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IS THE ANTI-ANALGESIC EFFECT OF ACUPUNCTURE A “PLACEBO”-RESPONSE
Gustav J. Dobos
University of Duisburg-Essen, Essen, Germany
As the outcomes of the recent German Acupuncture Trials (GERAC) and Acupuncture Randomized Trials (ART)
showed that sham acupuncture was as effective as verum acupuncture in three out of four examined indications, the
specific nature of acupuncture interventions have been questioned and have raised the hypothesis, that the antianalgesic
properties of acupuncture are a placebo-effect and are therefore largely dependent on a possible
expectancy-effect. Also the results of a poll on acupuncture done by the German Institute for Demoscopy in Allensbach
in 2005 showing that 89 % of those with acupuncture experience preferred the combination of acupuncture to the
regular treatment in case they were sick confirmed the high expectation towards acupuncture in the German population.
Similarly to the expectation-induced analgesia, acupuncture-induced analgesia can be blocked by naloxone and
is thus mediated by the opiate system. Furthermore, the fact that the anti-nociceptive effect of acupuncture is also
dependent on the brain CCK-system has been well-established in animal experiments. Similarities to the expectancydependent
component of the placebo response are obvious and will be discussed. However, the “diffuse noxious
inhibitory controls” (DNIC) hypothesis would predict, that “sham”-acupuncture at non-acupuncture points often used
as “placebo-condition” control for acupuncture can be neurophysiologically as effective as real acupuncture.
Therefore, the analgesic properties of acupuncture may be a net-effect of cortical processes such as expectation, and
anti-nociceptive effects at the level of the medulla and even the spinal cord.
Finally in the talk our new results of experimental pain studies using the tourniquet technique will be shown
supporting the hypothesis that the anti-analgesic effect of acupuncture is no “placebo”-response.
PATHOPHYSIOLOGY EXPRESSED IN ADVANCED AURICULAR THERAPY
Bryan L. Frank
Colleyville, Texas, USA
The initial presentation recognized by Dr. Paul NOGIER regarding the somatic projections to the external ear has
been commonly known as the “inverted fetus” presentation. In following years, he and his colleagues recognized
that somatic pathophysiology may present to the ear as additional homunculi, namely the Phase 2 and Phase 3
presentations. Critically, these phases project somatic pathophysiology of more advanced degree than the Phase 1
projection, with Phase 2 representing dense or degenerative pathophysiology and Phase 3 represents intermediate,
inflammatory, or transitional pathophysiology. Many auricular therapy practitioners world-wide only practice with the
common Phase 1 projection. Often clinical results will be incomplete or transient and the practitioner will not fully
understand the Phase dynamics as a function of the projected pathophysiology.
Key words: Auricular Therapy, Phases, pathophysiology
Since the remarkable discovery by Dr. Paul NOGIER of the auricular somatotopic projections that are commonly
known as auricular therapy or auriculotherapy, many, perhaps most, of the auricular practitioners in the world today
continue to only utilize his initial homuncular projection on the ear, known as the “inverted fetus”, or Phase 1. However,
in search of clinical results for patients who had partial or complete failures to treatment with auricular therapy, he and
his colleagues discovered and described additional phase projections for more advanced pathophysiology. Treatment
of these advanced phase points, when active, are critical to enhanced clinical response for the more advanced
pathophysiologies.
Over 40 years of writings, research, and teachings by Nogier and his colleagues have demonstrated the Phase 2
and Phase 3 projections of the ear. Phase 2 was found to present the somatic projections of the dense or degenerative
pathophysiology on the ear. Phase 3 has been shown to represent the intermediate or transitional pathophysiologies,
including inflammation.
Commonly, treatment of the Phase 1 projection, which represents the functional or energetic somatic
pathophysiology, will lead to complete recovery and healing. This, however, is generally seen in pathophysiology
that is of “soft” or energetic characteristic. For patients demonstrating more advanced pathophysiology, the Phase 1
treatment will often lead to partial or complete treatment failure. Some patients may experience significant recovery
but of only very limited duration while others may experience only a moderate or minimal decrease in symptomotology
from the Phase 1 treatment alone.
Phases have been repeatedly shown to represent these various aspects of pathophysiology for nearly 50 years.
Upon auricular examination, clinicians are urged to seek active points within the zones of various organs, tissues, and
structures that are being considered due to the specific patient complaint, or as a possible etiology of the complaint,
a complicating factor or foci (blockage) to healing. Each of these potential pathophysiologies should be sought in
Phases 1, 2, and 3. The time required for the additional investigation is brief, and if active points are identified, these
should be treated. Failure to treat Phase 2 and/or phase 3 points often lead to partial or complete treatment failure
as the more advanced pathophysiology cannot be adequately addressed in the Phase 1 or “inverted fetus”
presentation alone.
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