Operational procedures of auricular point sticking technology

Hong CHEN, Shanshan LIU, Kexin LIU,Suna LI, Ling TANG

1Department of Breast Surgery, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China; 2Department of Nursing, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China

ABSTRACT

As an external treatment technique of traditional Chinese medicine (TCM), auricular point sticking, which is rooted in holographic biology theory and TCM viscera and meridian theory, is a safe and effective treatment method.This article introduces the technology overview and development process.The auricular point sticking technique for constipation is taken as an example to specify the basic requirements, assessment, operational points, acupoint selection and matters needing attention during the implementation of the auricular acupressure technique, providing a reference for the operating procedures of this technique in the clinical treatment of other diseases such as insomnia, diarrhea, colds, hypertension,headache, and dysmenorrhea.

Keywords: Auricular acupressure, auricular point massage, auricular point sticking, operating procedures, technology,traditional Chinese medicine nursing

INTRODUCTION

Auricular points originate in China.BeforeHuangdi’sCanon ofInternalMedicinewas written, ancient medical scientists accumulated a lot of experience and knowledge about the connection between ears and the whole, and summarized them and compiled them into the early medical literature.The relationship of the ear with meridians, branches of meridians,and meridian tendons was expounded in detail inHuangdi’s CanonofInternalMedicine.[1]In recent years, unprecedented progress has been made in auricle visual diagnosis and auricular points in treating diseases, which almost covers internal medicine, surgery, gynecology, pediatrics, and so on.Manipulation techniques include auricular point sticking/auricular acupressure, auricular point massage, ear/auricular acupuncture, auricular needle-embedding therapy, auricular acupoint bloodletting, ear clip method, ear moxibustion method, and ear acupoint magnetic therapy.The former three methods are widely used in clinic.

Different from the system of Western medicine, auricular point sticking is mainly based on the viscera and meridians theory and the holographic biology theory (proposed by Zhang Yingqing) under the demonstration of traditional Chinese medicine (TCM).Prof.Zhang Yingqing put forward in viscera and meridians theory that the ear and viscera are interconnected, that is, Qi of the twelve meridians,Yinqiao meridian and Yangqiao meridian goes up to the ear.Meanwhile, the theory of holographic biology supplements the argument that there are corresponding points in the ear which are related to the internal viscera, limbs, and body,and a positive reaction point in the ear reflects the lesion information of the corresponding organ.Moreover, this intercommunication relationship has been confirmed from the perspectives of neurophysiology and neurohumorology.Stimulating auricular points can promote the release of endorphins, cortisol, dopamine, 5-hydroxytryptamine, and norepinephrine to regulate body function.[2]Therefore,auricular acupoints can be used to diagnose diseases, and can also be used to treat diseases by selecting acupoints and sticking and pressing positive reaction points.This article takes auricular point sticking technique for constipation as an example to specify the basic requirements, assessment,operational points, principle of acupoint selection and matters needing attentions during the implementation of this technique, providing a reference for the operating procedures of this technique in the treatment of other diseases such as insomnia, diarrhea, colds, hypertension, headache, and dysmenorrhea.

DEVELOPMENT PROCESS OF AURICULAR POINT STICKING TECHNOLOGY

In China, auricular points have a long history of preventing and treating diseases.The records first appeared in the medical booksMoxibustionClassicofElevenFoot-ArmChannels byMoxibustionandMoxibustionClassicofElevenYin-Yang Channels,unearthed in Mawangdui Han Tomb in Changsha.Although the name and location of auricular points were recorded only sporadically in ancient times, the auricular diagnosis framework and treatment experience guided by holistic medical thought gradually formed, which has provided a foundation for the formation of the modern auricular point diagnosis and treatment system.[3]

Prof.Zhang Yingqing put forward holographic biology in 1973.In 1992, China promulgated the National Standard of the People’s Republic of China on the Names and Positions of Auricular Points, which was implemented in 1993 and referred to as 1993 National Standard on Auricular Points.In 2008, the National Standard - Name and Positioning of Ear Acupoints was issued by the General Administration of Quality Supervision, Inspection and Quarantine and the National Standardization Administration of China to establish the standard of ear acupoints.For the next 4 years, to promote the continuous and in-depth development of TCM medical technology, the department of medical administration of National Administration of TCM set up a TCM medical technology cooperation group.In 2012, the cooperation group selected, sorted out and standardized more than 100 mature TCM medical technologies as well as draft the technical operation plan, including auricular point sticking technology among them.In order to facilitate publicity and promotion, they compiled theMedicalTechnicalManual ofTCM(Popular Edition) in 2013.[4]Due to the continuous value of auricular point sticking technology in clinical application, the Dongfang Hosipal of Beijing University of Chinese Medicine as one of the main drafting units, assists in the development of standard operating specifications of auricular point sticking technology for constipation, which was numbered T/CNAS02-2019[5]among nine standards initiated by the Chinese Nursing Association in 2019.It clearly stipulates for the basic technical requirements, evaluation,and operational points.

STANDARDIZED PROCEDURES OF AURICULAR POINT STICKING TECHNIQUE

Auricular point sticking/auricular acupressure technique is defined as an operation method of preventing and treating diseases by meridians conducting stimulation produced by pressing auricular points or reaction points onto which are pasted with pill, seeds, and cereal items with medical adhesive tape.It is indicated for the treatment of constipation, insomnia, diarrhea, colds, dysmenorrhea,etc.

Take constipation as an example, constipated patients present one bowel movement every three or more days, dry and hard stools, difficult or prolonged bowel movements, mostly accompanied by abdominal distension and discomfort, loss of appetite, dizziness and tinnitus, and fatigue, no organic intestinal pathology.[6]In view of this, auricular point sticking is used for those with constipation.

Basic requirements of auricular point sticking

The personnel who implement auricular point sticking and pressing technology are registered nurses or doctors,and have received relevant knowledge and operation skills training.Patients and caregivers should be given relevant health knowledge about auricular point sticking.

Preparation and evaluation of auricular point sticking

Preparation before operating

Attentions should be paid to the following: (1) Operating environment: It must be clean and unpolluted with appropriate ambient temperature.(2) Preparation of materials: Hand disinfector, cotton swabs, 75% alcohol,probe, hemostatic forceps, ear beans strip (a strip of medical adhesive tape with cowherd seeds), disposable dressing change curved plate, medical trash can, dirt tub should be prepared.Probes and hemostatic forceps should be disinfected twice with 75% ethanol before operation.(3)Posture of the patient: A sitting position, prone position or comfortable and easy-to-operate treatment position is taken according to the actual situation.

Evaluation

Patients are assessed in the following aspects: (1) The main symptoms, past history, pregnancy, tolerance to pain, etc.should be assessed; (2) The ear skin condition should be assessed, including whether to have local skin infection,ulceration, scar, or adhesive tape and drug allergy.

Method of application of auricular point sticking

Auricle massage

Massage is done for the auricle starting from the front of the ear, followed by the back of the ear, helix (from earlobe zone 1, along helix to tragus), antihelix (from subcortex, along the antihelix to triangular fossa), auricular concha (from auricular concha cavity to cymba conchae) and back of the ear.Slightly reddish and slightly hot in the local ear indicates appropriate massage intensity.

Acupoint selection

For constipated patients with excess syndrome, auricular points large intestine (CO7), rectum (HX2), lung (CO14),sympathetic (AH6a), liver (CO12), gallbladder (CO11), and constipation point are selected.For constipated patients with deficiency syndrome, auricular points large intestine (CO7),rectum (HX2), subcortex (AT4), spleen (CO13), stomach (CO4),kidney (CO10), and constipation point are selected.

Disinfection and auricular point sticking

The whole ear skin is disinfected with 75% alcohol, from top to bottom, inside to outside, and front to back.Seek the auricular sensitive points to determine the acupoint positions, onto which the 0.6 cm × 0.6 cm medical desensitization tape with cowherd seeds clamped using the mosquito-type curved pliers are pasted.When pressing the auricular points, there is a feeling of “arrival of Qi” such as heat, numbness, swelling, and pain.It is necessary to observe the local auricular skin condition of the patients and ask whether the patients feel uncomfortable.

Commonly-used pressing manipulation

Counter-pressing manipulation

Place the abdomen of the index finger and thumb on the same position of the front and back of the auricle of the patient to press until the patient feels hot, numb, swelling, and painful.The index finger and thumb can move left and right or make a circular movement during which process if a sensitive point is found, continue to press for 20-30 s.

Vertically-pressing manipulation

Press auricular points vertically with fingertips until the patient feels swelling and pain and press more 20-30 s.Repeated pressing is performed after a short interval of time,3-5 min at a time.

Point-pressing manipulation

Click the auricular points with the fingertips at an interval of 0.5 s.It is advisable for the patient to feel swelling, slightly heavy and slightly stabbing pain, and the force should not be too heavy.

Management and precautions of auricular point sticking Management of auricular point sticking

It is necessary to avoid the auricle being soaked with water during pressing to prevent the adhesive tape from falling off.For patients with sprain or limb movement disorder, it is advised to inform the patients to move the affected limb properly or cooperate with massage of the affected part when the auricle is congested and hot after sticking and pressing to improve the curative effect.If the ear feels uncomfortable in the lateral position, the patients can adjust their body position appropriately.In the event of the patients having severe pain and palpitation, the auricular point patches can be removed.In case of local skin lesions, after auricular point patches are removed,they should be treated immediately to prevent infection.

Matters needing attention of auricular point sticking

(1) Auricular point sticking is not applicable for patients with auricular local inflammation, chilblain or ulceration and pregnant women with a history of habitual abortion.(2) As a result of sweating in summer, the retention time of adhesive tape with cowherd seeds pasted to the auricular acupoints is 3 days, but 7 days in winter.(3) During the period of auricular point sticking, patients should press 3-5 times a day to strengthen the stimulation, each acupoint for 1-2 min.(4)It is necessary to observe the skin condition of the ear of the patient, prevent the adhesive tape from falling off or being contaminated during retention of adhesive tape,and use desensitization adhesive tape for those who are allergic to ordinary adhesive tape.(5) The patients who feel uncomfortable in lateral position can adjust their posture appropriately.(6) Auricular point sticking should be used with caution for patients with severe heart disease and severe anemia and strong stimulation should be prohibited.

CLINICAL APPLICATION OF AURICULAR POINT STICKING IN OTHER DISEASES

Principle of acupoint selection

The principle of acupoint selection is as follows: (1) Selecting auricular points according to the corresponding parts of diseases.For example, stomach point (CO4) is selected for stomach diseases and shoulder point (SF4-5) is taken for shoulder pain.(2) Selecting auricular points according to syndrome differentiation along meridians.For example,because migraine, hypochondriac pain, and hernia belong to circulating parts of Gallbladder Meridian of Foot Shaoyang,hence gallbladder point (CO11) is selected for treating those diseases.(3) Selecting auricular points according to viscera syndrome differentiation.For example, osteoarthropathy,tinnitus, deafness, alopecia, and spermatorrhea belong to kidney disease, so kidney point (CO10) is selected for treating those diseases; insomnia is closely related to heart, so heart (CO15)is chosen; similarly, lung (CO14) is selected for skin diseases,etc.(4) Selecting auricular points according to modern medical knowledge.For example, sympathetic point (AH6a) is taken for digestive ulcer; adrenal gland (TG2p) is taken for infusion reaction; endocrine point (CO18) is chosen for abnormal menstruation.(5) Selecting auricular points according to clinical experience.For example, shenmen point (TF4) has obvious sedative, analgesic, anti-inflammatory effects; hence, it can be selected for treating insomnia, neurasthenia, pain syndrome,and inflammation.The ear apex (HX6.7i) has antipyretic,anti-inflammatory, and antihypertensive effects, so it can be selected for treating fever, inflammation, and hypertension.

Insomnia

The study has found that auricular point sticking can reduce the PSQI score of clinical insomnia patients, indicating it plays a role in improving sleep quality.[7]The main auricular points for auricular point sticking for the treatment of insomnia are subcortex (AT4), shenmen (TF4), occiput (AT3), heart (CO15),neurasthenic area, and neurasthenia point.The addition of spleen point (CO13) to the main auricular points is used for deficiency of both heart and spleen.The addition of liver (CO12) and gallbladder (CO11) is used for insomnia with heart and gallbladder qi deficiency syndrome.The addition of the kidney (CO10) is used for insomnia with heart-kidney disharmony syndrome, the addition of liver (CO12) for insomnia with liver-fire disturbing heart syndrome, and the addition of spleen (CO13) and stomach (CO13) for insomnia with spleen-stomach disharmony syndrome.

Diarrhea

The study has shown that auricular point sticking is effective in improving the symptoms of female irritable bowel syndrome manifested as loose stool, diarrhea and abdominal pain.[8]The main auricular points selected for auricular point sticking in the treatment of diarrhea are rectum (HX2), large intestine (CO7), shenmen (TF4), occiput (AT3), spleen (CO13),and sympathetic (AH6a).The addition of kidney (CO10) to the main points is indicated for diarrhea with spleen and kidney yang deficiency syndrome, and the addition of small intestine and stomach (CO4) for diarrhea with intestines and stomach disharmony type.

Nausea

Auricular point sticking is one of the important nonpharmaceutical therapies to relieve nausea.The study has shown that it can relieve nausea and vomiting caused by surgical anesthesia and cancer chemotherapy.[9-12]The main auricular points selected for auricular point sticking treating nausea are stomach (CO4), gallbladder (CO12), cardia (CO3),occiput (AT3), and shenmen (TF4).The addition of spleen (CO13) to the main points is indicated for stomach-cold syndrome, the addition of triple energizer (CO17) for upper reversal of stomach fire, the addition of gallbladder (CO11)for stagnation of Qi mechanism, and the addition of sympathetic (AH6a) and subcortex (AT4) for spleen-stomach Yang deficiency syndrome.

Colds

The main auricular acupoints selected for auricular point sticking treating colds are lung (CO14), internal nose (TG4), and external nose (TG1.2i).[13]In case of fever,ear apex (HX6.7i), apex of tragus (TG1p), and adrenal gland (TG2p) are added to prick and bleed.In case of headache, forehead (AT1) is added.In case of muscle soreness and fatigue of the whole body, mouth (CO1),spleen (CO13), liver (CO12), and triple energizer (CO17) are added.In case of cough and expectoration, trachea (CO16),Zhiqiguan point and Pingchuan point are added.In case of chest tightness and chest pain, plus chest (AH10),sympathetic (AH6a), and subcortex (AT4) are added.In case of poor appetite, abdominal distension and constipation,stomach (CO4), large intestine (CO7), and abdominal distension area are added.

Hypertension

A randomized controlled trial showed that auricular point sticking was effective in lowering blood pressure in patients.[14]Zhaoetal.[15]found that auricular point sticking has effects in lowering blood pressure and improving sleep quality and anxiety.The main auricular points for auricular point sticking in the treatment of hypertension were hypotensive point,heart (CO15), forehead (AT1), subcortex (AT4), liver (CO12),and sympathetic (AH6a).The addition of kidney (CO10) to the auricular main points is indicated for Yin and Yang deficiency type and liver-and kidney-Yin deficiency type.In case of dizziness, occiput (AT3) and dizzy area are added.

Headache

Systematic review shows that auricular point sticking is a promising intervention of relieving chronic pain, especially chronic low back pain and chronic tension headache.[16]The main points for auricular point sticking in the treatment of headache are forehead (AT1), temple (AT2), occiput (AT3),subcortex (AT4), sympathetic (AH6a), and shenmen (TF4).In case of frontal headache, migraine, neck pain and whole-head ache, Waijiaogan point is added.In the case of posterior headache, lesser occipital nerve point is added.

Dysmenorrhea

The study has shown that auricular point sticking can effectively increase parasympathetic nerve activity, maintain the steady state of autonomic nervous function of young women with primary dysmenorrhea, and alleviate women’s dysmenorrhea.[17]The main auricular points for auricular point sticking in the treatment of dysmenorrhea are uterus, oarium,endocrine (CO18), lower energizer and subcortex (AT4).Liver (CO12), spleen (CO13), and tripe energizer (CO17) are added for treating Qi stagnation and blood stasis syndrome.The addition of the liver (CO12) is used for cold-dampness stagnation syndrome, the addition of spleen (CO13) and stomach (CO4) for Qi and blood deficiency syndrome, and the addition of liver (CO12) and kidney (CO10) for liver and kidney deficiency syndrome.

CONCLUSION

In 2020, Liuetal.[18]deeply mined auricular point sticking technology associated content from the Chinese and foreign databases based on CiteSpace visualization software and concluded that auricular point sticking technology at home and abroad presents many research directions in the nursing field.The clinical application keywords cluster is mainly constipation, sleep disorder, insomnia, abdominal distension,hiccup, pain, negative emotion, and so on.A clinical controlled trial conducted by Zhangetal.[19]showed that the recovery effect of the auricular point pressing group was better than that of other three groups, and it can be concluded that auricular point pressing was effective in treating abdominal distention and constipation after thoracic surgery with less related complications.Fanetal.[20]performed a meta-analysis of systematically evaluating the effect of auricular point sticking on postoperative gastrointestinal function recovery,which showed that auricular point sticking could shorten the recovery time of bowel sounds, and be superior in reducing the incidence of abdominal distention, nausea and vomiting, and postoperative pain score when compared with conventional therapy.A randomized clinical trial conducted by Tsengetal.[21]of evaluating the effect of auricular point sticking on anxiety and depression in older adults showed that both the Geriatric Depression Scale score and anxiety scores improved significantly in older adults with patches with magnetic beads pasted onto the auricular Shenmen acupoints after 14 days of intervention when compared with the control group with blank patches, suggesting that auricular point sticking can reduce depression and anxiety among older adults in long-term care institutions.A systematic review and meta-analysis conducted by Zhaoetal.[15]including 1685 patients with hypertension and insomnia in 18 randomized controlled trials showed that auricular point sticking had good effects in reducing blood pressure and improving sleep in hypertension and insomnia patients.A systematic review and meta-analysis conducted by Yanetal.[22]including nine RCTs involving 783 patients with cancer pain showed that auricular point sticking plus drug therapy has significant advantages in relieving pain when compared with drug therapy alone.

To sum up, auricular point sticking technology reflects the therapeutic effect in its application field.In the future, animal experiments can be carried out to explore the mechanism of auricular point sticking on different diseases, and it can also be combined with psychology, sociology, and other disciplines to carry out multi-field researches, so as to finally promote the development of auricular point sticking technology in the nursing field at home and abroad.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.