laser is used therapeutically either in combination with the other methods or on its own. Being sometimes only a welcome diagnostic aid, which may be replaced by other methods, the laser is in many cases absolutely essential for therapy (treatment of children, etc., see above).

Laser and VAS

Ideally, the laser is used while monitoring the VAS. The laser beam itself has an extremely small diameter, and treating an ear point “blindly” will not yield an instant result. However, even the beginner may treat an identified point with a laser by screening a larger area with the laser beam. This will just take more time.

Finding Focus Indicator Points with the Laser The Focus Indicator Points, like the foci themselves, respond to frequency A. When irradiated with this frequency, an intense VAS is triggered if the point examined is active.

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182 Practical Application

Fig. 104 Searching for Focus Indicator Points with the diagnostic frequency A.

Weak Laser Beam

For diagnostic purposes, only a very weak laser beam is used so that the active point is not yet treated and, thereby, inactivated or weakened by irradiation that is too intense (the strength of the beam used for therapy is normally 30 mW, while that used for diagnostic purposes is less than 5 mW). The laser beam is released by pressing the diagnosis button of the handle.

Resonance VAS

In the same way as during the diagnosis with 3-volt hammer or indicator ampoules, one examines each individual Focus Indicator Point with a weak laser beam at frequency A while monitoring the VAS (Fig. 104). A resonance VAS obtained over a Focus Indicator Point shows that this point is active, and one must then search for the corresponding focus. The patient is grounded as usual. If the 9-volt rod is used, this is done in addition to the procedure already described, that is, the Focus Indicator Points are searched for in the intermediate tissue layer (9-volt rod in the contralateral hand; see p. 168) with the laser probe replacing the 3-volt hammer.

Body Points

In analogy to the Focus Indicator Points on the ear one may also irradiate the corresponding acupuncture points on the body with the diagnostic frequency A. From the resonance VAS triggered, one can deduce their activity.

Focus Diagnosis with the Laser Replacing the 3-Volt Hammer

Similarly to the method of searching for the focus by means of 3-volt hammer or indicator ampoules (local resonance, see p. 130), one may also search for a focus with the diagnostic laser beam (frequency A). Contact-free examination is performed on the ear surface or directly on the body under VAS control. If the 9-volt rod is used, this is done in addition to the procedure already described, that is, the Focus Points are searched for in the

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The Laser in Focus Diagnosis and Therapy 183

deep tissue layer (9-volt rod in the ipsilateral hand; see p. 168), with the laser probe replacing the 3-volt hammer. Once an active point has been found, it is marked with a fine felt pen as described earlier. Under VAS control, the point is later searched for again with the tip of the needle. It is then located very accurately (within fractions of a millimeter) and needled, or it is treated with the therapeutic laser beam, again under VAS control.

Examining Scars

Fig. 105 Searching for focal disturbances in a scar.

With the diagnostic laser beam one can quickly find out whether there are, for example, several focal disturbances within a scar. The entire scar is screened with frequency A until one or two (or no) sites are found over which a resonance VAS can be triggered (Fig. 105). These sites are marked for future therapy. Here, too, the patient should be grounded during the search.

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184 Practical Application

Focus Therapy with the Laser Intense Laser Beam

The therapeutic laser frequencies (full capacity, usually 30 mW) may be used either alone as exclusive laser therapy or in addition to acupuncture needles. The preferred frequency for focus therapy is frequency A.

Laser Safety Goggles When working with the full laser capacity, both therapist and patient must wear special glasses to protect the retina from the laser beam.

Exclusive Laser Therapy

Fig. 106 Additional treatment with laser of an ear acupuncture point that has already been needled.

Exclusive laser therapy means that the active points are treated exclusively with the laser beam of the appropriate frequency (frequency A for foci or Focus Points) until they are no longer active. In this case, the laser beam replaces the acupuncture needle or infil-

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The Laser in Focus Diagnosis and Therapy 185

tration with local anesthetic. For example, either the ear point corresponding to the disturbing scar or the disturbing site of a scar itself is treated with the laser (this applies to superficial scars only). As mentioned earlier, this noninvasive but highly effective form of therapy has become essential for treating children (up to age 10, I only needle volunteers). Furthermore, the laser allows for contactfree therapy when inflammatory irritation or a mole do not permit needling. The potential applications beyond focus therapy are the same as for ear acupuncture treatment (see p. 204ff.).

Laser as Supplementary Treatment

The laser beam is often used in addition to the usual needle treatment so that a point can be influenced even better, or a symptom complex can be treated quicker and more intensively. For example, the ear point corresponding to a disturbing scar is pierced with an acupuncture needle and then treated additionally with the laser, or the disturbing site of the scar is treated directly with an acupuncture needle or local anesthetic and, in addition, with the laser. Under VAS control, the laser beam is directed to the site of needle insertion (not to the end or shaft of the needle). If an acupuncture point has not been accurately needled, this can be corrected by means of additional treatment with the laser beam (Fig. 106). It also happens that a “point” is really a small zone and should be treated with several needles next to each other. In such a case, one may needle the center of the zone and treat the surrounding area with a laser beam of the appropriate frequency.

Hidden Dental Foci There are foci in the dental region which escape the usual focus diagnosis by means of Focus Indicator Points. The body seems to set them apart from their surroundings in an attempt to control the focal activity. This isolation consumes a huge amount of energy, as is reflected time and again by the energy condition of the patient. This also manifests itself, for example, by the following fact: Once such a hidden dental focus has been treated, the existing overt foci (such as scars) drop two to three levels without having been treated themselves. (This does not apply to the reverse scenario: Treatment of a regular focus does not change the status of a hidden dental focus). If unrecognized, a hidden dental focus can lead to therapy resistance even though excellent acupuncture has been applied. It was not until 1996 that a few special cases in my practice made me aware of the existence of such hidden dental foci (see footnote in Table 8). I also discovered through the laser method the very first chance to diagnose them despite their isolation and to identify the intensity and extent of their focal activity. (A detailed discussion would go beyond the scope of this book.) Subsequently, Bahr found a specific laser frequency which is particularly suitable for diagnosing dental foci: Bahr frequency 7 (see Table 7, p. 180):

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186 Practical Application

Using Bahr Frequency 7

The application is simple: The therapist examines all known Focus Indicator Points with the diagnostic frequency 7 while monitoring the pulse. It is interesting to note that the Focus Indicator Points that respond with a resonance VAS are very different from those found before, although the same system is used as with the usual search for foci. (Normally, active Focus Indicator Points are located with the indicator ampoules—without any laser application—or with frequency A if a laser is used.) If the original examination revealed two foci, for example, one indicated by the Endoxan Point and one by the Vitamin C Point (see Table 8), then it could well be that only the Histamine Point responds to frequency 7 (although it did not respond when examined in the overt system), while all other points would remain silent. Using frequency 7 once again, it is now possible to assign a root-canal-treated tooth to the Histamine Point by directly checking the teeth with the laser while monitoring the VAS. Though we are looking here at the same system of Focus Indicator Points, it is done at a different level of function.

Table 8 Comparison of overt system versus hidden system 1: Different findings in the same patient Focus Indicator Point

Assigned focus (Overt system: ampoules or frequency A)

✓

Master Point for Oscillation (Point K3)

Histamine Point

Endoxan Point

Appendix scar

✓

PGE1 Point Vitamin C Point Laterality Point 1

Focus Indicator Point

Assigned focus (Hidden system: frequency 7)

✓

Dental focus

✓

Endoxan Point PGE1 Point

Tonsils

✓

Vitamin C Point Laterality Point

Strittmatter, B.: Verborgene Zahnstörfelder – häufiger Grund für “unerklärliche” Therapieresistenz in der Akupunktur. Der Akupunkturarzt/Aurikulotherapeut 1997 (1), 20–32 and 1997 (2), 3–12.

Examination with the tooth-specific frequency 7 provides an invaluable opportunity for identifying one disturbing tooth, or several teeth, out of many root-canal-treated teeth. If no Focus Indicator Point responds to frequency 7, one can safely assume that there is no hidden dental focus. In the event that no disturbing tooth is discovered in the overt system either, the patient may well hold on to all his/her root-canal-treated teeth without risking any harmful effects. It is important to examine not only the Focus Indicator Points with frequency 7 but also the Master Point of Oscillation near the ear, which is an indicator for an extremely severe focus. Examination of the Focus Indicator Points with frequency 7 is performed subsequent to the regular focus diagnosis.

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The Laser in Focus Diagnosis and Therapy 187

Complete Examination Procedure

Check for oscillation. Check for inversion on both sides of the body. Determine the handedness. Check for unstable laterality. Locate active Focus Indicator Points as usual. Assign the corresponding focus by using the cable or ampoule method. Up to here, one is already familiar with the procedure; the following steps are new: Search for the Master Point of Oscillation with frequency 7 (if active, assign the focus, needle the corresponding ear point, and reexamine the Master Point of Oscillation). Locate active Focus Indicator Points with frequency 7. Assign the focus in the mouth with frequency 7. Therapy of overt foci (see p. 144) or hidden dental foci (see p. 188ff.). When assigning a hidden dental focus by using the laser in the mouth, the laser probe should be covered with the finger of a glove (see p. 189). Caution: Use laser safety goggles. If more than two Focus Indicator Points respond to frequency 7, one can also expect to find several dental foci when searching in the mouth. One should definitely go to the trouble of determining the most severe of several dental foci, for the most severe focus always leads the entire process. If it is decided that one of the teeth needs to be removed, or corrected conventionally, then it should definitely be the one that disturbs most.

Determining the Most Severe Dental Focus

In the case of hidden dental foci, the ear points are not active (electrically altered) and cannot just be located in the usual way like the overt foci. Rather, they respond exclusively and specifically to laser frequency 7. In order to find out which focus belongs to which Focus Indicator Point, the active Focus Indicator Point found on the ear is irradiated with frequency 7 and the oral cavity is examined with the 3-volt hammer or the corresponding indicator ampoule (cover ampoule with the finger of a glove). One may also use the Tooth Points on the ear to search for the region in which the focus may be found. When the Focus Indicator Point is irradiated with the tooth-specific frequency 7, the corresponding dental focus will reveal itself by responding with a resonance VAS to the 3-volt hammer or the corresponding ampoule.

Therapy of a Dental Focus Following the diagnosis of a focus in the dental region one will want to know how to treat it. It is often not the best solution to send the patient back to the dentist, who usually has deemed the finding in the dental region as inconspicuous. Not every dental focus needs surgical treatment. There is a series of steps for treating a disturbing tooth in a naturopathic context: The first measure is the insertion of an acupuncture needle (or needles) into the Tooth Point on the ear and additional treatment with Bahr frequency 7 at the insertion site of the needle and also over

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188 Practical Application the affected tooth itself. In many cases, this will result in a successive decline in the status of the focus within the hierarchy of Focus Indicator Points. One may conclude from this that the focus becomes less of a burden to the body. The body acupuncture point belonging to the tooth (see Schmid-Bahr points, Table 9), may be needled concomitantly and in support of the ear acupuncture treatment. Table 9 Tooth Points on the body according to Schmid and Bahr, a tool for detecting and treating dental foci KI 3

LU 1

GB 1

HT 4

KI 7

GB 30

GB 43

LU 7

ST 41

GB 30

K 7

HT 4

GB 1

LU 1

KI 3

Yin BL Tang 11

LI 15

KI 6

BL 67

PC 6

LI 4

BL 62

LI 4

PC 6

BL 67

KI 6

LI 15

BL 11

Yin Tang

Once the focus intensity of the hidden dental focus has come down to Type 5 (Laterality Point as Focus Indicator Point) by repeated treatment, further acupuncture needles on the ear will usually push it into the overt system, thus making it appear during the subsequent session as a focus of the Histamine Type. (Incidentally, this clearly confirms the priority of dental foci in the hidden system over foci in the overt system). At least after three acupuncture treatments by means of reflex points on the ear (Tooth Points) and the corresponding body acupuncture points (Schmid-Bahr points) one is able to decide whether or not the burdening effect of the tooth on the body can be positively influenced. In the event that always the same corresponding Focus Indicator Point is found in each session it may be assumed that dental sanitation is inevitable if one wants to free the body from this burden. Prior to the decision to remove the tooth one should consider root resection, if anatomically possible at this site. In many cases, removal of the inflamed tip of the root really does weaken the disturbing effect of such a tooth, at least to a point at which the tooth does not have to be sacrificed and the body can tolerate it well. It should not be overlooked that removal of any tooth might affect occlusion and, furthermore, that the construction of a bridge usually necessitates intervening measures at otherwise healthy neighboring teeth. In any event, root resection should be followed by ear acupuncture treatment (insertion of a needle into the reflex point on the ear and/or Schmid-Bahr point on the body, checking whether the focus drops to a lower level of intensity). If even a root resection does not have the desired effect, then the tooth must be finally removed. Of course, the effect of tooth removal should be measurable not only in the evaluation of the focus via

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Focus Indicator Points but also in the decline of physical symptoms triggered by the tooth. A clean scrape-out of the alveolus prevents residual focal activity in the empty section of the jaw, especially when the tip of the root showed cystic alteration. In any case, a follow-up treatment by ear acupuncture at the corresponding reflex points should subsequently be performed several times. For the experienced acupuncturist there are other potential ways of influencing a dental focus, for example, with certain nosodes (special homeopathic remedies) or with flower essences. It seems even more important to treat a dental focus in the hidden system than a focus in the overt system, as the body obviously spends tremendous energy in tolerating this disturbance.

Unfortunately, so far, no alternative to laser has been found for diagnosing isolated or hidden dental foci.

Equipment Most of the commercially available lasers are intended for both focus therapy and laser therapy in acupuncture. This means that they can be set to all Nogier frequencies and all Bahr frequencies.

Lasers for Focus Therapy

A smaller device that has only the frequencies A, B, and C is sufficient for those who want to deal exclusively with focus therapy (e. g., ABRA by schwa medico, see p. 237). Frequency C is also used for treating Symptom Points of the locomotor system, in addition to focus therapy. Frequency B is also used for treating nutritional disturbances and for influencing organ functions through the reflex zones of ear acupuncture (e. g., Lung Zone in the case of bronchial asthma). If the Allergy Point 1 (Histamine Point) is found to be active, frequency C offers a valuable opportunity to differentiate between its function as Focus Indicator Point and as the true allergy reflex zone of an allergic person, especially if the point is active in the intermediate tissue layer. If the active Allergy Point 1 acts as Focus Indicator Point, it will respond with a resonance VAS to frequency A. If it acts “only” as allergy reflex zone, it will respond to frequency C. In the case of double function, it will respond to both frequencies. (Depending on its function, an acupuncture point may have different responses to different frequencies.)

Lasers for Acupuncture

It is worth contemplating whether one might also begin to use acupuncture some time in the future, for in that case all the other frequencies are essential for therapy. For this purpose, various lasers are available that are comparable to one another, if certain principles are adhered to. The wavelength of the laser beam and how the beam is generated (e. g., helium—neon or gallium—arsenide lasers) are not the only factors important for diagnosis and therapy in ear and body acupuncture (a wavelength of slightly more than 900 nm is particularly suitable). More important and absolutely essential for the purpose of the application in question are frequency precision, quartz stability, and output power.

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190 Practical Application

Fig. 107 Commercially available laser with basic functions (for sources, see p. 237).

Essential Properties

Ideally, a laser for acupuncture should have the following properties:

all Nogier frequencies A–G, all Bahr frequencies 1–7, adjustable constant power output of 5–30 mW, and a pulse power of 5–30 W (Fig. 107).

Diagnostic Button

Although a diagnostic button does come in handy, a device without one is often less expensive. The button is not absolutely essential if the therapist is able (and willing) to adjust the output on the device—which requires reaching over to the device on the table rather than being able to adjust the output directly on the handle of the probe.

Time Switch Is Not Essential

A timer, that is, a digital time switch for setting the duration of the therapy, is certainly a part of the device one can do without. There are no fixed treatment periods. While monitoring the VAS, the therapist must decide whether an ear point or zone still needs treatment (between 30 seconds and several minutes).

Nonspecific Frequencies Are Unsuited

Universally employable devices with one or two nonspecific frequencies are in no way suitable for our purpose. When working on the ear (and the body), we take advantage of the phenomenon of biological resonance for which specific frequencies are essential, just as they are for the reception of radio waves.

Precision and Stability

Of course, all devices—including high-powered manual lasers— should have perfect frequency precision. Any precision up to and including the first position after the decimal point, combined with frequency stability, is normally only provided by specially cut and

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Fig. 108 Dental probe of a laser.

produced quartz crystals, but not by a (less expensive) standard quartz. New quartz crystals may change the emitted frequencies after several hundred hours in operation due to aging characteristics, that is, they are not stable in frequency. Specially prepared quartz crystals are artificially aged in order to prevent this from happening. In some devices the frequencies produced by microprocessors show deviations of up to 1.6 Hz during test measurements. This is not precise enough for effective therapy, and one should speak to the manufacturer about the matter.

Dental Probe

A dental probe (a curved, elongated probe, similar to that of a Heine lamp) is highly recommended for dentists and perhaps also for ear, nose, and throat specialists, because all affected structures in the oral region can then be treated directly rather than through the reflex zones on the ear (Fig. 108). After a while such a probe will be of interest even for nondentists. We often have to deal with dental foci, and a diagnosis in the mouth is often impossible with the normal short probe. The dental probe is not only well suited for local irradiation of inflammatory or other processes in the mouth, but also for direct identification of a disturbing tooth (e. g., the identification of a dental focus found by screening the ear reflex zones; Fig. 109). To protect the laser probe inside the oral cavity, the finger of a glove is pulled over the tip of the probe. (Fingers of a glove are often too narrow; more practical are the rubber sheaths from vaginal ultrasound heads. However, it is sufficient to use a small regular plastic bag which is then discarded).

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Fig. 109 Diagnosing dental foci with the dental laser probe.

The dental probe may also be used for treating points on the ear, it just requires some time to get used to.

Dual Laser

A dual laser (with two laser probes) should be considered only if one plans to commit a larger portion of one’s daily work to acupuncture. Furthermore, one laser probe is initially sufficient unless one has scientific ambitions. Often the ordinary version of a laser can later be equipped with a second probe so that this problem does not have to be addressed immediately (one should inquire when purchasing a devise).

Programmable Frequencies

Freely programmable frequencies are certainly very interesting for experiments and research in one’s practice, but they should remain a luxury of more ambitious colleagues. So far, there has never been a need for them in my own practice.

Pulsed Laser

Almost all table-top devices are pulsed lasers, while hand-held lasers of the same nominal intensity are continuous wave lasers. Pulsed lasers are in any case better suited to our purposes since— due to their relatively high peak output—the optimum is obtained not only from the resonance effect of a specific frequency but also from the biological effect of the intense laser light itself.

Therapeutic Objectives Determine Which Device Is Purchased

In conclusion, the purpose or aim of the therapy should influence one’s decision when purchasing a laser:

If one wants to do focus therapy, nonspecific frequencies (of a “universal” device) are unsuitable, also for body acupuncture.

If one wants to take advantage of laser treatment also in the field of symptom treatment (through ear acupuncture), one should purchase a device with all Nogier and Bahr frequencies. Pulsed lasers are biologically more active than continuous wave lasers with the same power output and are therefore preferable.

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If one is toying with the idea of later exchanging an ordinary device for a dual laser, it is recommended that one starts with a large casing that can be retrofitted with a second laser probe. If one wants to treat children, a laser will become essential in the long run.

Second-Hand Lasers

A good source for purchasing one’s first laser is certainly the second-hand exchange column in magazines published by various acupuncture associations, such as the journal published by the German Academy of Acupuncture and Auriculomedicine (see p. 236).

Laser Safety Goggles It is absolutely essential to purchase two pairs of laser safety goggles (one for the patient and one for the therapist).

Service

Finally, one aspect should not be neglected when purchasing a laser: It is recommended that one inquires with the laser manufacturer or marketing company whether there are service technicians in one's area. Does the device have to be shipped to the company for the safety inspection of medical devices, or will a technician drop by? In case of repair, will a replacement laser be provided within 24 hours so that the therapy of the patient is not interrupted? This is especially important if certain office hours have been reserved for laser therapy and needles cannot be used instead (e. g., in children).

References 1. Airaksinen, O., Rantanen, P., Kolari, P. J., Pöntinen, P. J.: Effects of infra-red laser irradiation at the trigger points. Scand. J. Acupunct. Electrother. 3 (1988) 56–61 2. Bahr, F.: Systematik und Praktikum der wissenschaftlichen Ohrakupunktur für Fortgeschrittene (Stufe 3). Self-published, Munich 1995 3. Barnes, J. F.: Electronic acupuncture and coldlaser therapy as adjuncts to pain treatment. J. craniomandib. Pract. 2/2 (1984) 148– 152 4. Basford, J. R.: Low-energy laser treatment of pain and wounds: hype, hope or hokum? Mayo Clin. Proc. 61/8 (1986) 671–675 5. Basford J. R., Sheffild, C. G., Mair, S. D., Ilstrup, D. M.: Low energy helium neon laser treatment of thumb osteoarthrits. Arch. phys. Med. 68/11 (1987) 794–797 6. Bischko, J.: Handbuch der Akupunktur und Auriculotherapie. Ergänzungswerk aus dem Ludwig-Boltzmann-Institut für Akupunktur. Technische Hilfsmittel und Kombinationsmöglichkeiten. Broschüre 23.2.2: Bahn, J.: Laser- und Infrarotstrahlen in der Akupunktur. 4th ed., Haug, Heidelberg 1990 7. Bilddal, H., Hellesen, C., Ditlevsen, P., Asselberghs, J., Lyager, L.: Softlaser therapy of rheumatoid arthrits. Scand. J. Rheumatol. 16/4 (1987) 225–228 8. Brunner, R., Haina, D., Landthaler, M., Waidelich, W., Braun-Falco, O.: Applications of laser light of low power density. Experimental and clinical investigations. Curr. Probl. Dermatol. 15 (1986) 111– 116 9. Choi, J. J., Skrikantha, K., Wu, W. H.: A comparison of electroacupuncture, transcutaneous electrical nerve stimulation and laser photo-biostimulation on pain relief and glucocorticoid excretion. A case report. Acupunct. Electro-Ther. Res. 11/1 (1986) 45–51

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194 Practical Application 10. Cornelius, W. A.: Application of lasers in medicine. Aust. phys. Engng Sci. Med. 6/3 (1983) 100–105 11. Danhof, G.: Lasertherapie in der Allgemeinmedizin. WBV, Schorndorf 1991 12. Danhof, G.: Lasertherapie in der Sportmedizin und Orthopädie. WBV, Schorndorf 1993 13. Flöter, T.: Laser in the management of chronic pain. Preliminary results with a power laser. Scand. J. Acupunct. Electrother. 2 (1987) 73–75 14. Flöter, T., Rehfisch, H.-P.: Pain treatment with laser: A double blind study. Acupunct. Electro-Ther. Res. 13/4 (1988) 236–237 15. Funke, L. A.: Laserakupunktur, eine Alternative in der Schmerztherapie. In: Akupunktur – Theorie und Praxis, published by: Deutsche Ärztegesellschaft für Akupunktur. 4 (1986) 242–252 16. Gallachi, G., Müller, W.: Akupunktur und Laserstrahlenbehandlung beim Cervical- und Lumbalsyndrom. Z. phys. Med. 10 (1981) 95– 102 17. Kamikawa, K., Tawa, M.: Clinical application of low-intensity lasers. 3. Therapy of pain and inflammation. Nippon Rinsho 45/4 (1987) 756–761 18. Kolari, P. J., Hietanen, M., von Nandelstadh, P., Airaksinen, O. Pöntinen, P. J.: Lasers in physical therapy: Measurement of optical output power. Scand. J. Acup. Electrother. 3 (1988) 96–102 19. Kreczi, T., Klingler, D.: A comparison of laser acupuncture versus placebo in radicular and pseudoradicular pain syndromes as recorded by subjective responses of patients. Acupunct. ElectroTher. Res. 11/3–4 (1986) 207–216 20. Lehmacher, W.: Verlaufskurven und Crossover. Statistische Analyse von Verlaufskurven im Zwei-Stichproben-Vergleich und von Crossover-Versuchen. Springer, Berlin 1987 21. Lundeberg, T., Hode, L., Zhou, J.: A comparative study of the painreliefing effect of laser treatment and acupuncture. Acta physiol. scand. 131/1 (1987) 161–162 22. Mastallier, O.: Reflextherapien in der Zahn-, Mund- und Kieferheilkunde. Quintessenz, Berlin 1991 23. Miehle, W.: Umstrittene und sogenannte außerschulische Therapieansätze. Z. Rheumatol. 46/1 (1987) 1–12 24. Müller, G. J., Ertl, T.: Angewandte Laser-Zahnheilkunde. Lehr- und Handbuch für die Praxis und Klinik. ecomed, Landsberg 1995 25. Pöntinen, P. J., Pothmann, R.: Laser in der Akupunktur. Hippokrates, Stuttgart 1993 26. Porges, P., Dirnberger, H., Bader, R.: Laserbehandlungen des Kopfschmerzes. In: Kopfschmerzen: zur Diagnostik und Therapie von Schmerzformen außer Migräne. Editor: H. Tilscher, P. Wessely, M. Eder, P. Porges und F. L. Jenkner. Springer, Berlin 1988 27. Ratanen, P., Airaksinen, O.: Laser effects on the pressure pain in healthy subjects. Scand. J. Acup. Electrother. (1988) 51–55 28. Schaffler, K., Rother, W.: Laser in der Medizin. Dtsch. Ärztebl. 21 (1978) 1245–1249 29. Schmid, H.-D., Nagel H., Bahr, F.: Akupunktur in der Zahn-, Mundund Kieferheilkunde für Anfänger und mäßig Fortgeschrittene. Self-published, Munich 1996 30. Schwing, C.: Dichtung und Wahrheit beim „Soft-Laser“. Behauptete „Biostimulation“ des athermischen Lasers – Streichung der Vergütungsfähigkeit. Fortschr. Med. 105/14 (1987) 78–79 31. Schwing, C.: Laser geringer Leistung, Humbug oder therapeutisches Licht? Therapiewoche 39 (1989) 3637–3644 32. Seichert, N., Schöps, P., Siebert, W., Schnitzer, W., Lieberneister, R.: Wirkung einer Infrarot-Therapie bei wichteilrheumatischen Beschwerden im Doppelblindversuch. Therapiewoche 37 (1987) 1375–1379

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The Laser in Focus Diagnosis and Therapy 195 33. Senda, A., Gomi, A., Tani, T., Yoshino, H., Hara, G.: A clinical study on “soft-laser 632” a He-Ne low energy medical laser. 1.: Pain relief immediately after irradiation. Aichi Gakuin Daigaku Shiagakkai Shi 23/4 (1985) 773–780 34. Siebert, W., Seichert, N., Siebert, B., Wirth, C. J.: What is the efficacy of “soft” and “mid” lasers in the therapy of tendinopathies? A double-blind study. Arch. orthop. traum. Surg. 106/6 (1987) 358– 363 35. Stelzl, I.: Fehler und Fallen der Statistik. Beltz, Weinheim 1982 36. Trelles, M. A., Mayayo, E.: Bone fracture consolidates faster with low-power laser. Lasers Surg. Med. 7/1 (1987) 36–45 37. Walker, J.: Relief from chronic pain by low power laser irradiation. Neurosci. Lett. 43 (1983) 339–344 38. Waylonis, G. W., Wilke, S., O’Toole, D., Waylonis, D. A., Waylonis, D. B.: Chronic myofascial pain: management by low-output heliumneon-laser therapy. Arch. phys. Med. 69/12 (1988) 1017–1020 39. Zimmermann, M.: Schmerzbehandlung in der Zahn-, Mund- und Kieferheilkunde mit dem Softlaser. Quintessenz 36/6 (1985) 1137– 1139

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Other Applications of the Vascular Autonomic Signal VAS in Orthopedics Normally, the exact localization of an irritated structure in the locomotor system is only possible through a detailed and skilled manual examination. A targeted therapy by infiltration can only be performed once the site of pain has been accurately located (e. g., blockage of a facet joint, irritation of a ligament insertion).

Fig. 110 Searching for muscular trigger points while monitoring the VAS.

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VAS Control Instead of Manual Diagnostics

However, not every physician has a complete command of manual diagnostics (chirodiagnostics). The vascular autonomic signal method enables the general practitioner who is unfamiliar with the procedures of manual diagnostics to carry out a detailed examination of patients with complaints related to the locomotor system. Similar to the situation with active ear points, the electrical potential of the skin covering zones of pain or inflammation is basically altered as well. Therefore, such points or zones can be accurately located with the 3-volt hammer. For example, the affected tendon of the shoulder or the center of a muscular trigger point can be precisely located by monitoring the VAS. Such targeted localization of affected structures can spare the patient the intake or injection of anti-inflammatory agents or the production of an unnecessarily high number of wheals over the affected area. The VAS method is very efficient and can be integrated into one’s daily practice in order to save time. This is true not only for the orthopedic specialist but also for every other physician treating disorders of the locomotor system. The following examples illustrate the use of VAS in the daily routine of an ordinary practice.

Muscular Trigger Points

Muscular trigger points can be quickly found and their centers precisely located with the tip of the 3-volt hammer. As described on page 140, there is normally also a resonance with the local anesthetic so that a VAS may be obtained when searching with the respective ampoule over the electrically altered region (Fig. 110).

Deep Infiltration

As already discussed in detail on page 148ff., a strong VAS response is obtained when the tip of the injection needle reaches the center of a disturbing scar or muscular trigger point deep in the tissue. When the needle is inserted too deep, the VAS becomes weaker (Fig. 111). Only when the needle is slightly withdrawn so that its tip again reaches the center can the maximum VAS be obtained once more. A few drops of local anesthetic are deposited at this very site. This method leads to a considerable saving of local anesthetic, for already a few drops in the center can dissolve the hardened zone. It goes without saying that, in the thoracic region, deep infiltration of a trigger point or any other structure should definitely not be performed with one hand while palpating the pulse with the other. Even when using both hands, deep infiltration should only be carried out by a skilled practitioner and only while using a special two-finger safety method.

Blockages of the Vertebral Column

Blockages of the vertebral column can also be found with the VAS method, even clinically silent counterblockages. In particular, clearly defined thoracic or lumbar pain is often due to blockage of a facet joint (pain induced by rotational movement, pain while breathing). These blockages—as well as the counterblockages that are usually present at other sites of the vertebral column—can be easily located with the 3-volt hammer while monitoring the VAS.

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Fig. 111 a Needle tip inserted exactly into the center of a trigger point: maximal VAS response. b Needle tip inserted too deep: no VAS response or only a moderate one.

Counterblockages serve to maintain the overall statics of the vertebral column blocked at one site, and they are usually clinically silent. Only very experienced chiropractors are able to find them without using the VAS (e. g., main blockage of C7 on the right— counterblockage of C0 on the left, sacroiliac joint on the left). However, if left untreated, the success of treating the main blockage (by manual therapy or infiltration) may be jeopardized, and there will be a relapse.

Pain in the Shoulder

If tendopathies of the abductor (supraspinatus muscle), external rotator (infraspinatus muscle), or internal rotator (subscapularis muscle) are present, a distinct resonance VAS will be obtained at the respective insertion site of the tendon (greater or lesser tubercle of the humerus) because of the local inflammation (Fig. 112). Diagnostic infiltrations into these areas can confirm one’s own diagnosis as they cause immediate freedom from pain (the rotatory cuff insertions lie outside the joint capsule, which allows one to insert the needle up to the point where the bone is contacted). The trigger points of the affected muscle should be infiltrated as well (they are not always reported to be painful and may need to be located by palpation or with the 3-volt hammer).

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Fig. 112 VAS-controlled search for the center of an inflammatory tendinopathy in the shoulder region.

Pain in the Knee

In the event that the examination yields unclear findings, the VAS is checked after palpation of the knee: ventral to the tibial collateral ligament, above the inner joint space (medial meniscus), above the patella, and above the insertions of the superficial adductors of the thigh on the tibia (pes anserinus superficialis) (Fig. 113). Intense VAS responses clearly indicate where the pain originates. For example, if a vigorous VAS is obtained over the muscular insertions on the medial head of tibia (pes anserinus superficialis, which forms the insertions of the sartorius, gracilis, and semitendinosus muscles), diagnostic infiltration with a local anesthetic can quickly provide an answer as to whether or not the infiltrated structure was the cause of the pain. If the patient becomes immediately free

Fig. 113 VAS-controlled infiltration of muscle insertions in the region of the pes anserinus superficialis.

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200 Practical Application of pain, there is certainly no damage to the meniscus and no other disturbance in the region of the joint.

Pain in the Hip

In addition to being helpful during the clinical examination, the VAS method is an excellent complement when it comes to differentiating pain in the hip joint, tendinopathies near joints, and irritation of the bursa near the trochanter (trochanteric bursitis). The zones are examined individually with the 3-volt hammer or with an ampoule containing a local anesthetic while monitoring the VAS.

Trigger Points of the Neck Muscles

The trigger points of the neck muscles can be accurately found on the occiput. They often cause headaches. Exact localization and infiltration can alleviate or eliminate tension-related headache. The list of examples is potentially endless—descriptions of the different VAS-controlled methods applicable in the area of the locomotor system alone would fill a textbook. The interested practitioner should pursue further practical training by taking the appropriate courses (see p. 233ff.).

VAS in Neural Therapy As already described in detail, the electrical potential of the skin overlying the areas of pain or inflammation is altered in a similar way as in the case of active ear acupuncture points. Hence, such points or zones can be accurately located with the 3-volt hammer or by using the resonance with an ampoule containing a local anesthetic.

Precisely Targeted Injections

The methods of neural therapy or therapeutic local anesthesia (TLA) partially overlap with the previously described methods of VAS-controlled diagnosis and infiltration used in an orthopedic practice. A good neural therapy can manage with very few, but precisely targeted injection sites. VAS diagnosis makes it possible to save up to 90 % of the commonly applied injections and, thus, 90 % of the local anesthetic. The main methods are:

superficial intracutaneous injections (whealing method), infiltration of muscular trigger points, infiltration of the insertions of tendons and ligaments, infiltration of facet joints of the vertebral column (blockages), deep infiltration at the sympathetic trunk, nerve roots, and ganglia, deep infiltration into body cavities (e. g., in the gynecological region) and joints, and focus therapy. The VAS-controlled neural therapy or TLA can normally manage sufficiently with the three first-mentioned methods. The beginner may already have considerable success just by superficial infiltration. The infiltration of facet joints requires some basic knowledge of palpation and should not be performed autodidactically by beginners, especially not in the region of the thoracic spine. Deep in-

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Fig. 114 Intracutaneous wheals over blocked facet joints of the thoracic spine.

filtration at nerve structures, in body cavities, and in joints should be left to training in special courses and under individual instruction.

Fewer Wheals

However, targeted neural therapy can do without deep infiltration, particularly when focus diagnosis is used. Blockages of facet joints can often be dissolved by producing an accurately located, strictly intracutaneous wheal in the corresponding zone of the skin (Fig. 114). The usual series of wheals on both sides of the vertebral column (often more than 10 wheals) can be avoided by locating and infiltrating the exact point in the affected area of the skin under VAS control. The method of producing wheals by intracutaneous injection is very effective and, nevertheless, completely harmless—provided the local anesthetic is tolerated by the patient. Unfortunately, it is the most painful of all injection methods. The patient will appreciate every single wheal that can be avoided. The targeted infiltration of muscular trigger points or insertions of tendons or ligaments is described in detail on page 197ff.

A More Targeted Search for Foci

In contrast to the VAS-controlled search for a focus, the diagnosis of a focus in classical neural therapy is based exclusively on the patient’s history: The practitioner infiltrates all potential foci on a trial basis and then waits for the effect of the treatment. In this way, it may take some time until the actual focus is located because every scar and every suspicious tooth must be treated one after the other. Foci located inside the body cannot be treated at all, and foci not recorded in the patient’s history will not be included in the infiltra-

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202 Practical Application tion treatment that is performed on a trail basis. Because trial extraction of a suspicious tooth is out of the question, a diagnostic infiltration is placed near the root of the tooth. However, the result is often not sufficiently convincing to justify an extraction. Ideally— and at the latest when there has been resistance to treatment by other measures—a VAS-controlled search for the focus is performed, if possible, by taking advantage of the Focus Indictor Points according to Bahr (see p. 115ff.).

VAS in Allergy Treatment The more advanced user of VAS is able to test very accurately and reliably for food intolerance or allergies, especially in areas where the commonly used tests are no longer completely reliable.

Food Allergy (Gastrointestinal Allergy)

Food allergies not only occur in patients with diseases associated with a set of allergic symptoms. Like focal disturbances, food allergies may be the reason why a disease develops or becomes chronic, or why it becomes resistant to treatment. Especially when treating a disease with ear acupuncture, it may be very helpful to dedicate some time to this problem. In many cases, the stability of the therapeutic success and also the overall rate of healing can be considerably improved. The underlying causes of resistance to treatment, which may be observed once in a while, are often found to be associated with food allergies or intolerance. It is not important for the therapy to distinguish between true food allergies and food intolerance—the clinical consequences are very similar. It is important, though, that these conditions are recognized at all in order to give the patient a chance to remove the burden from his/her system by avoiding particular food items.

Skin Diseases, Asthma

Food allergies are frequently associated with neurodermatitis and also with psoriasis and other skin diseases (such as unclear eczema and acne vulgaris). They also play an important role in bronchial asthma, as several studies have impressively demonstrated (1).

Allergies

Patients with pollen allergy (hay fever) or other allergies often are even more sensitive to inhalants or contact allergens if they also suffer from intestinal allergies. Here, again, it makes sense to search for and eliminate the offending allergens. The success then usually lasts much longer and can be achieved with far fewer acupuncture sessions. Of course, the guidelines for a proper diet apply here like in all other diseases and even in healthy individuals (see p. 88).

Headaches

Food allergies may also cause migraines or headaches that do not respond to skillfully applied ear acupuncture based on a targeted search for the focus.

Intestinal Disorders

Intestinal allergies are almost always responsible for long-term chronic diarrhea. Consequent avoidance of the allergens usually leads to complete remission. In the case of ulcerative colitis or Crohn’s disease, the elimination of allergenic food results in faster

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and long-lasting healing (adequate focus therapy and, above all, the elimination of amalgam are a prerequisite in all cases).

Avoiding Provocation Tests

Targeted testing can eliminate the need for costly exploratory diets or oral provocation tests that are very stressful for the patient. Furthermore, careful testing can often result in abandoning some of the restrictions that physicians and naturopathic doctors had recommended to the patient as a prophylactic measure. The VAS-controlled testing is therefore not only a possible option but often also the precondition for identifying intestinal allergens.

Drugs and External Remedies

Suitability or unsuitability of external remedies (ointments, cremes, etc.) can be tested, and drug tolerance can be determined. This way, uncomfortable side effects as well as the purchase of often costly substances can be avoided. The methods required for VAS-controlled allergy testing are only taught in the ear acupuncture course for the well advanced (see p. 234).

VAS in Dentistry Monitoring the VAS has now become an important method also in dentistry. In the context of adjuvant acupuncture, for example, the VAS method is used before, during, or after dental treatment (in cases of gingivitis, periodontitis, disturbed wound healing, or pain). Testing for dental foci by means of VAS monitoring is described on page 127f. and, in combination with laser frequency 7, on p. 185ff.

Testing Dental Material

Another important area of application is the testing of dental material. Intolerance or allergy to certain dental materials are increasingly causing problems in the dental practice. An allergy to a single component of a dental prosthesis may sometimes cause such problems to the patient that the entire denture needs to be removed. Here, VAS-controlled testing offers a valuable opportunity to test for the intolerable component out of all the individual components of the alloy in question; ideally, this should be done prior to dental treatment, that is, before committing to a major financial investment. Individual components of the denture, such as adhesives, cements, or plastics, can also be tested for tolerance. The methods required for VAS-controlled testing of dental material are only taught in the ear acupuncture course for the well advanced (see p. 234).

References 1. Hofmann, T., Hanasz-Jarzynska, T.: Die Bedeutung von Nahrungsmittelallergien bei kindlichem Bronchialasthma. EAACI, Paris 1992

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Other Applications of Ear Acupuncture For those who want to use the full range of ear acupuncture, the following options are available:

symptomatic therapy focus diagnosis and therapy functional or constitutional therapy.

Symptomatic Therapy When dealing with diagnosis and therapy by means of ear acupuncture, tackling the reflex zones of the ear surface becomes unavoidable. From here, it is only a small step to supplementary symptomatic therapy by means of ear acupuncture. In the case of pain or inflammation, the ear points belonging to the affected region are electrically altered and, hence, can be detected with the point-finder or the vascular autonomic signal method.

Pain Management

The symptomatic management of pain is especially easy for beginners to understand. As a rule, the active Symptom Points in the respective reflex zones are located on the ear and then needled (or treated with the laser). By considering the combined symptoms of a disease as the trouble spot through which a focus manifests itself, effective stimulation of the diseased organ (i. e., the trouble spot) becomes possible—in addition to focus therapy by means of ear acupuncture.

Level 1

The beginner searches for the Symptom Points on the ear with the point-finder, as described in detail on page 60ff. This is followed by inserting needles into the points previously marked. Pain Points and Symptom Points are usually Gold Points and require gold needles. The needles remain in the ear for about 20 minutes.

Focus Diagnosis and Therapy In principle, the focus therapy as described below should be an integral part of every acupuncture treatment. Of course, a purely symptomatic treatment is also possible. However, the therapeutic success is usually hampered if intense foci are present. As a result, freedom from symptoms may be delayed or not achieved at all, or once achieved, it may not last long enough.

Level 2

The advanced practitioner searches for Symptom Points with the 3volt hammer while monitoring the VAS, as described on page 114ff. However, the diagnosis should not do without the preliminary examination described in detail on page 135ff. Immediately following the preliminary examination comes the search for Symptom Points, then the search for foci, and finally, the treatment of both symptoms and foci by inserting gold needles into the ear points lo-

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cated. Symptom Points should always be needled first, that is, before the Focus Points, because needling of a Focus Point may silence or weaken the Symptom Point so that it becomes difficult or even impossible to locate it on the ear with the VAS method. The needles remain in the ear for about 20 minutes.

Functional or Constitutional Therapy Functional Points

Depending on the symptoms, Functional Points may be used in addition to other ear points, for example, the Allergy Point (in the case of genetic predisposition to allergies), the Laterality Point, energizing points (such as Point Zero and Point GV 4), or Psychotropic Points. The following is a treatment example for hay fever (pollen allergy), where even the beginner may have good therapeutic success (Fig. 115). Focus diagnosis and therapy should be performed in addition to this. Depending on the complaints, Nose Point and Eye Point (or perhaps the Lung Zone) may also be needled.

Only Active Points Are Needled

In principle, one should never treat according to a set pattern. Only those points that have been found to be active should be needled. Any suggestions for treatment, including those in textbooks, can only give an idea as to which points should be examined for activity (1, 5, 7).

Fig. 115 Hay fever as an example of treatment: 1 Allergy Point 2 Interferon Point 3 Nose Point 4 Eye Point 5 Thymus Gland Point

Indications for Ear Acupuncture Therapy It goes without saying that, prior to acupuncture treatment, one should always carry out a thorough patient history, physical examination, and, if necessary, the usual diagnostic laboratory tests and imaging procedures.

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206 Practical Application Provided these preconditions are met, the disorders listed below can be treated with ear acupuncture.

Pain of a Functional Origin

Pain in the locomotor system, internal organs, urogenital region, proctologic region, and ear, nose, and throat region; pain due to inflammation or injury.

Headache, Migraine

Strictly speaking, these have a functional origin as well. They are rewarding indications because some basic treatment can achieve lasting freedom from pain, even for several years.

Trigeminal Neuralgia

Trigeminal neuralgia and other conditions of pain in the head region.

Allergies

All diseases that are associated with a set of allergic symptoms, such as hay fever, allergic eczema, or neurodermatitis. Hay fever is a rewarding indication for acupuncture; even beginners can usually achieve a success rate of about 80 % (provided they use the method properly). Success in this context means that the patient is needled two or three times per season and then remains free of symptoms for the rest of the season. Especially in children, ear acupuncture provides an ideal and well tolerated way of treatment (for noninvasive laser therapy, see p. 181).

Gastrointestinal Diseases

Gastritis and florid ventricular or duodenal ulcer respond very quickly to ear acupuncture, provided the needles have been placed correctly. Needling the ear reflex zones not only alleviates the pain but also promotes the healing of the ulcer. Obstipation can also be positively influenced if accompanied by the usual dietary measures.

Bronchitis, Asthma

These can be easily treated by ear acupuncture, especially in children.

Susceptibility to Infections

This can be easily treated especially in children. The normal number of infections per year (six to eight) can be considerably reduced by ear acupuncture treatment.

Irritable Bladder, Prostatopathy, Singultus

These are often stubborn problems after surgery and usually difficult to treat with conventional methods (6).

Hormonal Disorders, Fertility Disorders

Difficult menstruation and menopausal complaints as well as female and male fertility disorders can be easily treated with ear acupuncture (4).

Morning Sickness

Ear acupuncture represents the ideal form of therapy for complaints during pregnancy.

Glaucoma, Hypertension

Here, ear acupuncture should only be used under regular control of both eye pressure and blood pressure and only as a measure accompanying the drug treatment. Medication should only be reduced after the pressure has decreased and, in the case of glaucoma, exclusively in consultation with the ophthalmologist.

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Addiction Treatment Nicotine withdrawal, obesity treatment. Depression, Insomnia

In cases of depression, anxiety, and feeling of oppression, adjuvant therapy by needling the Psychotropic Points of ear acupuncture has a mood-enhancing effect. It is also effective in cases of insomnia.

Focal Disturbances

For locating and eliminating foci that otherwise would block symptomatic treatment. Ear acupuncture provides a unique opportunity for the external treatment of foci located inside the body.

Emergency Treatment

Auriculotherapy is certainly also suitable as initial pain management in emergency cases, when other measures are not yet at hand, such as a sprained ankle at the beach, a finger hit by a car door, and an acute biliary colic or renal colic (3). In case of injury, the corresponding ear points become immediately pressure sensitive in contrast to the surrounding ear surface. In an emergency, palpating the respective ear zone with the end of a match may be sufficient to locate the precise ear acupuncture point, and the point can then be treated by massage. In many cases, alleviation of pain or even freedom from pain can be achieved by this very simple method. Even for this primitive method, a detailed knowledge of ear reflex zones is the prerequisite for locating the respective point. One must know the exact location of the reflex zone (e. g., for the ankle joint) in order to be able to find the location of the very point that corresponds to the injury.

Contraindications for Ear Acupuncture Therapy Generally unsuitable for ear acupuncture are metabolic disorders (such as diabetes mellitus), carcinoma, seizures, psychoses, and infectious and sexually transmitted diseases. As a rule, the Hormone Points must not be needled during pregnancy. However, a skilled gynecologist can achieve a lot even here, for example, by needling Hormone Points in the event of imminent abortion (2).

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References 1. Bahr, F., Zeitler H.: Akupunktur in der täglichen Praxis im Bereich der Ohr-, Körper- und Schädelakupunktur – empfehlenswerte Punktprogramme mit Kommentaren. Self-published, Munich 1989 2. Bauermeister, B.: Ohrakupunktur bei Blutungen in der Schwangerschaft. Der Akupunkturarzt/Aurikulotherapeut 1 (1995) 34–35 3. Dahlhausen, P.: Rasche Schmerzfreiheit bei akuter Nierenkolik. Der Akupunkturarzt/Aurikulotherapeut 3 (1996) 39–41 4. Gerhard, I.: Wirkung der Akupunktur bei männlichen Fertilitätsstörungen. Der Akupunktarzt/Aurikulotherapeut 5 (1992) 3–16 5. Linde, N.: Ohrakupunktur, Leitfaden für Theorie und Praxis. Sonntag, Stuttgart 1994 6. Permal, P.: Behandlung des therapieresistenten, postoperativen Schluckaufs mit Ohrakupunktur. Der Akupunkturarzt/Aurikulotherapeut 2 (1991) 5–14 7. Rubach, A.: Propädeutik der Ohr-Akupunktur. Hippokrates, Stuttgart 1995

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Ear Acupuncture: Case Histories From My Practice The following case studies demonstrate how diagnosis and therapy can be improved and refined by using the special methods discussed.

Back Pain Following Ankle Surgery A 40-year-old athletic patient complained about back pain on the left side at L4/L5/S1, with the pain having occurred for the first time a few years ago. As documented by his medical records, prolapse of an intervertebral disk had been excluded. The patient stated that he had already undergone local infiltration, but neither this treatment nor exercises and physical therapies were able to improve his complaints. Clinical examination found only a hardening of the left erector muscle of the spine. The back muscles were well developed, and the pelvis was in the proper position. There was no evidence for any facet joint blockage or nerve root irritation.

Inversion of the Left Side

The patient was a right-hander. There was no oscillation but inversion on the left side (when holding the positive pole of the 9-volt rod in his left hand, he responded with oscillation, thus indicating an inversion). Next, I examined both ear surfaces with the articaine ampoule under vascular autonomic signal control (see p. 140f.), searching for an active point representing the focus that triggered the inversion. In the reflex zone of the left ankle, I found an active point which I was able to assign to a surgical correction of the left external ligament as recorded in the patient’s history. The patient had suffered a ligament injury about five years ago while doing sport. To confirm, I checked the scar on the foot directly with the articaine ampoule and obtained a clear VAS response in the middle of the scar. In order to treat the inversion, I inserted an acupuncture needle into the point found on the ear. When checking once more, the inversion was no longer present (no oscillation when holding the 9-volt rod). I subsequently checked the laterality. According to the patient, he was a right-hander. Holding the positive pole of the 9-volt rod in the right hand and the negative pole in the left hand did not induce oscillation, thus confirming the dominance of the right hand.

Unstable Laterality

When checking the Laterality Point without the rods, an active Laterality Point was found on the right side—revealing that the patient exhibited unstable laterality. I then examined unsuccessfully the intermediate tissue layer for Focus Indicator Points. Even the Laterality Point, which functions as a Focus Indicator Point in the intermediate tissue layer, could not be found.

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Fig. 116 Active ear points in a patient with back pain and a scar acting as focus: 1 Sensory portion of Point L5/S1 on the left ear, 2 Reflex point of a scar on the left ankle joint, 3 Point C0 on the right ear, 4 Motor portion of Point L5/S1 on the back of the left ear

The focus-triggering inversion, namely, the scar on the left ankle, was probably a focus of the Histamine Type. Since the corresponding Focus Point was no longer active once the acupuncture needle had been inserted, I could no longer trigger a VAS response. At this point in time, incidentally, the patient indicated alleviation of pain.

Symptomatic Treatment

Apart from this, I carried out symptomatic acupuncture treatment. Since the complaints had been reported on the left side, I searched in the deep tissue layer for the primary Symptom Point on the ear, with the patient holding the positive pole of the 9-volt rod on the side to be examined, that is, in the left hand. There was an active point in the reflex zone of L5/S1 (Fig. 116). In the intermediate tissue layer I also found Point C0/C1 on the right ear, with the patient holding the positive pole of the 9-volt rod on the opposite side of the ear to be examined, that is, in the left hand. Subsequent clinical examination revealed a distinct pressure sensitivity of the right transverse process of the atlas, thus confirming the finding. When questioned, the patient did indicate recurrent complaints in this region. As expected, I found in the superficial tissue layer the “forceps point” to the primary Symptom Point, namely, Point L5/S1 as Silver Point on the back of the left ear. I inserted an acupuncture needle into each of the three Symptom Points located. The patient was subsequently free from pain for about two weeks. After each new treatment, he was again free from pain. I treated him repeatedly until the focus in the region of the left ankle joint had almost disappeared, having dropped to a Type 5 focus. Already after the first treatment, unstable laterality could no longer be demonstrated (no VAS response at the Laterality Point, without the rods).

Comments

Why did this scar on the left ankle joint become a focus? Because it interrupted the Bladder Meridian, thus disturbing the energy flow to the back muscles. The Bladder Meridian runs on both sides in a double course over the extensor muscle of the back (Fig. 117).

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Fig. 117_Course of the Bladder Meridian.

Fig. 117 The Bladder Meridian.

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Hay Fever in a Child A 7-year-old girl was introduced by her mother because she had suffered from hay fever since age 4. The mother had allergies as well; the disposition was therefore already in the family. The child’s history revealed tonsillectomy, adenoidectomy, and one amalgam filling.

Foci: Maxillary Sinus, The girl was a right-hander, and I found neither oscillation nor inversion. When checking the Focus Indicator Points, I found the EnAmalgam doxan Point and the PGE1 Point in the intermediate tissue layer. Assignment was done by searching with indicator ampoules in the deep tissue layer. I found the reflex point of the right tonsillar scar as the focus of the Endoxan Type and the reflex point of the right maxillary sinus as the focus of the PGE1 Type. At the same time, the PGE1 ampoule resulted in a mild VAS response in the area of Point Omega I. Since this is the Indicator Point for amalgam load and is best found in the superficial tissue layer, I searched for it once more with the PGE1 ampoule in the superficial tissue layer (for the righthanded person: positive pole of the 9-volt rod in the right hand and negative pole in the left hand), and it was clearly present here. As confirmation, the substance amalgam (amalgam pin) triggered a resonance VAS. Thus, the right maxillary sinus and a moderate amalgam load together formed the focus of Type PGE1. When questioned, the mother reported recurrent infections. Because the child had allergies, I also checked the Allergy Point in the deep tissue layer. Here, it was clearly present as Indicator Point for a genetically-based disposition to allergies. I also found the points for the acute symptoms (Eye Point, Throat Point) in the intermediate tissue layer and the Interferon Point in the superficial tissue layer (Fig. 118).

Fig. 118 Active ear points in a girl suffering from hay fever: 1 Allergy Point 2 Eye Point (right eye) 3 Throat Point 4 Interferon Point 5 Tonsil Point (tonsillar scar on the right side) 6 Maxillary Sinus Point (right side) 7 Omega Point I

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In this special case, examination without the 9-volt rods would have found the Allergy Point as a Focus Indicator Point. One would have assumed that the child had a focus of the Histamine Type and would have searched in vain for this focus.

Laser Therapy

As always with children under age 10, treatment was carried out with the laser. The Focus Points were treated with Nogier’s frequency A, with the treatment lasting until there was no longer a palpable VAS (about 1–2 minutes). The Allergy Point was treated with frequency C. If the findings are not clear, one can use frequency analysis to decide whether the Allergy Point represents the reflex point for allergies or a Focus Indicator Point. While a Focus Indicator Point always responds to frequency A when active, the Allergy Point of an allergic person responds to frequency C (TCM connection with hereditary energy of the Kidney, which resonates with frequency C). The following points were also treated with the laser: Eye Point with frequency G, Throat Point with frequency B, Interferon Point with frequency D (see p. 179).

Symptom-Free after Focus Therapy

After removal of the amalgam filling and two sessions of focus therapy, the girl was completely symptom-free, even during her principle hay fever season. It should be mentioned here that the previous therapist (who referred the child to me for focus diagnosis) had improved the symptoms—but did not make them disappear—by merely treating the Symptom Points with the laser.

Unclear Pain in the Knee A 50-year-old patient presented with pain in his left knee. There were no radiographs available, but I did not want to turn him away just for that. Asking him to provide the records later, I started searching for a focus and treating him with ear acupuncture.

Focus: Liver

Clinical examination of the knee joint did not result in any remarkable findings. The patient was a left-hander, and there was neither oscillation nor inversion, but unstable laterality (without rods, there was an active Laterality Point on the left side). The search for Focus Indicator Points revealed an active Endoxan Point on the left ear (intermediate tissue layer, Endoxan Point on the left in lefthanded persons, 9-volt rod in the right hand). Searching with the Endoxan ampoule triggered a response over the Liver Zone on the right ear, while all potential foci indicated by the patient’s history remained silent. When I questioned the patient, he reported an episode of hepatitis.

Active Hip Point

I now searched in the deep tissue layer for the primary Symptom Point on the left ear and expected to find the Knee Point. However, there was no active point in the reflex zone of the knee. I therefore enhanced the sensitivity by screening the zone with Bahr’s diagnostic laser frequency 1 (the frequency for the deep tissue layer). Here, too, I did not find an active point. However, when the laser accidentally passed over the reflex zone of the hip while I was still

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214 Practical Application monitoring the VAS, I found an active point there. When questioning the patient, he did not mention any pain in the hip but said he sometimes feelt stiff in that area. I examined both hip joints and, to our mutual surprise, I found evidence of initial stages of osteoarthritis on the left side (abduction and internal rotation were clearly restricted, and there was pain over the hip joint upon pressure and compression). Apparently, the pain in the knee was just pain projected by the irritated hip joint. According to this assumption, I did find the Knee Joint Point in the intermediate tissue layer (9-volt rod in the right hand, regardless of handedness) with laser frequency 2 (the frequency for the intermediate tissue layer). In addition, the Hip Joint Point on the back of the ear was active in the superficial tissue layer. I tested what might be achieved by needling the Hip Joint Point and the Focus Point in the Liver Zone (Fig. 119). The pain in the knee improved considerably. My suspicion was later confirmed by radiograph diagnostics; the knee was without pathological findings, while there were initial stages of osteoarthritis in the hip joint. This patient was completely free of pain after three treatment sessions. I had to convince him that the focus (the liver) still needed treatment once in a while. After all, the Liver Meridian runs through the hip joint (Fig. 120) and could have caused the initial disturbance in this region when the patient was weakened by an episode of hepatitis.

Comments

Fig. 119 Active ear points in a patient with unclear pain in the knee and the liver acting as a focus: 1 Hip Joint Point 2 Knee Joint Point (inactive!) 3 Liver Point

In this case, I could not have identified the situation so clearly without taking advantage of the tissue layers and the corresponding diagnostic laser frequencies. As a rule, the reflex point of the principle pain almost always responds in the deep tissue layer.

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Fig. 117_Course of the Bladder Meridian.

Fig. 120 The Liver Meridian.

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Focus-Relevant Reflex Localizations on the Auricle The focus therapist should make an effort to learn the most important ear points. This will make focus diagnosis and therapy not only more precise and targeted, but also much easier and less time-consuming. The following descriptions provide an overview of the most important focus-relevant reflex localizations on the ear. For more detailed descriptions, please refer to existing textbooks (1–6).

Overview The reflex zones and points on the ear are arranged in such a way that they produce the inverted projection of an embryo (Fig. 121). This image serves as a helpful mnemonic when learning the ear points.

The Inverted Embryo

Fig. 121 Auricle with projection of the inverted embryo according to Nogier.

The head of the embryo occupies the entire lobule. In fact, this is the projection area of the most important parts of the head (sensory organs, brain, temporomandibular joint, teeth, maxillary sinus,

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facial muscles). The embryo lies with its back (spinal cord) against the posterior margin of the auricle, the descending helix—here are the reflex zones of sensory and motor portions of the spinal cord. The embryo covers the concha with its belly (internal organs)— here are the reflex zones of almost all internal organs, again in the upside-down arrangement. The embryo crosses its legs over the triangular fossa—this is the reflex zone of the lower limb. As a rule, the sensory portions of the reflex localizations are found on the front of the ear (lateral surface of auricle), while the motor portions are found on the back of the ear (medial surface of auricle).

Ear Terraces

When memorizing the different groups of points it is helpful to inspect or palpate the different levels of the ear surface (ear terraces):

Almost all internal organs are projected on the deepest level, the concha (Fig. 122).

The entire locomotor system is projected on the terrace above, which is formed by scapha, triangular fossa, and antihelix (Fig. 123). The spinal cord and genital organs are projected on the uppermost terrace, which is formed by the anterior, superior, and posterior border of the ear, the helix (Fig. 124).

Ear Models and Ear Stamp

The purchase of ear models made of rubber is a worthwhile investment (for sources, see p. 237). The rubber ear models are of great practical help when learning the reflex localizations on the ear. It is recommended that one owes a pair of ears, not just one ear, because some reflex localizations are located only on one side (e. g., Spleen Point and Gallbladder Point).

Fig. 122 Concha, projection of the internal organs.

Fig. 123 Scapha, projection of the locomotor system.

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Fig. 124 Helix, projection of the spinal cord (descending helix, 1) and the genitals (ascending helix, 2)

Fig. 125 Antihelix, projection of the vertebral column: 1 Cervical Spine Zone 2 Thoracic Spine Zone 3 Lumbar Spine Zone 4 Point C0/C1 5 Point C7/T1 6 Point T12/L1 7 Point L5/S1

Also recommended is the purchase of an ear stamp. It allows the therapist to keep a sketch of an ear in the patient’s medical records in order to document every point found to be active.

Locomotor System As mentioned above, the projection of the locomotor system occupies the intermediate ear terrace (scapha, triangular fossa, and antihelix). The points of the sensory portions are located on the front of the ear, and those of the motor portions are on the back of the ear. All body parts, organs, or anatomical structures located in the same region of the body are also projected very close to each other on the ear (e. g., knee joint, popliteal artery, peroneal nerve).

Vertebral Column Antihelix

The projection of the vertebral column occupies the entire antihelix, again in an upside-down arrangement (Fig. 125). It starts at the postantitragal fossa (Atlanto-occipital Joint Point, Point C0/C1) and ends at the Coccyx Point where the antihelix ends underneath the ascending helix (the point is only visible when the ear is unfolded; next to it lies the Hemorrhoid Point).

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Lumbar Spine Zone

Thoracic Spine Zone

Cervical Spine Zone

Fig. 126 Different shapes of the ear relief in different sections of the Zone of Vertebral Column.

The varying shape of the scapha–antihelix reflection (antihelical fold) results in the division of the Vertical Column Zone into different sections:

Cervical Spine Zone (antihelical fold sharply defined) (Fig. 126) Thoracic Spine Zone (antihelical fold gently rounded) (Fig. 126) Lumbar Spine Zone (steep overhang of antihelical cartilage) (Fig. 126)

Fig. 127 Projection of the sacrum (Sacral Spine Zone).

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Fig. 128 Projection of vertebral column: 1 Point C0/C1 5 Scapula Point 2 Point C7/T1 6 Sternum Zone 3 Point T12/L1 7 Rib Zone 4 Point L5/S1

Fig. 129 Projection of trunk muscles: 1 Zone of Thoracic Muscles/ 3 Zone of Erector Spinae Abdominal Wall Muscles Muscle 2 Zone of Anterior Cervical Muscles

Sacral Spine Zone (hidden beneath the ascending helix; starting with Point L5/S1 at the intersection of antihelix and ascending helix and ending with the Coccyx Point) (Fig. 127).

Thorax Scapha

The Rib Zone extends between the Sternum Zone and the Zone of Thoracic Vertebrae on the scapha (Fig. 128). The reflex points of all neighboring structures are also found in this area (Acromioclavicular Joint Point, First Rib Point, etc.). All muscles and overlying skin basically project onto the reflex zones of the bony structures of the same region. Thus, if a scar runs across the 12th rib, the ear is examined in the reflex zone of the 12th rib (using point-finder or VAS). The back muscles project very close to the vertebrae on the scapha. The abdominal and thoracic muscles project parallel and posterior to the back muscles (Fig. 129).

Pelvis Triangular Fossa

The pelvis projects into the acute angle of the triangular fossa, where the two limbs of the superior and inferior antihelical crura meet (Fig. 130). Here are the Hip Joint Point, Pubic Bone Point (important, e. g., in the presence of a scar resulting from a Pfannenstiel’s incision following sterilization, etc.), Sacroiliac Joint Point, and points of the iliac crest.

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Fig. 130 Projection of the hip and pelvis: 1 Hip Joint Point 2 Pubic Bone Point 3 Sacroiliac Joint Point

Fig. 131 Projection of the upper limb: 1 Scapula Point 6 Upper Arm Zone 2 Shoulder Joint Point 7 Ulna Zone 3 Elbow Joint Point 8 Radius Zone 4 Wrist Zone 9 Thumb Zone 5 Finger Zone 10 Clavicle Zone

Upper Limb Scapha, Helical Groove

The projection of the upper limb occupies the scapha and part of the helical groove. The reflex zones of hand and fingers occupy a relatively large area in comparison to those of upper arm and forearm, thus reflecting the high number of motor units and receptors (Fig. 131). The Shoulder Joint Point is located at the level of Point C7 on the scapha. The Elbow Joint Point is located between the Shoulder Joint Point and the Wrist Zone in the lower third of this area. The Wrist Zone is located at the level of the Knee Joint Point but occupies a larger area. Upper Arm Zone and Forearm Zone are found between the corresponding Joint Points. The hand is projected in the region between Wrist Zone and the helix: the Metacarpal Bone Points and the Finger Points are found here. The Thumb Point meets the Big Toe Point below the upper part of the helix. The projections of the tips and nails of the fingers are halfway hidden underneath the helical fold.

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Lower Limb Triangular Fossa, Upper Area of Scapha

The projection of the lower limb occupies the relatively small area of the triangular fossa where Hip Joint Point, Knee Joint Point, and Ankle Joint Point form an axis. The Foot Zone is located transversely to this axis in the upper area of the scapha (Fig. 132). The Knee Joint Point is located at the deepest site of the triangular fossa and is thus easy to find. It serves as a guide for finding the reflex zones of thigh and lower leg. The Hip Joint Point is located at the tip of the triangular fossa, in the angle formed by the two antihelical crura. This region also contains the projections of all hip-associated structures, that is, the reflex points of inguinal region (scar after inguinal hernia), greater trochanter, buttock muscles, upper section of the sciatic nerve, and pelvic bones with sacroiliac joint. The Ankle Joint Point is partly hidden by the reflection of the ascending helix. In order to find it on the rubber ear, the needle is vertically inserted into the scapha at the upper end of the leg axis, very close to the reflection of the ascending helix. Thigh Zone and Lower Leg Zone are located between the Joint Points described above. The Heel Point lies near the Coccyx Point (hidden underneath the ascending helix), because the foot projects transversely to the axis formed by the reflex zones of hip, knee, and ankle joints (Fig. 133).

Fig. 132 Projection of the lower limb: 1 Knee Joint Point 4 Heel Zone 2 Hip Joint Point 5 Toe Points 3 Ankle Joint Point

Fig. 133 Projection of the foot: 1 Heel Point 3 Ankle Joint Point 2 Achilles Tendon Point 4 Toe Points (Dotted lines and circles show hidden reflex localizations. The dashed line indicates the antihelix extending to the Coccyx Point underneath the ascending helix.)

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Slightly caudal to it lies the Achilles Tendon Point. (Hidden localizations are drawn in dotted lines.) The Toe Points reach underneath the helix and are partly hidden by the reflection. The Big Toe Point meets the Thumb Point below the upper part of the helix.

Head Lobule, End of Helical Groove

The reflex zones of the head project onto the lobule and the end of the helical groove. They include the reflex zones of nose, eye, ear, tongue, teeth, tonsils, lymph nodes, maxillary sinuses, and frontal sinuses (Fig. 134). The brain, too, projects onto the lobule, but it is not discussed in this section.

Upright Arrangement

The projection of the entire head deviates from that found in all other ear regions. Instead of the usual upside-down arrangement, the reflex zones of individual parts of the head are arranged like those of a person standing upright (lower jaw projects below the upper jaw rather than above it). When imagining the head of the well known inverted embryo in retroflexion (as in the face presentation in the uterus), the upright arrangement of the organ reflex zones on lobule and antitragus makes sense (Fig. 135).

Temporomandibular Joint

The temporomandibular joint (TMJ) projects at the lower end of the scapha where the helical groove merges into the lobule (Fig. 136). Very close to the TMJ Point (and thus impossible to distin-

Fig. 134 Projection of the head: 1 Oral Cavity Zone bordered 4 by Upper Jaw Zone and 5 Lower Jaw Zone 6 2 Temporomandibular Joint 7 Point 8 3 Eye Point

Nose Point Maxillary Sinus Zone Bony Skull Zone Tongue Zone Ear Point

Fig. 135 Projection of an inverted embryo with its head in retroflexion, illustrating the location of reflex zones on the lobule (reflex zone of the head) as well as the location of abdominal muscles and anterior cervical muscles near the posterior margin of the ear (descending helix).

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Fig. 136 Projection of the temporomandibular joint and tonsils: 1 TMJ Point 2 Palatine Tonsil Point

Fig. 137 Projection of the jaws: 1 Upper Jaw Zone 2 Lower Jaw Zone

guish from it during the initial diagnosis) lie the projections of other focus-relevant structures, namely, the reflex points of the palatine tonsils, molars of upper and lower jaws, retromolar cavity, posterior parts of the masseter muscles (sensory portion), and central parts of the deep and superficial parotid glands (which are rarely affected). For the sake of completeness, the Depression Point (synonym: Joy Point) should be mentioned here, because it is located at almost the same site. These reflex points listed above can be distinguished by using the VAS and the cable method (see p. 125ff.).

Jaws and Teeth

In the upper posterior part of the lobule, starting from the TMJ Point, are the projections of upper and lower jaws (Fig. 137). The reflex zone of the mandible, the Lower Jaw Zone, is located in anterocaudal direction at an angle of about 40° to that of the maxilla, the Upper Jaw Zone. The Teeth Points are located along the border of the bone projections. The TMJ Point represents the pivot between Upper and Lower Jaw Zones. All structures belonging to a tooth (periodontium, gingiva, pulp, etc.) project close to the corresponding Tooth Point.

Lips

The lips project onto the front part of the Upper and Lower Jaw Zones, namely, onto the reflex points of the 1st–5th teeth. (Medial scars on chin and lips can have special focal activity.)

Oral Cavity, Tongue

The Oral Cavity Zone is located in front of the TJM Point between Upper and Lower Jaw Zones. From here, the Tongue Zone extends across the lower edge of the lobule and onto the back of the ear for almost 1 cm (Fig. 138).

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Fig. 138 Projection of the tongue: 1 Tongue Zone on the lobule 2 Tongue Zone on the back of the ear

Fig. 139 The Eye Point forms the center of a circular area that occupies the entire lobule.

Eye

The eye is represented in the center of the ear lobe where many people wear an earring. (Sometimes, ears are pierced in the area of the Nose Point in the anterior region of the lobule.) When imagining a circular area occupying the entire lobule, the Eye Point forms the center of the circle (Fig. 139). Near the Eye Point there are also the reflex zones of all structures belonging to the eye, such as cornea, eyelashes, eyelids, retina, and the extraocular muscles. (Even scars on the retina can have focal activity.)

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Fig. 140 Projection of the nose and sinuses: 1 Nose Point 2 Maxillary Sinus Point 3 Frontal Sinus Point

Fig. 141 Ear Point and Auditory Line.

Paranasal Sinuses

The paranasal sinuses project just below the Nose Point. Here are the reflex zones of maxillary sinus, sphenoidal sinus, ethmoidal sinuses, and frontal sinus (Fig. 140). They all represent the mucosal portion of these sinuses. (These sinuses are among the most common foci).

Ear

The ear is represented at the end of the helical groove, in the posterior region of the Auditory Line (Fig. 141). All structures belonging to the ear project close to this point.

Internal Organs

Most of the inner organs project onto the concha. Like all other reflex zones (except those of the head), their reflex zones are arranged upside down. The organs of the upper body half project onto the inferior concha (e. g., the lung), while the organs of the lower body half project onto the superior concha (e. g., the intestine) (Fig. 142).

Heart

The heart projects onto the antihelix, at the level of the reflex points of the 4th–7th intercostal spaces (Fig. 143). The heart muscle is a special form of striated muscle. Accordingly, the Heart Point is not located in the concha but in the reflex zone of the thoracic spine muscle.

Appendix

The appendix projects near the root of helix underneath the helical fold, “like a swallow’s nest under a roof” (Fig. 144). The position of the Appendix Point may vary as far as height is concerned.

Anus

The inner (mucosal) portion of the anus projects near the Coccyx Point where the antihelix meets the ascending helix. This is the He-

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Fig. 142 Projections of the internal organs: 1 Lung Zone 2 Liver Zone 3 Gallbladder Zone 4 Pancreas Zone 5 Stomach Zone 6 Intestine Zone 7 Spleen Zone 8 Kidney Point 9 Urinary Bladder Point 10 Heart Point (Solid areas represent reflex points and zones; they must not be confused with Silver Points).

Fig. 143 Projection of the heart: 1 Motor portion of the Heart Point 2 Sensory portion of the Heart Point

morrhoid Point (Fig. 145); it plays an important role in the treatment of hemorrhoids.

Gallbladder

The Gallbladder Point is located in the middle third of the superior concha (Fig. 142). It plays an important role in the treatment of headaches and migraine.

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Fig. 144 Appendix Point.

Fig. 145 Hemorrhoid Point.

Fig. 146 Kidney Point.

Kidney

The Kidney Point is located on the inside of the ascending helix (precisely in the concavity), at the level of the Knee Joint Point in the middle of the triangular fossa (Fig. 146).

Urinary Bladder

The sensory portion of the urinary bladder is represented in the upper region of the superior concha, just at the antihelical wall, at the level of the upper Lumbar Spine Zone (Fig. 147). The motor portion of the urinary bladder (spasms) is usually represented as a Silver

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Fig. 147 Projection of the bladder: 1 Motor portion of the Urinary Bladder Point 2 Sensory portion of the Urinary Bladder Point

Fig. 148 Projection of the genitals: 1 Uterus Point 2 Ovary/Testis Point

Point on the back of the ear, in the upper half of the auricle near the attachment to the scalp.

Uterus

The Uterus Point is located on the inside of the ascending helix, above the intersection of helix and antihelix (Fig. 148). It plays an important role in treating inner scars after cesarean section.)

Ovary/Testis

The Ovary Point/Testis Point is located on the inside (underside) of the ascending helix (Fig. 148), about 2 mm away from the anterior

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230 Practical Application reflection, roughly in the middle between the Navel Point (Point Zero) and the Uterus Point.

References 1. Bahr, F., Reis, A., Straube, E. M., Strittmatter, B.; Suwanda, S.: Skriptum für die Aufbaustufe aller Akupunkturverfahren (Stufe 1 Ohr-, Körper-, Hand- und Schädelakupunktur). Self-published, Munich 1995 2. Hecker, U.: Ohr-, Schädel-, Mund-, Hand-Akupunktur. Hippokrates, Stuttgart 1996 3. Kropej, H.: Systematik der Ohrakupunktur. Haug, Heidelberg 1998 4. Linde, N.: Ohrakupunktur, Leitfaden für Theorie und Praxis. Sonntag, Stuttgart 1994 5. Rubach, A.: Propädeutik der Ohr-Akupunktur. Hippokrates, Stuttgart 1995 6. Strittmatter, B.: Ear Acupuncture, A Precise Pocket Atlas Based on the Works of Nogier/Bahr. Thieme, Stuttgart, New York 2003

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Part C Training, Equipment, and Practical Aids

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Training This book is aimed at introducing an efficient procedure for focus diagnosis in a way that is both practice-oriented and easy to understand also for the nonacupuncturist. Only focus-relevant methods have been selected from the general training program for ear acupuncture. They are presented here separately because they can be used on their own for pure diagnostic purposes in the medical practice. Learning these methods requires a fair amount of practical training and instruction. Special courses dealing exclusively with this subject are not yet available. However, both focus diagnosis and focus therapy are essential parts (about 70%) of the ear acupuncture training program provided by the German Academy for Acupuncture and Auriculomedicine, Munich, Germany (for contact details, see p. 236). As discussed in detail on page 234 ff., the basic difference between the methods for beginners (Level 1) and those for the more advanced (Level 2) lies in the highly developed diagnostic method of searching for foci while monitoring the pulse (vascular autonomic signal, or Nogier reflex). The conscientious focus therapist will also aim to learn the ear reflex zones, for they provide increased diagnostic accuracy. From here, it is only a small step to symptomatic therapy by means of ear acupuncture—it would be a pity not to take this opportunity when it arises. The methods of diagnosis remain the same (either point-finder or VAS palpation). Any therapist using the ear reflex zones for focus diagnosis should be prepared to be involved in symptomatic ear acupuncture as well.

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Courses for Focus Therapists at the German Academy of Acupuncture and Auriculomedicine The fields of ear, body, and scalp acupuncture are taught together at the first two knowledge levels, Level 0 (introduction) and Level 1 (beginners). That way, every participant can get a first impression at a very early stage so that he/she can decide where to set his/her personal preference. Starting at Level 2 (moderately advanced level) the courses for ear acupuncture and body/scalp acupuncture are taught separately. Each course usually lasts one weekend. These intensive seminars, or crash courses, focus on the practical application: The fundamentals are usually taught on a Saturday; starting at Level 1, the Sunday is reserved for practical demonstrations, including the hands-on treatment of a number of patients and course participants. Modern large-screen video projection ensures that every participant has a perfect close-up view of the entire process. Practical courses, or clinical courses, accompany the crash courses in order to allow participants to practice in small teams as often as possible (see p. 234).

Level 0—Introductory Course on Ear, Body, and Scalp Acupuncture The anatomical, embryological, and neurological basics; animal experiments; the principles of point selection for beginners; treatment of simple symptoms. Duration of the course: one weekend.

Level 1—Crash Course on Ear, Body, and Scalp Acupuncture for Beginners Ear acupuncture: Detailed descriptions of reflex zones on the ear; hidden and difficult ear localizations (important for the focus therapist); the electrical point-finder as an essential aid; recommended point combinations; treatment methods (needling, moxibustion, electrical stimulation). Body acupuncture: The basics, such as the meridians; tonification and sedation; the Shu Mu method (Front Collecting Point/Back Transporting Point); various methods of treatment. Scalp acupuncture: Practical introduction. Duration of the course: one weekend.

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Level 2—Crash Course on Scientific Ear Acupuncture for the Moderately Advanced Introduction to the Nogier Reflex (VAS) in order to achieve even better results when diagnosing and treating focal disturbances. Essential aids: 3-volt hammer, 9-volt rod. Duration of the course: one weekend.

Level 3—Crash Course on Scientific Ear Acupuncture for the More Advanced This course includes the use of laser light which is absolutely essential for treating children (see p. 181). Procedures for finding and treating points with laser light of various frequencies; deep, intermediate, and superficial tissue layers of the ear; Nogier frequencies A–G; using frequency A for extended focus diagnosis and therapy; Bahr frequencies 1–7. Obstacles to diagnosis and treatment; systematic approach in problematic cases; hands-on treatment of patients who have been resistant to therapy. Duration of the course: one weekend.

Level 4—Crash Course on Scientific Ear Acupuncture for the Most Advanced The main topics are: testing of medications with simple means (polarization filter), uncovering unknown allergens (e. g., food allergies); further improvements of focus diagnosis and treatment. Duration of the course: one weekend.

Clinical Courses under Supervision Starting at Level 1, all clinical courses are held in small groups to accompany the crash courses. Under the guidance of an experienced practitioner, between 15 and up to 22 participants are to apply, and practice actively, the material learned at the respective knowledge levels. Problems encountered in one’s own practice can be discussed here in detail, and patients can be brought into the course, provided they have been registered. Clinical courses are held in the form of bedside teaching and taught separately for each level and field (ear and body/scalp acupuncture). In order not to interfere with other participants, prior participation in the crash course of the respective level is required for attending such a practical course. Duration of the course: one day, either Saturday or Sunday.

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The following information is for those interested in the topics taught in the advanced courses on body acupuncture.

Level 2—Crash Course on Scientific Body/ Scalp Acupuncture for the Moderately Advanced The causes of illness according to Traditional Chinese Medicine; therapy by the classic acupuncture points; hierarchy of points due to feedback systems (Organ Networks); points used in ancient China; transverse and horizontal Luo (Connecting) Vessels, chronobiological connections between Luo Points, Group Luo Points, Big Luo. Using Confluent Points, Influential Points, and Focus Points at the moderately advanced level. The role of positron emission tomography (PET) in brain research. The emphasis is on hands-on treatment of patients. Duration of the course: one weekend.

Level 3—Crash Course on Scientific Body/ Scalp Acupuncture for the More Advanced Introducing the Nogier Reflex (VAS) to achieve better results during diagnosis and therapy through VAS-controlled body acupuncture. Only important (active) points are selected by using a special search method; inactive points are not treated for regulatory reasons. Practicing the VAS in small groups. Checking for obstacles to diagnosis or therapy: oscillation, inversion, unstable laterality, and focal disturbances. This is also a course on using laser light for acupuncture. Procedures for finding and treating points with laser light of various frequencies; deep, intermediate, and superficial tissue layers of the ear; Nogier frequencies A–G; Bahr frequencies 1–7. Practical approach to VAS-controlled body/scalp acupuncture. Hands-on treatment of patients who have been resistant to therapy. Duration of the course: one weekend.

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Training Institutions German Academy of Acupuncture and Auriculomedicine Oselstrasse 25 D-81245 Munich, Germany Tel: +49 (89) 814 5252, Fax: +49 (89) 8 91 1026 E-mail:[emailprotected] Web: www.akupunktur-arzt.de www.schmerzakupunktur.de www.zahnmedizin-naturheilkunde.de Swiss Medical Association of Auriculomedicine and Acupuncture P.O. Box 176, CH-8575 Bürglen, Switzerland Tel: +41 (71) 6 34 66 19, Fax: +41 (71) 6 34 66 18 E-mail: [emailprotected] Austrian Society of Controlled Acupuncture Kreuzgasse 21, A-8010 Graz, Austria Tel: +43 (316) 37 40 50, Fax: +43 (316) 37 40 51 E-mail: [emailprotected] Auriculotherapy Certification Institute (ACI) 8033 Sunset Blvd., P.O. Box 270 Los Angeles, CA 90046-2427, USA Tel: +1 (323) 656-2084, Fax: +1 (323) 656-2085 E-mail: [emailprotected] Web: www.auriculotherapy.org Dr. Muriel Agnes Vital Principle Seminars Box 75 River John, Nova Scotia Canada BOK 1NO Tel: +1 (902) 351-1010 E-mail: [emailprotected]

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Supply Sources Acupuncture Supplies Asiamed Professional LP 25 Drydock Ave. Boston, MA 02210-2344, USA Tel: (617) 261 0033 Fax: (617) 261 0034 Toll Free 866 728 9023 Thomas Corbin, P.A. cell: (945) 540-5637 E-mail: [emailprotected] M.E.D. Servi-Systems 8 Sweetnam Drive Stittsville, Ontario, Canada K2S 1G2 Tel: +1 (800) 267-6868 (North America), +1 (613) 836-3004 (worldwide) Fax: +1 (613) 831-0240 E-mail: [emailprotected] Web: www.medserv.ca schwa medico Rotlintstrasse 86, D-60389 Frankfurt/Main, Germany Web: www.schwa-medico.de Dr. Muriel Agnes Vital Principle Seminars Box 75 River John, Nova Scotia Canada BOK 1NO Tel: +1 (902) 351-1010 E-mail: [emailprotected]

Focus Indicator Ampoules Dr. E. Heck Bahnhofstrasse 21, D-82377 Penzberg, Germany E-mail: [emailprotected] Web: www.ampullenshop.de

Laser and TNS Equipment schwa medico GmbH Gehrnstrasse 5, D-35630 Ehringshausen, Germany Web: www.schwa-medico.de

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Market for Second-Hand Equipment Dr. E. Heck Bahnhofstrasse 21, D-82377 Penzberg, Germany Tel: +49 (8856) 9595, Fax: +49 (8856) 9596 E-mail: [emailprotected] Please provide a self-addressed envelope and postage. Please do not call Dr. Heck in his practice.

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Experienced Acupuncturists Contact details of experienced acupuncturists to whom patients with special problems may be referred are available through the following institutions: German Academy of Acupuncture and Auriculomedicine Oselstrasse 25 D-81245 Munich, Germany Tel: +49 (89) 814 5252, Fax: +49 (89) 8 91 1026 E-mail: [emailprotected] Web: www.akupunktur.de www.schmerzakupunktur.de; www.zahnmedizin-naturheilkunde.de Auriculotherapy Certification Institute (ACI) 8033 Sunset Blvd., P.O.B 270 Los Angeles, CA 90046-2427, USA Tel: +1 (323) 656-2084 Fax: +1 (323) 656-2085 E-mail: [emailprotected] Web: www.auriculotherapy.org Acupuncture Canada 107 Leitch Drive Grimsby, Ontario Canada, L3M 2T9 Tel: +1 (905) 563-8930 Fax: +1 (905) 563-8930 E-mail: [emailprotected] Web: www.acupuncture.ca Dr. Muriel Agnes Vital Principle Seminars Box 75 River John, Nova Scotia Canada BOK 1NO Tel: +1 (902) 351-1010 E-mail: [emailprotected]

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Patient Information Leaflets Many patients will be exposed to the healing capacity of focus therapy or acupuncture for the first time in your practice. Every day you will have to spend a fair amount of time explaining the same thing over and over again: the activity of a focus, the effect of a wheal in the skin, the effect of laser treatment, or simply answering the question “what is acupuncture?” The following patient information is designed to explain the basic terms in a way your patients can easily understand. The leaflets may be photocopied and used in your daily practice.

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Patient Information Leaflet: What is Acupuncture? The stimulation of acupuncture points is one of the oldest and most widely spread healing methods in the world. Sticking needles into precisely defined points of the skin can eliminate or alleviate disturbances in the body. Acupuncture points are connected by energy pathways which are called “meridians.” According to ancient Chinese teaching, the life energy circulates through the body along these meridians. The two components of the life force, Yin energy and Yang energy, act in the body as opposite poles. The ideal state of health is achieved by balancing Yin and Yang in the body. Any imbalance or blockage of energy leads to illness in the long run. To restore the flow of energy, acupuncture points can be influenced in various ways. Sticking a needle into a point is called acupuncture. The points can also be stimulated by heat (moxibustion), pressure (acupressure), laser beam (laser acupuncture), underwater massage by a jet of water, or ultrasound. The course of a meridian through the body can explain why, for example, a disturbed gallbladder function can lead to headaches: The meridian running through the gallbladder region (the Gallbladder Meridian) extends further to the head. The meridian may be compared to a water hose: If the hose has a knot at one end, the water cannot flow out at the other end. Likewise, a headache may occur when the flow of energy in the Gallbladder Meridian is interrupted due to a disturbed gallbladder function. In this example, the disturbed gallbladder needs to be treated first, in order to fight the headache. Most people are scared by the idea of having needles stuck into their body. However, acupuncture does not hurt because acupuncture needles are very thin. Ear Acupuncture This special form of acupuncture was developed in the 1950s by the French physician, Dr. Paul Nogier. He discovered that the surface of the outer ear (auricle) is a reflex area on which all parts of the body are represented (see Fig. 149 on p. 243). By examining individual reflex zones on the ear it is possible to identify precisely where in the body the pain is located—or which of the organs are affected if the origin of pain is unclear. Certain disturbances in the body which can delay, or even prevent, the healing process can also be located. At first glance, such a focus has nothing to do with the disease process itself and is often not even noticed by the patient. However, these foci can have such a negative effect on the body that it becomes prone to falling ill. In addition, they can prevent a preexisting disease from responding to conventional therapies so that the body cannot get rid of it. Focal disturbances may originate in dead or putrid teeth, chronically inflamed maxillary sinuses, inflamed tonsils, and all other inflammations. Every scar may develop into a focus, but it does not necessarily do so. By examining the ear reflex zones, a physician can determine very precisely whether any scar (and which one) has become a focus. He/she can also determine whether there is an inflammation or toxic load somewhere in the body (e. g., mercury load due to amalgam fillings).

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Successful healing is only possible when an existing focus is included in the treatment. Examination is carried out by measuring voltage differences on the ear surface. Individual ear points that represent specific parts of the body are checked for electrical changes. Thus, the auricle can be regarded as the body’s own diagnostic center because an ear point corresponding to a body part can only be detected when the part in question is disturbed. For example, an electrical change at the Liver Point on the ear indicates a disturbance of the liver. Treatment is performed by needling the respective points on the ear and, if necessary, also on the body. Children are usually not needled but treated with the laser instead. All signals induced by ear acupuncture travel through a specific part of the brain, the diencephalon, to the corresponding body parts. The body parts strictly obey these commands because they come straight from the brain. Thus, ear acupuncture takes advantage of the human body’s own control center, namely, the brain. All diseases that can be traced back to a disturbed (rather than destroyed) organ function can be treated by ear and body acupuncture: migraine, insomnia, depression, addictions, indigestion, autonomic symptoms, rheumatism, and most conditions of pain (such as tennis elbow, pain in the shoulder, back pain, neck–shoulder pain). Some patients feel immediately relieved, others need several days (about four to five treatments) before they notice an improvement. Some people feel as if they were walking on air after the treatment, and almost all feel very relaxed afterward. Of course, it is impossible to treat destroyed structures, such as a tooth destroyed by caries. Likewise, a hip joint disease cannot be undone. However, acupuncture treatment can increase the blood flow to the joints and thus alleviate the pain. Acupuncture cannot dissolve biliary or renal stones nor can it heal a fractured bone, but it can alleviate pain after surgery. As an emergency measure, acupuncture may be used in addition to conventional medical treatment in the following cases: pain in the heart, biliary colic, renal colic, toothache, asthmatic attacks. Body acupuncture and ear acupuncture are both effective forms of treatment and do not have any risks or side effects, provided they are performed properly. However, they should only be performed in connection with clinical diagnostic procedures carried out by a physician. Should you have further questions, please feel free to contact us. Information can also be obtained from the various acupuncture training institutions listed on page 236.

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Fig. 149 Overview of the reflex localizations on the ear. This diagram may be used to explain to the patient that the various body regions are represented on the auricle in the form of an inverted embryo (according to Nogier).

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Patient Information Leaflet: Permanent Needles Permanent needles are sterile disposable needles. Your doctor will insert them into some of the ear points found after individual inspection. Both ears—onto which the points for the entire body are projected—will be examined prior to inserting the permanent needles. Once these short needles are positioned correctly in the ear, they should be stimulated in order to be fully effective. This is done with the dipole magnet contained at the end of the plastic case of the permanent needle. The small, black magnet is easily visible. The stimulation is best achieved by holding the magnet very close to the needle (or gently touching it) and then turning the plastic case quickly back and forth between thumb and index finger. This acts like a small generator—like a bicycle dynamo—and produces a weak electric current that enhances the effect of the needle. The stimulation may be repeated several times during the day without reservation, each time for about 15–20 seconds per needle. In addition, you may use this stimulation every time the symptoms occur for which you have received the permanent needle (such as pain, or the urge to smoke). The faster the magnet is turned, the more effective the stimulation will be. The stimulating effect of the magnet penetrates the adhesive patch that covers the needle. The protective patch therefore remains in place when using the magnetic needle stimulator. If the protective patch comes off or gets dirty, you should replace it. You can make a new patch by cutting out a piece of hypoallergenic adhesive tape (available in a pharmacy or drug store). The permanent needles project only about 1 mm above the surface of the skin and thus do not show up. You should avoid washing your ears in the areas where the needles have been inserted. You may temporarily use eau de toilette or aftershave to clean the area if necessary.

The needle should not cause any pain or inflammation. The skin around the needle should not be red. If the skin becomes inflamed (reddened), the needles must be removed with a forceps. After removal, the area should be cleaned with ethanol or wound disinfectant. If in doubt, ask your doctor to check the site. You should keep the permanent needles in the ear for about a week. If the skin does not reject the needles and if the skin around the needles is not reddened, you may keep the needles longer than a week. Normally, it is not necessary to see your doctor for removal of the needles. You can easily remove the needles yourself with a forceps. Please remove all needles on the day before the next treatment.

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Patient Information Leaflet: What Is Laser Acupuncture? Your doctor has advised you that the disease of your child should be treated by ear or body acupuncture. Children usually do not like to be needled. Laser acupuncture is an equivalent alternative to needle treatment. A laser is a device that produces light in only one direction, with only one wavelength, and with all rays leaving the laser at the same time. Laser light is therefore parallel, monochromatic, and coherent. Laser light also differs from natural light by its extreme intensity. A laser can produce visible light or infrared light. When the laser beam falls on the skin, some of its energy is passed on to the cells. This effect is used to influence acupuncture points and reflex zones, and even focal disturbances in the body. Lasers with specific, specially tested resonance frequencies are also used for diagnostic purposes. Acupuncture points are connected by energy pathways called “meridians.” If the energy flowing along these pathways is in equilibrium, the organism is healthy. Any imbalance or blockage of energy leads to illness in the long run. The disease can manifest itself at a site of the body that is very different from that of the existing disturbance. The energy flow can be restored by adjusting the energy at the disturbed acupuncture points with a laser beam. Depending on the findings of the examination, the ear points are treated with laser light of specific frequencies until the energy balance is restored. Like needle acupuncture, the laser treatment should be repeated several times until stabilization of the body is achieved.

The Importance of Focal Disturbances Successful healing will only be possible if existing disturbances are also treated. At first glance, focal disturbances seem to have nothing in common with the disease process itself. Still, they can affect the body in a negative way so that the body’s own defenses are weakened. The person easily falls ill or is unable to overcome an already existing illness. Possibly, the body no longer responds to conventional therapeutic measures. In children, focal disturbances include chronically inflamed paranasal sinuses, inflamed tonsils, scars (e. g., the navel as the first scar of the human body, scars resulting from surgery and injuries), intestinal disorders, and toxic load (e. g., mercury load due to amalgam fillings or acquired from the mother during pregnancy or breast feeding). Prior to every laser treatment there will be an examination for focal disturbances that can (and should) be eliminated by stimulating the reflex points with the laser.

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Who Benefits from Laser Acupuncture? The laser is predominantly used for treating children. Children of all ages can be treated with laser acupuncture. Starting at age 8–12, treatment with fine acupuncture needles is more intense than pure laser treatment—as is the case with adults. The effect of the needles can be enhanced by additional laser treatment, if necessary. Laser acupuncture on the ear or on the body can treat all diseases that are caused by a disturbed (rather than destroyed) body function (e. g., enuresis, stuttering, difficulty concentrating, neurodermatitis and other skin diseases, and allergies). However, laser acupuncture should only be performed in connection with clinical diagnostic procedures carried out by a physician. Laser therapy is completely free of pain and is well tolerated even by infants. Laser acupuncture does not damage the skin. However, it is absolutely essential to protect the eyes with antilaser goggles because of the extreme intensity of the laser light.

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Patient Information Leaflets 247

Patient Information Leaflet: What Is Neural Therapy? Neural therapy or therapeutic local anesthesia (TLA) is the treatment by infiltrating certain points, tissues, or scars with a local anesthetic (e. g., procaine HCl, lidocaine HCl). The effect on the body is achieved by taking advantage of the autonomous (involuntary) nervous system. We know that certain areas of the skin are somehow connected with inner organs and various muscle groups (e. g., these connections often cause back pain during menstruation and sometimes also swelling of the skin over the sacrum). It is therefore possible to influence muscles and inner organs by means of these skin areas. For this purpose, small amounts of a local anesthetic are injected into the uppermost layer of the skin to produce a wheal. This type of neural therapy is called “segment therapy.” In particular, diseases caused by a disturbed (rather than destroyed) organ function can be treated by neural therapy: migraine, rheumatoid arthritis, pain in the locomotor system (such as pain in shoulder, back, or neck; tennis elbow), indigestion, autonomic symptoms, lower abdominal pain, and asthma. Of course, neural therapy cannot treat diseases due to destroyed structures, such as hip joint disease. However, it can increase the blood flow to the joints and thus alleviate pain. Another important branch of neural therapy is the treatment of focal disturbances. At first glance, these foci seem to have nothing in common with the disease process itself and are often not even noticed by the patient. However, they can have such a negative effect on the body that it becomes prone to illness. In addition, they can prevent a preexisting disease from responding to conventional therapy so that the body cannot get rid of it. Such foci can be dead or putrid teeth, chronically inflamed maxillary sinuses, or inflamed tonsils. Furthermore, every scar may develop into a focus. A physician can determine by specific examination whether or not a scar has become a focus. He/she can also find out if there is perhaps an inflammation somewhere in the body.

Successful healing will only be possible if an existing focus is also treated. Treatment of focal disturbances is performed by infiltrating certain scars, or by needling the respective points on the ear and, if necessary, also on the body. The foci are thus prevented from having a disturbing effect (of course, most teeth acting as foci must be removed). Neural therapy, or TLA, is an effective form of treatment and has hardly any risks or side effects, provided it is performed properly. There is one restriction: there must be no allergy to the local anesthetic, which should be confirmed prior to the treatment by producing a test wheal. Furthermore, patients being treated with anticoagulants (warfarin, heparin) should not undergo neural therapy. Neural therapy should only be performed in connection with clinical diagnostic procedures carried out by a physician. Should you have further questions, please feel free to contact us.

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248 Training, Equipment, and Practical Aids

Tables 10–13 Energetic correlation between the dental regions and the body Editor: A. Rossaint, DMD, von-Coels-Strasse 370, D-52080 Aachen, Germany Advisor: F. Kramer, DMD, Ostendstrasse 161, D-90482 Nuremberg, Germany Table 10 Right upper jaw Reflexes

C8 Ciliospinal reflex; pupillary reflex (dilatation)

T11, T12 Lower abdominal wall reflex

C5–C7 Tendon reflexes of hand and forearm; biceps reflex; triceps reflex; pupillary reflex tract

T8–T10 Upper abdominal wall reflex

Intercostal nerves

T1, T2, T5–T7

T11, T12

T3, T4

T8–T10

Dermatomes

C8, T1, T2, T5–T7

T11, T12, L1

C5–C7, T 3, T4

T8–T10

L2, L3, S3–S5, coccyx

Focal disturbances

Duodenal diverticulum (2nd and 3rd parts)

Esophageal diverticulum

Bronchial focus; diverticulum of ascending colon

Biliary focus

Urogenital focus

Paranasal sinuses

Cavernous sinus

Maxillary sinus

Ethmoidal sinuses

Cavernous sinus; Frontal sinus; sphenoidal sinus sphenoidal sinus

Cranial nerves

VIII, IX, XII

IX, XII

I, V

Sensory organs

Tongue (taste); hearing, inner ear

Tongue (taste)

Nose (sense of smell)

Vision; retina and choroidea

Nose (sense of smell)

Joints

Shoulder (posterior); elbow (ulnar); hand (ulnar); fingers (ulnar)

TMJ; hip (R, anterior); knee (R, anterior); ankle joint

Shoulder (anterior); elbow (radial); hand (radial); fingers (radial)

Hip (lateral); knee (medial, lateral); ankle joint and talocalcaneonavicular joint

Knee (posterior)

Spinal cord segments

C8, T1, T2, T5–T7, S1–S3

T11, T12, L1

C5–C7, T2–T4, L4, L5

T8—T10

L2, L3, S3–S5, coccyx

Vertebrae

C7, T1, T2, T5–T7, S1, S2

T11, T12, L1

C5–C7, T3, T4, L4, L5

T8–T10

L2, L3, S3–S5, coccyx

Heart (R); kidney (R)

Pancreas

Lung (R); trachea; larynx; bronchi

Liver (R); biliary ductules

Kidney (R); ureter (R)

Duodenum (1st–3rd parts)

Esophagus (R); hypopharynx

Colon (R)

Gallbladder

Urinary bladder (R); urogenital region

Endocrine glands

Anterior lobe of hypophysis

Parathyroid Thymus Thyroid Posterior lobe of hypophysis

Intermediate lobe of hypophysis

Pineal gland

Miscellaneous

Central nervous system; psyche

Mammary gland (R)

Tonsils

Lingual tonsil

Laryngeal tonsil

Tubal tonsil

Yin

Heart (right)

Organs Yang Duodenum

Intensity of focus: U severe O moderate Z weak R Right L Left

C5–T1 T1–T4 T5–T7 T8–T10 T11–T12

Brachial plexus Superior intercostal nerves Middle intercostal nerves Inferior intercostal nerves The most inferior intercostal nerves

16 15

Anal canal; rectum Palatine tonsil

T12–L3 L4–S3 S4–S5 S5

L2, L3; S3–S5 Patellar reflex; ejaculation; micturition reflex; defecation reflex; anal reflex

Pharyngeal tonsil

Lumbar plexus Sacral plexus, sciatic plexus Pudendal plexus Ccoccyx, coccygeal plexus

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Dental Tables 249 The following correlations were established by R. Voll, MD, Plochingen, Germany, and co-workers during diagnostic procedures using electroacupuncture. They were summarized in a table for the first time by F. Kramer, DMD, Nuremberg, Germany. The data have been updated by A. Rossaint, DMD, in the form of a dental scheme based on Dr. Voll’s publication, “Tabellen über energetische Wechselbeziehungen von Odontonen zu Organen und Gewebssystemen”. ML-Verlag, Ülzen, 1978. Table 11 Left upper jaw T8–T10 Upper abdominal wall reflex

C5–C7 Tendon reflexes of hand and forearm; biceps reflex; triceps reflex; pupillary reflex tract

T11, T12 Lower abdominal wall reflex

C8 Ciliospinal reflex; pupillary reflex (dilatation)

Reflexes

T8–T10

T3, T4

T11, T12

T1, T2, T5–T7

Intercostal nerves

L2, L3, S3—S5, coccyx

T8–T10

C5–C7, T3, T4

T11, T12, L1

C8, T1, T2, T5–T7

Dermatomes

Urogenital focus

Biliary focus

Bronchial focus; diverticulum of descending colon

Cardiac diverticulum; esophageal diverticulum

Jejunal diverticulum; duodenal diverticulum (4th part)

Focal disturbances

Frontal sinus; sphenoid sinus

Cavernous siEthmoidal nus; sphenoid si- sinuses nus

Maxillary sinus

Cavernous sinus

Paranasal sinuses

I, V

IX, XII

VIII, IX, XII

Cranial nerves

Nose (sense of smell)

Vision; retina and choroidea

Nose (sense of smell)

Tongue (taste)

Tongue (taste); hearing, inner ear

Sensory organs

Knee (posterior)

Hip (lateral); knee (medial, lateral); ankle joint; talocalcaneonavicular joint

Shoulder (anterior); elbow (radial); hand (radial); fingers (radial)

TMJ; hip (L, anterior); knee (L, anterior); ankle joint

Shoulder (posterior); elbow (ulnar); hand (ulnar); fingers (ulnar)

Joints

L2, L3, S3–S5, coccyx

T8–T10

C5–C7, T2–T4, L4, L5

T11, T12, L1

C8, T1, T2, T5–T7, S1–S3

Spinal cord segments

L2, L3, S3–S5, coccyx

T8–T10

C5, C6, T3, T4, L4, L5

T11, T12, L1

C7, T1, T2, T5–T7, S1, S2

Vertebrae

Kidney (L); ureter (L)

Liver (L); biliary ductules

Lung (L); trachea; larynx; bronchi

Spleen

Heart (L); kidney (L)

Heart (L)

Urinary bladder (L); urogenital region

Biliary ducts (L)

Colon (L)

Cardia; fornix; hypopharynx; esophagus (L)

Jejunum; duodenum (4th part)

Duodenum; jejunum

Pineal gland

Intermediate Posterior Thyroid Anterior lobe of lobe of hypophy- lobe of Parathyroid hypophysis sis hypophysis Thymus

L2, L3, S3–S5 Patellar reflex; ejaculation; micturition reflex; defecation reflex; anal reflex

Anal canal; rectum Pharyngeal tonsil

I II III IV V3

Mammary gland (L) Palatine tonsil

Olfactory nerve Optic nerve Oculomotor nerve Trochlear nerve Lingual nerve

Tubal tonsil

VI VII VIII X XI

Organs

25 26

Abducens nerve Facial nerve Vestibulocochlear nerve Vagus nerve Accessory nerve

Miscellaneous Tonsils

Lingual tonsil

Yang

Endocrine glands

Mammary Central nervous gland (L) system; psyche Laryngeal tonsil

Yin

Intensity of focus: U severe O moderate Z weak

XII Hypoglossal nerve Every odontogenous focus irritates the C1 and C2 segments of the vertebral column, the C1 and C2 segments of the spinal cord, and the C1 and C2 dermatomes.

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250 Training, Equipment, and Practical Aids

Tonsils

Lingual tonsil

Tubal tonsil

Laryngeal tonsil

Arteries Veins

Mammary gland (R) Lymph vessel

Palatine tonsil

Pharyngeal tonsil

Miscellaneous

Lymph vessels; mammary gland (R)

Peripheral nerves

Endocrine glands

Thyroid; parathyroid; thymus

Adrenal gland (energy balance)

Yang

Stomach; pylorus

Terminal ileum; ileocecal region

Cecum; appendix; ileocecal region

Stomach; pylorus

Gallbladder; cystic duct and choledochous duct

Urinary bladder (R); urogenital region

Yin

Pancreas

Heart (R)

Bronchioles; lung (R)

Pancreas

Liver (R)

Kidney (R)

Vertebrae

T11, T12, L1

C7, T1, T2, T5–T7, S1, S2

C5–C7, T3, T4, L4, L5

T11, T12, L1

T8–T10

L2, L3, S3–S5, coccyx

Spinal cord segments

T12, L1

C8, T1, T5–T7, S1–S3

C5–C7, T2–T4, L4, L5

T11, T12, L1

T8–T10

L2, L3, S3–S5, coccyx

Joints

TMJ; hip and knee (anterior); ankle joint (medial)

Shoulder, elbow; metatarsus (fibular); 3rd–5th toes; sacroiliac joint

Shoulder, elbow; metatarsus (tibial); 2nd toe, big toe

TMJ; hip (R, anterior); knee (R, anterior); ankle joint (medial)

Hip (lateral); knee (medial, lateral); ankle joint and talocalcaneonavicular joint

Sacrococcyx; knee (posterior); talocalcaneal joint

Sensory organs

Middle ear; tongue; outer ear

Nose (sense of smell)

Tongue (taste)

Eye (anterior part)

Nose (sense of smell)

Cranial nerves, parasympathetic nerves

V, VII, XII

V, X, XI

V3, X, XII

III, IV, V, VI, XI

Pelvic splanchnic nerves; pelvic plexus; parasympathetic portion of sacral spinal cord

Cavernous sinus

Ethmoidal sinuses

Maxillary sinus

Cavernous sinus; Frontal sinus; sphenoid sinus sphenoid sinus

Diverticulum of terminal ileum; ileocecal focus

Diverticulum of cecum; ileocecal focus

S1–S3

L4, L5

Organs

Paranasal sinuses

Maxillary sinus

Focal disturbances Dermatomes

T11, T12, L1

Intercostal nerves

T11, T12

Reflexes

T11, T12 Lower abdominal wall reflex

R Right L Left

C5–T1 T1–T4 T5–T7 T8–T10 T11–T12

S1, S2 Achilles tendon reflex; plantar reflex; erection

Rectum; anus; anal canal

Gonads Gonads

L4, L5 Gluteal reflex

Brachial plexus Superior intercostal nerves Middle intercostal nerves Inferior intercostal nerves The most inferior intercostal nerves

Adrenal gland

Biliary focus

Urogenital focus; proctitic focus

T11, T12, L1

T8–T10

L2, L3, S3–S5, coccyx

T11, T12

T8–T10

T11, T12 Lower abdominal wall reflex

T8–T10 Upper abdominal wall reflex

T12–L3 L4–S3 S4–S5 S5

L2, L3, S3–S5 Patellar reflex; ejaculation; micturition reflex; defecation reflex; anal reflex

Lumbar plexus Sacral plexus, sciatic plexus Pudendal plexus Ccoccyx, coccygeal plexus

001_252_Strittmatter.fm Seite 251 Montag, 20. Dezember 2010 10:27 10

Dental Tables 251 The following correlations were established by R. Voll, MD, Plochingen, Germany, and co-workers during diagnostic procedures using electroacupuncture. They were summarized in a table for the first time by F. Kramer, DMD, Nuremberg, Germany. The data have been updated by A. Rossaint, DMD, in the form of a dental scheme based on Dr. Voll’s publication, "Tabellen über energetische Wechselbeziehungen von Odontonen zu Organen und Gewebssystemen". ML-Verlag, Ülzen, 1978. Table 13 Left lower jaw

Pharyngeal tonsil

Palatine tonsil

Rectus; anus; anal canal

Intensity of focus: U severe O moderate Z weak Tonsils

Laryngeal tonsil

Tubal tonsil

Lingual tonsil

Mammary gland (L) Lymph vessels

Veins Arteries

Peripheral nerves

Lymph vessels; mammary gland (L)

Miscellaneous

Adrenal gland (energy balance)

Thyroid; parathyroid; thymus

Endocrine glands

Adrenal gland

Gonads

Urinary bladder (L); urogenital region

Biliary ducts (L); common, left, and right hepatic ducts

Stomach (L); gastric body

Sigmoid colon

Ileum (L)

Stomach (L); gastric body

Yang

Kidney (L)

Liver (L)

Spleen

Bronchioles; lung (L)

Heart (L)

Spleen

Yin

L2, L3, S3–S5, coccyx

T8–T10

T11, T12, L1

C5–C5, T3, T4, L4, L5

C7, T1, T2, T5–T7, S1, S2

T11, T12, L1

Vertebrae

L2, L3, S4, S5, coccyx

T8–T10

T11, T12, L1

C5–C7, T2–T4, L4, L5

C8, T1, T5–T7, S1–S3

T12, L1

Spinal cord segments

Sacrococcyx; knee (posterior); talocalcaneal joint

Hip (lateral); knee (medial, lateral); ankle joint and talocalcaneonavicular joint

TMJ; hip (L, anterior); knee (L, anterior); ankle joint (medial)

Shoulder, elbow; metatarsus (tibial); 2nd toe, big toe

Shoulder elbow; metatarsus (fibular); 3rd–5th toes; sacroiliac joint

TMJ; hip (L, anterior); knee (L, anterior); ankle joint (medial)

Joints

Nose (sense of smell)

Eye (anterior)

Tongue (taste)

Nose (sense of smell)

Middle ear; tongue; outer ear

Sensory organs

Pelvic splanchnic nerves; pelvic plexus; parasympathetic portion of sacral spinal cord

III, IV, V, VI, XI

V3, X, XII

V, X, XI

V, VII, XII

Cranial nerves, parasympathetic nerves

Frontal sinus; sphenoid sinus

Cavernous sinus; sphenoid sinus

Maxillary sinus

Ethmoid sinuses

Cavernous sinus

Urogenital focus; proctitic focus

Biliary focus

Diverticulum of sigmoid colon

Meckel’s diverticulum; small bowel diverticulum

L2, L3, S3–S5, coccyx

T8–T10

T11, T12

L4, L5

S1–S3

T8–T10

T11, T12

T8–T10 Upper abdominal wall reflex

T11, T12 Lower abdominal wall reflex

L2, L3, S3–S5 Patellar reflex; ejaculation; micturition reflex; defecation reflex; anal reflex I II III IV V3

Olfactory nerve Optic nerve Oculomotor nerve Trochlear nerve Lingual nerve

VI VII VIII X XI

Organs

L4, L5 Gluteal reflex

Abducens nerve Facial nerve Vestibulocochlear nerve Vagus nerve Accessory nerve

S1, S2 Achilles tendon reflex; plantar reflex; erection

Maxillary sinus

Paranasal sinuses Focal disturbances

T11, T12, L1

Dermatomes

T11, T12

Intercostal nerves

T11, T12 Lower abdominal wall reflex

Reflexes

XII Hypoglossal nerve Every odontogenous focus irritates the C1 and C2 segments of the vertebral column, the C1 and C2 segments of the spinal cord, and the C1 and C2 dermatomes.

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252 Training, Equipment, and Practical Aids

Index_253—257.fm Seite 253 Montag, 20. Dezember 2010 10:33 10

Index 253

Index Page references in bold refer to illustrations. A ACTH point, 83 acupressure, body points, 86 acupuncture, see ear acupuncture acupuncturists, contact details, 239 allergens, 88–89 allergy, 120 gastrointestinal, and migraine, 35–36 points, 118, 119, 120, 120 treatment, and VAS, 202–203 amalgam, dental, 36, 71–72 and omega point I, 130, 130– 131, 131 procedure, 83–84, 153–154 anesthetic vs. acupuncture, 149 infiltration of focus, 77–78, 78, 148–149 see also therapeutic local anesthesia antidepression point, 72 antihelix, and vertebral column, 217, 218–220, 218– 220 anus, 226–227, 229 apical periodontitis, chronic, 20, 21 apicectomy, and large intestine meridian, 33 appendix, 17, 226, 228 application, practical, 53–230 arms, see upper limb articaine ampoule, 141 auricle cardiac reflex, 103 diagnosis, 43 and disturbing scars, 42–43 and inverted embryo, 216, 216–217 reflex localizations, 216–230 see also ear autonomic nervous system, reaction, 85, 108

B backflow phenomenon, 108, 109 back pain active ear points, 210 after ankle surgery, 209–210 and impacted wisdom teeth, 159, 159–160, 160

Bahr, F.R., 44 focus diagnosis, 27 frequencies, 179, 180, 186 and histamine point, 116 test procedure, 46–47 validity of method, 45–46 basics, 1–51 bladder, urinary, 228, 229 bladder meridian, 211 bleeding after needle insertion, 147 insertion canal, 96 blood flow, vascular pattern, 109

C cable method, assigning foci, 125–130, 126 cardiac reflex, auricular, 103 caries, dental, 18 case histories, see examples from practice children hay fever treatment, 212–213 laser treatment, 68–69, 213 chronicity, symptoms, 7 color markings, 66 conception vessel, 132 concha, internal organs projection, 217 connective tissue, role, 7–8 constitutional therapy, vs. functional therapy, 205 contraindications, needle treatment, 90 conventional diagnosis, 73 courses, in Germany, 233–235 cyclophosphamide point, see Endoxan point cysts, jaw region, 23–24

D deep tissue layer, 167 dental amalgam, see amalgam dental foci, 203 detection, 45 hidden, 185–187 and shoulder pain, 158 therapy, 187–189 see also focus points; teeth dental probe, laser, 191, 191– 192, 192 dental regions, correlations with body, 248–251 dentistry, and VAS, 203 depolarization, continuous, 26– 27 depression, 72, 73, 92–93

diagnosis, see focus diagnosis diazepam analogue point, 72 diet, 88 Dosch, P., 28 dysbiosis, intestinal, 33–34

E ear, 226, 226 acupuncture, see ear acupuncture dominant, 69 electrode imprint, 66 map, 54, 74 models, 54, 217 needle inflammation, 90 needling, 77, 80 palpating, 57 points, see ear points reflex localizations, overview, 243 stamp, 55, 217 terraces, 217 see also auricle; auricular ear acupuncture, 79 vs. anesthetic infiltration, 149 case histories, 209–215 contraindications, 207 frequencies, 180 indications, 205–207 laser equipment, 189, 190 needles, 93–94 patient information leaflets, 240–242, 245–246 points, see ear points symptomatic therapy, 204 testing for foci, 41–43 ear points activity, 63 additional, 82, 82, 83 in back pain, 210 finding, 56–57, 60–69, 70–71, 75 and hay fever treatment, 205, 212 and knee pain, 214 massage by patient, 86 measurement, error sources, 66–67 mechanical search, 57–59, 58 palpable, 58–59 and scar, 43 use of pressure probe, 59–60, 60 see also gold points; silver points ear probe, stirrup, 57, 58 ear reflex zones, 43 focus diagnosis, 54

Index_253—257.fm Seite 254 Montag, 20. Dezember 2010 10:33 10

254 Index focus therapy, 77–99 needling, 144–147 therapeutic procedure, 80–85 eczema, and dental root remnants, 21–22 electric hammer, see hammer electric point-finders, 42 electrode application, 63, 64, 67 imprint on ear, 66 needle, 62 electromagnetic fields, 55 electrosmog, 38 embryo, inverted, and auricle, 216, 216–217 Endoxan point, 120, 120, 125, 131 energetic correlations, dental regions and body, 248–251 energizer, middle, 35 energy level, 9 equipment essential, 99, 157 lasers, 189–193 second-hand, 193, 238 supply sources, 237 ethmoidal sinuses, 16 examination procedure extending, 171–174 laser, complete, 187 preliminary, 69–70, 135–141, 171–174, 176 with 9-volt rod, 176, 177 examiner, posture, 110, 110 examples from practice abdominal pain due to foreign body in leg, 160–163 assigning focus using ampoule method, 133–134 assigning focus using cable method, 127–129 chronic pain due to impacted wisdom teeth, 159–160 devitalized tooth, irritable bladder, 7 disturbing scar–ear point, 43 Huneke’s phenomenon, 11–12 knee pain, 63 meridianitis, 160–163 migraine–gallbladder meridian, 29–30 migraine therapy, 163–165 scar–migraine, 71 shoulder pain due to dental focus, 158 strumectomy scar–stomach meridian, 31–33 tooth remnant–eczema, 21–22 worry–migraine, 38 exodontics, 18 eye, 225, 225

F false readings, 56 feedback system, overload, 5 field of disturbance, 5 filling materials, teeth, 19 first rib, 173, 174 first strike/second strike theory, 6 focal disturbances, 5, 70 test procedures, 41–48 focal stimulation, expansion, 10 focus, foci, 2–3, 5–13 activity, basics, 7–8 assigning, with cable method, 127–129 chronically inflamed, 15 definition, 5–6 dental, detection, 45 diagnosis, see focus diagnosis disturbances, see focal disturbances failure to eliminate, 89–90 grading, 44 indicator points, see focus indicator points infiltration with local anesthetic, 77–78, 78 internal, 47 mental, 37–38 potential, 15–38 primary, 101 projection to body sides, 117 scars, 26–36 search for, 3 starting point, 8–9 target organs, 7 teeth, 18–26 treatment, in inversion, 173 focus diagnosis, 46–47 advanced, 47, 48 beginners, 46, 48 and ear acupuncture, 204–205 and ear reflex zones, 54–76 improving, 166 knowledge level 1, summary, 76 knowledge level 2, summary, 142 and laser, 178–193, 182–183, 183 levels, see knowledge level methods compared, 47 teeth, 18 with VAS control, 101–142 focus indicator points, 115– 125, 116, 117 assigning foci, 125–130 finding with laser, 181–182, 182 finding with 9-volt rod, 171 type 1, 118, 119, 120 type 2, 120, 120

type 3, 121–122 type 4, 122, 122 type 5, 122–123, 123 focus points finding with 3-volt hammer, 124, 124–125 finding with 9-volt rod, 171 hay fever treatment, 205 see also ear points; focus indicator points; points focus therapy additional points, 154–155 course of, 92–93, 156 dental foci, 187–189 ear reflex zones, 43, 77–99, 80– 85 knowledge level 1, 92 knowledge level 2, 157 and laser, 178–193, 184, 184– 185 laser equipment, 189, 190 methods compared, 47 monitoring, 151–153 optimizing, 166–177 with point-finder, 68 problems, 89–91, 155–156 and resistance to treatment, 6 supportive measures, 84–89, 156 training courses, 233–235 with VAS control, 144–157 see also therapeutic local anesthesia follicular cysts, 23 food allergy, 202 foreign bodies, in teeth, 23 foreign body granuloma, 27 frequencies, Bahr and Nogier, 178–180 functional points, 205 finding, with 9-volt rod, 171 and laterality, 174 functional therapy, vs. constitutional therapy, 205 fungal growth, 35

G gallbladder, 227, 227 meridian, 28, 29 galvanism, dental, 36–37 ganglion stellatum point, 174 gastrointestinal allergy, 202 ginseng point, 122–123, 123, 131 gnathitis, after tooth extraction, 24 goggles, laser safety, 193 gold needles, 82, 94 gold points, 62, 72 and focal disturbances, 70 palpation, 63 granuloma, foreign body, 27

Index_253—257.fm Seite 255 Montag, 20. Dezember 2010 10:33 10

Index 255 grounding, 55–56, 56, 74, 85, 135, 138–139

H hammer, 3-volt, 101, 103, 113– 115, 114, 115 and locating focus points, 124, 124–125 handedness, 69, 84, 87, 91, 135–136 and focus indicator point, 117 see also laterality hat-shaped patches, 97, 97 hay fever in children, 212–213 and ear points, 205, 212 head, 223–226, 223–226 headache, 202 heart, 226, 227 helix, spinal cord projection, 217 hip pain, 200 hip point, 213 histamine point, 115–116, 118, 119, 120, 131 holistic approach, 2 hooks, needle tips, 94 Huneke, F., 11 Huneke’s phenomenon, 11–13, 165 hyperalgesia, 10

I immune system, 33 infiltration of focus, local anesthetic, 148–149, 200– 201, 201 infiltration of local anesthetic, 77–78, 78 intermediate tissue layer, 167 internal organs, 217, 226–230 intestines disorders, 202–203 dysbiosis, 33–34 lymphatics, 35 meridian, 32, 33 wall leakage, 34 inversion, 171–172, 173 inverted embryo, and auricle, 216, 216–217

J jaw region, cysts, 23–24 jaws, 224, 224 jewelry, 123

K kidney, 228, 228 meridian, 26 knee pain, 63, 199, 199–200, 213–214 active ear points, 214

knowledge level 1, 46, 48, 54– 76 practical approach, 73–76 therapeutic steps, summary, 92 knowledge level 2, 101–142 diagnostic steps, summary, 142 therapy, summary, 157

L laser, 178–193 acupuncture, patient information leaflets, 245–246 application, 181–185 characteristics of light, 179– 180 and children, treatment, 213 in diagnosis, 182–183, 183 in therapy, 79, 90, 184, 184– 185 laterality, 135–136 determining, 174–175, 175 point, 122–123, 123, 131 unstable, 209–210 see also handedness legs, elevating during treatment, 85 see also lower limb Leriche, R., 11, 103 lips, 224 liver focus, 213 meridian, 215 local resonance, 130–135 locomotor system, 217, 218 lower limb, 222, 222–223 lymphatics, intestinal tract, 35

M magnet, turning, for needle stimulation, 97–98, 98 master omega point, 72, 73 master point of oscillation, 137 maxillary sinuses, 16 measurement errors, ear points, 66–67 medical history, 43, 73 mental fields of disturbance, 84, 155 mental foci, 37–38 mercury, toxic, 37 meridianitis case history, 160–163 and fresh scars, 30 meridians, 9 bladder, 211 clock, 10 course, 11 gallbladder, 28, 29 kidney, 26 large intestine, 32, 33 liver, 215 scars on, 28

stomach, 31, 31–32, 162 middle energizer, weakness, 35 migraine and gallbladder meridian, 29 and gastrointestinal allergy, 35–36 posttraumatic, 164–165 and scar, 71 therapy, 163–164 and worry, 38 misoprostol, 131 monitoring of therapy, 151– 153 moxibustion, 81, 150–151 muscle training, 88 muscular trigger points, 196, 197 myokinetic chains, 10

N neck muscles, trigger points, 200 needle electrode, 62 needle probe, Nogier, 167 needles acupuncture, 93–94 choice of metal, 80 contraindications, 90 disposal, 93–94 and ear inflammation, 90 fear of, 91 insertion, 81, 144–145, 146, 147 patient information leaflet, 244 permanent, 95–96, 96, 97–98, 98, 146–147 removal, 145–146 reusable, 94–95 sharpening, 95 sterilization, 95 needling of ear, 77, 80 nerve stimulation, transcutaneous, 86, 86–87 neural therapy, 44–45 patient information leaflet, 246–247 and VAS, 200–202 Nogier, P., 41, 103 frequencies, 178–180 and histamine point, 115 inverted embryo projection, 216 needle probe, 167 pressure probe, 60 reflex, 47, 101 resonance zones, 178 nose point, 138

O obstacle to healing, 5 omega point I, and amalgam, 72, 73, 83, 130, 130–131, 131

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256 Index oral cavity, 224, 225 orthopedics, and VAS, 196–200 oscillation, 136, 136, 137 detecting cause, 140–141 elimination, 139–140 and inversion, 173 osteitis, residual, 24–25 otoplasty, 90 ovary, 229, 229

P pain management, 204 see also back pain; hip pain; knee pain; shoulder pain palpable points, ear, 58–59 palpation, VAS, 108, 110, 110, 111, 112–113 paranasal sinuses, 226, 226 patches, for covering needles, 97, 97 patients fear of needles, 91 history, 43, 73 information leaflets, 240–247 positioning, 74, 110, 110 pelvis, 220, 221 periodontal disease, 25–26 periodontitis, 20, 21 permanent needles, patient information leaflet, 244 Pischinger, A, 8 point-finders, 46, 60, 65, 68 electric, 42 held by patient, 75 simple detector, 61 treatment with, 68 points additional, 154–155 BL 40, 118, 119 CV 12, location, 132 differentiation, with 9-volt rod, 168 first rib, 174 ganglion stellatum, 174 GB 41, 121, 122 GE1, 155, 155 GV 4, 154, 154 LI 1-1, 123, 123 LI 3-1, 118, 119 PC 9-1, 120, 120 PGE1, 121, 121, 131 and symptoms, 75 TE 1-1, 122, 122 TE 3-1, 121, 122 TE 5, 155, 155 tooth, 188 Yin Tang, 137, 137, 138, 139, 139–140, 174 zero, 58, 59, 154, 154 see also ear points; focus indicator points; focus points; functional points; gold points; silver points

positioning, of patient, 74, 110, 110 posture, for examiner, 110, 110 potential differences, 62, 65 potential foci, 15–38 practical application, 53–230 practical approach, knowledge level 1, 73–76 preliminary examination, 69– 70, 135–141, 171–174, 176 pressure probe, Nogier, 60 psychological strain, 15 psychotropic points, needling, 84 see also depression; mental fields pulp, inflamed, 18 pulse diagnosis, 36, 47, 107 pulse wave, propagation, 104

Q Qi, 9

R radial pulse, 111 radicular cysts, 23, 24 reflex localizations, auricle, 41, 41–42, 216–229, 216–230 reflex points, pressure-sensitive, 42 residual cysts, 23 resistance to treatment, 6 resonance, 130–135 chain, 9 zones, 178 rod, 9-volt, 166 finding points, 171 and laterality, 175 point differentiation, 168 root canal therapy, 20–21

S scapha, 217, 220, 221 scars and auricular diagnosis, 42–43 foci, 26–36 fresh, and meridianitis, 30 infiltrating, 78 laser diagnosis, 183, 183 on meridian, 28 and migraine, 71 and navel, 27 strumectomy, and stomach meridian, 31–32 treatment, 45 Schmid–Bahr points, 188 shoulder pain, 198, 199 and dental focus, 158 sieve method, 81, 150 silver needles, 94 silver points, 62, 64 sinuses, 16 skin diseases, 202

spinal cord projection, helix, 217 stationary wave, 104, 105, 106, 107, 107 sterilization, needles, 95 stimulation, of permanent needle, 97–98, 98 stirrup ear probe, 57, 58 stomach meridian, 31, 31–32, 162 stress, emotional, 15 substance intolerance, 36–37 summaries diagnosis, 76, 142 ear acupuncture with focus therapy, 79 equipment, essential, 99, 157 examination procedures, 177, 187 methods compared, 48 therapy, 92, 157 superficial tissue layer, 167 symptoms alleviating, 83 chronicity, 7 including in therapy, 84 no improvement, 89 points, 75

T target organs, 7 teeth, 224, 224 and Bahr frequency 7, 186 devitalized, 7, 20 displaced, 23 fillings, 19, 83 as foci, 18–26 fractures, 21 galvanism, 36–37 and gnathitis, 24 points on body, 188 regions, correlations with body, 248–251 root remnants, 21–22, 22 Schmid–Bahr points, 188 trauma, 19 wisdom, impacted, 23 see also amalgam; dental temporomandibular joint, 17, 223, 223 terraces, ear, 217 test ampoule, and VAS, 131– 135 testis, 229, 229 test procedures Bahr’s method, 46–47 and ear acupuncture, 41–43 focal disturbances, 41–48 therapeutic local anesthesia (TLA), 148, 149, 200 therapy, see focus therapy thorax, 220

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Index 257 thumb, and palpation, 110, 110, 111 thymus gland point, 82, 83, 83, 86, 155, 155 tissue layers, 166–167, 168– 171 tongue, 224, 225 tonsils, chronically inflamed, 16–17 Traditional Chinese Medicine, 9, 26 training, 231–236 transcutaneous nerve stimulation (TNS), 86, 86–87 device rental, 87–88 trauma, dental, 19 treatment, see focus therapy trigger points muscular, searching for, 196, 197 neck muscles, 200

U unconscious conflict, 91 upper limb, 221, 221 urinary bladder, 228, 229 uterus, 229, 229

V Valium analogue point, 72, 73 vascular autonomic signal (VAS), 101, 103–115 in allergy treatment, 202–203 case histories, 158–165 in dentistry, 203 and diagnosis, 47, 48, 101–142 discovery, 103 and focus therapy, 144–157 in neural therapy, 200–202 in orthopedics, 196–200 palpation, 108, 110, 110, 111, 112–113 physiology, 104 and test ampoule, 131–135

triggering, 108 vertebral column and antihelix, 217, 218–220, 218–220 blockages, 197 Virchow, R.L.K., 2 vitamin C point, 122, 122, 131 vitamin synthesis, 33

W wave, see stationary wave wisdom teeth, and back pain, 159, 159–160, 160 worry, and migraine, 38 wristwatches, 123

Y Yin Tang point, 137, 137, 138, 139, 139–140, 174

Z zero point, 58, 59, 154, 154

Strittmatter, Beate-Identifying and treating blockages to healing new approaches to therapy resistant patients _ [according to the work of Frank Bahr, M. D. and Paul Nogier, M (1) - PDFCOFFEE.COM (2025)