Auriculotherapy, auricular neuromodulation, auricular acupuncture: what are the differences?

Auriculotherapy, a French discovery in the 1950s

Auriculotherapy is a term formed by Dr. Paul Nogier in the 1950s, initially consisting in stimulating the auricle and the concha in order to have a therapeutic action. Stimulating the auricle for therapeutic purposes is an ancestral practice that has been known for several centuries around the Mediterranean basin. Debates still exist as to who first described this practice.

Before auriculotherapy, auricular cauterization

Ear stimulation for therapeutic purposes had been known for several centuries around the Mediterranean basin. While some authors go back to the fathers of Western medicine (Hippocrates, with the classic quote 'Diseases that medicine does not cure, iron cures;  those that iron does not cure, the fire heals them; those that fire does not cure, he regard them as incurable', then Galen) or even Egyptian medicine (Cf for example the Ebers manuscript), the authors who left a 'solid' written record are 'only' 400 years old. Here are some figures:

Zacutus Lusitanus (1575-1642)

In the 17th century, a Portuguese doctor, Zacutus Lusitanus (not to be confused with his namesake Amatus Lucitanus, also a Portuguese physician of the 16th century, but born 64 years earlier, known for his observations on venous valves), in his treatise on medicine 'Praxis Medica Admiranda' (1639-42), reports the effectiveness of retroauricular cauterization in a case of rebellious headache. He is simply reporting a practice that was common at that time. The substratum is that of Galen's humors: the ears can serve as drainage points for “humors”, whose congestion would be responsible for certain pathologies. For Lusitanus, cauterization is only one therapeutic method among others and his approach remains cautious about this technique, warning against cauterization that is too deep.

Antonio Maria Valsalva (1666-1723)

Valsalva, famous for the eponymous maneuver known to all divers, was an Italian surgeon and an anatomist, a student of Malpighi. In his treatise”de Aure Humana Tractatus“(first edition in 1704, second edition in 1717), he reports the effectiveness of cauterization on the medial side of the antitragus in the case of dental pain. Notably, the retro-antitragal location described by Valsalva is still used as an analgesic zone, by several schools of auriculotherapy or auricular acupuncture!

Pierre-Francois Percy (1754-1825)

Percy was a French military surgeon, famous for developing a means of transporting the wounded on the battlefields of the Napoleonic Wars, called a “flying cart”. He was a real pioneer in the organization of primary care with the introduction of the concepts of evacuation and triage of wounded on the battlefield, but also in surgical techniques. He was also a great humanist, providing care to the injured regardless of rank or nationality. These principles later inspired Henri Dunant, who founded the Red Cross. In his book 'Practical surgical pyrotechnics or the art of applying fire in surgery' (1811), he described several cauterization sites, including that of the antitragus in the ears for dental pain, in the same way that Valsalva did a century earlier.

Jules Germain Malgaigne (1806-1865)

Malgaigne was a French surgeon, famous for his work on fractures and dislocations. He described the Malgaigne line, an anatomical line from the anterior superior iliac spine to the pubis, used to diagnose pelvic fractures. In the 'Medical-surgical journal '(1850), he reported the success of cauterization of the anterior part of the helix in the treatment of sciatica. This dissemination in the scientific journals of the time could have been the beginning of clinical research on this technique, but that was without counting the opposition of other doctors, in particular Duchenne de Boulogne (1806-1875). The latter, while recognizing the effectiveness of auricular cauterization, discredited it because this technique seemed “barbaric” to him. Duchenne, a pioneer of electrophysiology, gave his name to a disease (Duchenne muscular dystrophy) and inspired the father of French neurology, Jean-Martin Charcot.

From cauterization to auriculotherapy: Paul Nogier (1908-1996)

Paul Nogier was a doctor from Lyon who, at the time, was already interested in an unconventional medical practice. He was interested in acupuncture, homeopathy, and osteopathy. In his patients, he had noticed that some of them suffering from sciatica had a dramatic improvement in their pain after having undergone a cauterization of a particular area in the auricle. This cauterization was performed by a healer from Marseille, Madame Barrin. Intrigued, Paul Nogier met Madame Barrin, then undertook to stimulate the auricular pavilion of his painful patients. Paul Nogier's genius was to propose a “mapping” of the auricle, allowing targeted stimulation according to the location of the pain. He presented his work in February 1956 at the first congress of the Mediterranean Acupuncture Society in Marseille. This work was noted and published in 3 articles in a leading journal at the time, the 'Deutsche Zeitschrift für Akupunktur', a German magazine.

After this initial publication, Nogier called his technique 'auriculotherapy'. There were numerous other advances in the decades that followed, including the description of particular therapeutic frequencies called “Nogier frequencies”, of a particular reflex called “vascular autonomic signal” and the possibility of treating with particular lights. These advances, grouped by some under the term Of 'auriculomedicine', are not practiced by all auriculotherapists and are not validated by scientific articles of good methodological quality. That is why the term 'auriculotherapy' brings together practices that are sometimes quite different.

Auricular acupuncture, evolution of auriculotherapy or conceptual revolution?.

Paul Nogier's works, published in 1956, landed in the hands of Japanese and then Chinese readers. The points described by Nogier were incorporated into the Chinese acupuncture corpus by Xu Zuo Lin, an acupuncture practitioner. In particular, it was this author who described the “Shenmen” point, not initially described by Nogier. The first maps that integrated the points described by Nogier were published in 1959 by the 'Study Group of Auricular Acupuncture of the City of Shanghai'. Auricular acupuncture was born. Several schools of Chinese thought emerged and the technique was exported to the United States in the 1970s, during a state visit by Nixon to China in February 1972. But that's another story...

Subsequently, several meetings aimed at unifying practices took place. The last took place in Lyon, under the aegis of the UN, in 1990. Some thirty points were the subject of consensus between the proponents of a Western approach based on Nogier's work and the proponents of a Chinese approach, auricular acupuncture. But at least as many points could not be accepted by consensus by both parties.

Auricular neuromodulation, the best of both worlds

The term 'auricular neuromodulation' appeared in the 1990s, first under the pen of Bazzoni, a student of Dr. Marco Romoli, before being re-used by other teams. This approach also consists in stimulating the auricle in order to have a therapeutic action, in a vision that only uses validated neurophysiological mechanisms. This approach is therefore based on the scientific corpus acquired with transauricular vagal stimulation, but also on work concerning trigeminal or occipital nerve stimulation: these last two routes have been proposed in the treatment of migraine.

Auricular neuromodulation will use the locations described, auricular acupuncture or auriculotherapy currents, but the stimulation of these locations will be performed on slightly different criteria, and by techniques that are not necessarily used in auriculotherapy or auricular acupuncture. While these techniques may differ in the way in which areas of interest are identified and the means of stimulating them, there are however common points: the three techniques stimulate the auricle in order to have a therapeutic action. Auricular neuromodulation therefore goes further than transauricular vagal stimulation by proposing a modulation passing through other nerves. This approach has been validated using functional MRI.

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