At the Canadian Institute of Auricular Medicine (CIAM) we continue to build on, and share learnings and research from, the collaborative efforts between academic leaders in both TCM and German Auricular Medicine. As part of this effort, CIAM conducted an interview with Dr. Jihong Liu, deputy director of the Center for Preventive Treatment of Diseases at the Foshan Hospital of TCM in Foshan, China. Dr. Liu, who is also a professor and teaches on the subject of ear acupuncture, recently presented research on the histology of active auricular points — just one of the reasons for our interest to talk with him.
Dr. Liu learned the VAS and European auricular methods from Dr. Andreas Wirz-Ridolfi, a subject advisor to CIAM and lecturer at the German Academy for Acupuncture (Deutsche Akademie für Akupunktur | DAA), to which CIAM is affiliated as an independent cooperation school. On an introduction by Dr. Wirz, CIAM has developed a relationship with Dr. Liu that started in 2014. Given his work at the Foshan Hospital of TCM, CIAM provides this interview to share leading TCM perspectives on the field of Auricular Medicine.
Auricular Medicine & Neurological Research
CIAM: “We understand that activity of reflex zones on the microsystem of the ear may be guided by visual assessment or imbalances in the relative across the surface of the skin. Your research shows that these changes from the projection of issues mapped by the brain onto the ear, actually reflect as histological and structural changes on the ear as well. Can you share more detail on these findings, and what role theories of Auricular Medicine play for future research?”
Dr. Liu: “In 2014, our research group obtained funding from the Guangdong Provincial Natural Science Fund to conduct an experimental study on the relationship between structural changes of the outer auricle and disease progression in rabbit models of acute and chronic gastritis. We found that the cuticle of the skin of the auricular point corresponding to the site of lesions in the mucous membranes of the stomach became thinner, even disappeared; the skin germinal layer and spinous layer proliferated and thickened, and a large number of lymphocyte-dominated inflammatory cells infiltrated the local area. After more than five years of research, it was also confirmed that the pathological changes of Erwei (stomach) point on the ear in the rabbit models with acute and chronic gastritis were characterized by loose stratum corneum, local epidermal and dermis thickening, dermal inflammatory cell infiltration and local connective tissue looseness. Under an electron microscope, the decrease of bridge particles, mitochondrial swelling, vascular degeneration and mitochondrial autophagy were observed, while no significant changes were observed in the normal group. Changes observed in the outer structure of the ear correlated to the pathology. The next step is to study the correlation between stimulation of the outer ear and therapeutic effects.
In the clinical treatment of diseases with ear acupuncture, we found that there was a connection between ear points and constitution. The color of the ear was related to the rise and fall of qi and blood. The constitution of people with soft ears was weak. I plan to further study how to use the ear to identify the constitution of patients to determine the disease.
I am interested to learn more about the work of Dr. Frank Bahr and the methods of German Auricular Medicine to identify and prioritize (with qualitative measure using VAS) key blockage points and even constitional issues. We are finding that the concepts in Auricular Medicine can support Traditional Chinese Medicine (TCM) treatment approaches as well as acupuncture and related research.
Of course, the theories and methods of European auricular acupuncture system taught by Frank R. Bahr and Wirz-Ridolfi will play a very important role in my next research. Characteristics of European ear acupuncture such as point projection, resonance and vascular autonomic signal are important concepts for precision in preventative care, and German Auricular Medicine concepts are concepts I have been applying in my academic framework for disease prevention.”
The Importance of the Ear
CIAM: “Beyond the anatomo-physiologic basis (i.e. innervation by major nerve branches, the unique tissue development of the ear, etc.), what are the underlying TCM aspects you use to explain the importance of the ear — that is to say, why should we use the ear to assess and treat the body?”
Dr. Liu: “The ear offers a means for comprehensive patient assessment and treatment. From my 30 years of clinical Traditional Chinese Medicine (TCM) experience, I have come to realize that the ear can help guide treatment because of its direct relationship to shape (anatomical aspect), Qi (aspect of function), and shen (aspect of spirit or mind/soul). As a microsystem projecting the entire body, the ear reflects shape, qi and shen, providing a holistic and precise view onto the entirety (mind and body) of the patient.
Shape is the material basis, which includes viscera tissue, skin, veins, muscles and bones, and life active substances (e.g. the entity part of the shape). The microsystem of the ear (the inverted fetus) as mapped by Dr. Paul Nogier reflects the entire body. Ear point maps of Dr. Paul Nogier, as well as Chinese National Standard ear point location maps, have shown to locate the highest number of reflective points of any microsystem on the body. More importantly, the auricles are directly innervated by all the major nerve branches; have an abundance of blood vessels which are directly connected to the external carotid artery (an artery that plays an important role in providing collateral blood supply to the brain); and sit among vital lymphatic vessels — preauricular and posterior auricular lymph nodes. This physio- and neuro-antomical basis is the reason that stimulation of auricular points is so effective in regulating imbalances in the body.
Qi is a dynamic system and a special substance in human life, which is distributed around the body. In Western medicine terms, Qi may best be described as function. The movement changes of the human “Qi engine” maintain normal human life activities. Balance in Qi is equivalent to a healthy state of homeostasis. Traditional Chinese Medicine (TCM) believes that Qi is a special intangible and non-substantial substance filled inside and outside the human body. Both TCM and Western medicine can perceive it through pulse diagnosis, which can be divided into tangible qi (blood) and intangible qi (such as Zongqi, Yingqi, Weiqi, etc.). Auricular Medicine, among other things, can regulate qi movement and dredge meridian qi and blood. The ear is the gathering of the clan veins, connects with various meridians (while also reflecting all meridians), and is closely related to Shaoyang. Shaoyang dominates the gallbladder and its veins lie in the ear. All kinds of ear stimulation, including auricular point therapy, have a certain regulatory effect on Shaoyang qi movement, as well as regulating the pivot of Shaoyang to rule the whole body.
Shen is spirit/soul and psychology. In a narrow sense, it refers to people’s mental consciousness and activities of thought/mind — will, intelligence, and emotional aspects such as anger, joy, sadness, fear and surprise. In TCM, Shen is related to the abdomen, kidney and the heart — all to which the ear is connected, and all of which are also reflected on the ear. In fact, the ear is closely related to all of the five viscera — kidney, spleen, heart, lung, liver. In TCM the five Zang Shen are formed with the growth and development of the five viscera: heart is hidden mind, lung is hidden soul, liver is hidden spirit, spleen is hidden will, and kidney is hidden morale. Shen is the general term of all mental and psychological thinking activities emodied in mind, soul, spirit, will, and morale. So, for example in TCM, when kidney qi is often stimulated by tapping or rubbing the ear, it is understood that stimulation of the ear can effectively regulate mental function.
On a related note, doctors often find that barriers between patient and doctor are removed when working with the ear. Directly touching the patient’s ears conveys a sense of comfort and care, helping quickly establish a sense of intimacy and trust as the doctor uses the auricle to convey rapid raport through keen patient understanding — we would say that touching a patient’s ears has the effect of ”seeking the same breath” as this interaction between doctor and patient can often produce a resonance of qi and a “positive adjustment” effect with greater likelihood of the patient’s spirit (mood/mentality/personality) moving towards more positive affect.”
Vascular Autonomic Signal
CIAM: “How did you learn about the VAS and why is it so important to you (e.g. how do you use it in your practice)?”
Dr. Liu: “I was introduced to the Vascular Autonomic Signal (VAS) in a presentation by Dr. Andreas Wirz-Ridolfi at the Beijing University of Chinese Medicine in November 2013. In November 2014, Dr. Wirz-Ridolfi was invited to Foshan to organize a workshop on “European Auricular Medicine Diagnosis and Treatment Methods for Clinical Application in General Practice and Preventive Medicine.” Following this workshop, I made two trips to Dr. Wirz’s clinic in Switzerland (in 2015 and 2017) in order to further study the Auricular Medicine methods based on the work of Frank Bahr and colleagues such as Dr. Wirz.
The VAS is a pulse palpation of an autonomic nervous system response which results in an instantaneous constriction of the vascular walls in the response to resonating stimuli presented within the field of the body/ear. The constriction, in essence a brief fight-or-flight response, can be palpated as a subtle but distinct shift in the standing pulse wave. Using this palpation in my clinic, the VAS reponse helps me diagnosis disease location, explore whether a disease is functional or anatomical, determine whether the patient is sympathetic or parasympathetic, and whether the treatment should be tonifying (i.e. gold needle) or sedating (i.e. silver needle). I often use VAS in rapid acupoint selection in clinical practice to determine whether the treatment is effective for patients.
Body and Auricular Acupuncture: A Comparison
CIAM: “How do you talk about body versus ear acupuncture?”
Dr. Liu: “Auricular Medicine offers a practical bridge to integrate TCM and Western medicine. It is a medicine with neurological basis, a means to assess and regulate neurological states, while clearly relating the brain’s map of somatic and emotional experiences (e.g. neurological states) to TCM concepts of shape (anatomical aspects), Qi (aspects of function), and Shen (aspects of spirit/mind/soul). There are both connections and differences between ear acupuncture and body acupuncture. Differences lie in mechanisms of action related to treatment of points. In my view, ear acupuncture seems to be biased towards central endocrine sensory regulation, while body acupuncture is biased towards mobilizing defensive Qi and Ying Qi.
Furthermore, body acupuncture has many schools, including abdominal acupuncture, umbilical acupuncture, tendon acupuncture, buccal acupuncture and so on. These are all based on meridian system theory, including fourteen meridians, meridian tendons, skin theory. Ear acupuncture can be approached from a basis of TCM, as is the case in Chinese ear acupuncture; or from the basis of frequency-, resonance- and neurology-based concepts, as is the case in German/European Auricular Medicine.
The theoretical basis of these two systems of ear acupuncture share commonalities but are different in approach. So, whereas body acupuncture is clearly grounded in TCM, ear acupuncture provides practical clinical approaches for adjunctive application of either Chinese ear acupuncture or Auricular Medicine. Many studies in China have shown that the combination of ear acupuncture and body acupuncture can improve and prolong the curative effect. Using the VAS and Auricular Medicine methods, auricular points offer a means by which to both diagnosis and treat a patient, support improved accuracy in the selection of body acupuncture points, and overall guide the clinical approach by identifying and prioritizing treatment options.”