FROM AURICULOTHERAPY TO AURICULAR NEUROMODULATION: AN EXTRAORDINARY STEP

For the past few years all authors who have introduced some changes in the mapping of the pinna’s reflex points have done so following the empirical model, applying their own experiences, and in many cases, following their intuition, without any other basis nor criteria which can sustain the applied changes and the different locations of the auricular points. All along, Auriculotherapy has gone hand-in-hand with Acupuncture, to such an extent where in occasions one was mistaken for the other. An essential difference between both is that while the points in Acupuncture have a neuroanatomical reference, the ones in Auriculotherapy do not.

Doctor Paul Nogier, following this same model, described an auricular mapping that was considered to be the most modern and accurate of its time, above all for the western world. The Chinese responded by initiating a treatment program with many patients, with which, after contrasting results, it created a mapping, the so-called “Chinese mapping”, considered by some as the most reliable up to now. Paul Nogier described the four articular phases: according to this theory, a specific alteration or dysfunction can manifest or reflect in four different points. He continued describing an auricular model for diagnosis, called Auriculomedicine, based on the so-called Cardiac Auriculo Reflex (C.A.R.) or Vascular Autonomic Signal (V.A.S.). This reflex appears in the radial pulse, as a signal to identify an active point. When we submit an auricular point to a specific frequency, and a light shines through a filter that contains a color, and projects itself over a point; the resonance of the encounter between two same frequencies produces a modification of the radial pulse, so when this different quality in the pulse is perceived, the point is identified as active, thus susceptible to being treated. It is a complex system that needs many elements and which, ultimately, makes the model confusing and not reproducible at all. A complete disaster.

This was the outlook on Auriculotherapy until a model based on the innervation of the pinna was established. This criteria set the bases to establish zones related to nerve terminals and that could justify their activity. This new way of understanding the performed activity over the pinna has been denominated Articular Neuromodulation (ANM). Some of the organizations which have promoted it are the Auricular Neuromodulation International School (ANMIS) and the Research Center on Auricular Neuromodulation and Complementary Therapies University of Sassari (CERNATEC), with Doctor Giancarlo Bazzoni as a representative of this procedure and diffuser of it all around the world.

The pinna is innervated by three types of nerves, in relation to their provenance: trigeminal (auriculotemporal nerve), vagal (auricular vagus nerve) and spinal (great auricular nerve, coming from the nerve roots C2-C3).

We are shifting from a model based on intuitive pragmatism which leaves a trace of many mapping differences and a number of points that are set around 100 (depending on the different mappings), to a model based on neuroanatomical criteria that describes about 10 active zones.

In this sense, the appearance of the Polyvagal Theory, elaborated by the North American neuropsychiatrist Stephen W. Porges (2011), where we can find what the role of the autonomic system is in general, and the role of the vagal system in particular. This theory considers that the vagus is not only a nerve, but also a group of neural pathways which originate in diverse areas of the brain stem, more specifically in the Dorsal Nucleus of Vagus nerve, and in the Ambiguous Nucleus. The vagal fibers of these two brain stem nuclei are different in structure and function. On one side, the vagal fibers in Ambiguous Nucleus are myelinated, and the ones in Dorsal Nucleus of Vagus nerve are amyelinic. It is also important to point out that, neuroanatomically, the motor component of the vagus nerve shares evolutionary origins with four cranial nerves: trigeminal, facial, accesory and glossopharyngeal.

The Polyvagal Theory recognizes that the vagal system is very complex and that it should be organized in terms of the common origins of the nuclei and their relation with the structures of the central nervous system.

The processes that require the capability to control and mediate complex conducts, such as attention, movement, emotion and communication are neurophysialogically dependent on the special visceral efferents of the Ambiguous Nucleus and the facial and trigeminal nerves.

One of the most interesting actions of this Polyvagal Theory is that the vagal activity reduces the inflammation when modulating the immune system, inhibiting the complex of the cytokines. Currently, in the U.S.A. they are using vagal stimulators to be able to control the inflammatory phenomena in, for example, aggressive rheumatic diseases that cannot reduce it with antiinflammatory drugs.

The innervation of the pinna provides vagal fibers for its stimulus. From this point of view and following this neurophysiological criteria, many concrete, justifiable and effective treatment strategies can be generated.

In conclusion, on one hand we have the empirical/experimental/intuitive model, without any criteria to discriminate the different locations of the auricular points in the mappings, and on the other hand, an up-to-date model based on the innervation of the pinna, and thus related to the neurophysiological and neuromodulation processes that can propose clear terapeutic strategies through their active zones, which can be reproducible and can be integrated in the regular terapeutic arsenal that is applied on a daily basis in our field.

The change from classic Auriculotherapy to Auricular Neuromodulation represents an extraordinary step towards a future filled with expectations about this great terapeutic procedure.

Dr. Pedro Marco Aznar



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