Instruments and Other Devices
for Administering Ear Acupuncture

The efficacy of ear acupuncture is dependent not only on knowing how to treat diseases via the ear. An important role is played by the "skill" of the therapist which I consider to be very essential.

First and foremost, all the relevant points in the ear must be located. This is not as easy as it sounds.

• A decision must be made as to whether the point discovered is indeed important and exactly which points should be included in the treatment plan.
• Treatment must be executed in a clinically correct manner, i.e. the needle must be properly placed in exactly the right spot, with the correct depth of insertion and the appropriate duration.  Without experience, inner calmness and detachment, many mistakes can be made.

Naturally, having the proper tools is necessary, however they do not have to be expensive. Tools must be suitable for treating the ear. Devices, instruments and needles that are appropriate for body acupuncture are generally not suited for treating the ear. High-tech needles with insertion depths of 1, 2 or 4 cm are uninteresting since insertion depth in the ear is generally only 1 to 1.5 mm! An electro-acupuncture stimulator would also be of little use since the slightest current input would cause immediate rejection of any needle in the ear, especially considering the1-2 mm insertion depth as mentioned above. A laser device is equally inappropriate because the laser beam emitted by the stylus is much too thick to precisely impact a point in the concha, which has only a 1 mm diameter.

Criteria for the application of needles are as follows:

• Each point must be precisely impacted. (A point has usually a diameter of 1 to 1.5 mm and is often difficult to access since it is located deeply within the concha underneath the helix brim, or elsewhere in the ear.)
• Use of slight pressure is often required since the tissue into which the needle is inserted is often very dense.
• When the needle is inserted into the ear, it should penetrate the tissue to a depth of no more than 1 (or a maximum of 2) mm.

Compared to body acupuncture, the time and effort required when working in the ear are negligible.

This leads to a very important conclusion:

• Every instrument used for ear acupuncture must be shaped in such a way that the treatment point remains fully visible and the ear remains accessible without loss of visibility.

Needles

We have seen that the volume of a needle plays an important part. It produces a stiffness that is necessary in order to overcome resistant points without piercing the ear. Also it provides an energy potential that is required in order to encourage appropriate healing reflexes in the ear.

As a rule, a thick needle (0.25 to 0.30 mm in diameter) is better than a thin one. We require a short needle having a long handle. Needles that are best suited for the ear thus have a format of 0.25 to 0.30 x 10 to 15 mm (maximum).

Another criterion regarding the shape of ear acupuncture needles concerns the depth of insertion. Needle points should be fairly short, since this serves to maintain the needle within the tissue. Thus the required primary effect of stimulus transmission is assured, including the release of energy through (destroyed) cells. Therefore, hand-made needles from China are more efficacious than mechanically pointed needles (masterpieces of German engineering that are used in space technology!) that glide into tissue almost without resistance. . Similarly, there are also no good arguments favouring coated needles.

Nevertheless, in some circumstances thinner and even longer needles may be required, e.g. for children and for other frail persons, or when needling Shen men. Here the needle should either be inserted subcutaneously from point 55 into the Fossa triangularis, or else subcutaneously when needling points 24 A and 24 B are to be connected. In such cases                                                                                                       so-called cosmetic needles are particularly well suited that have a format of 0.20 x 15mm (blue plastic handle). This constitutes an exception since, as a rule, needles with plastic handles are not utilized in ear acupuncture. Such handles isolate the needle - and thus the therapist - from the patient, thereby reducing potential energetic influence originating with the therapist. Every practitioner has experienced and appreciates this potential energetic transference. One feels that something is happening.

The material from which the needle is made is also very important. As mentioned above, needles ought to be made of metal. However, consideration should be given to the fact that different metals do have, and do produce, different energetic effects. In addition to steel, various metals utilized to attain synergistic effects when treating specific conditions include silver, gold, platinum and molybdenum.

Golden needles have an energetic potential of +0.285 on the hydrogen scale and produce toning effects in body acupuncture. In the concha, these effects are reversed and gold becomes sedating!

Silver has a comparatively small potential of 0.048 and has toning effects in the ear.

The energetic potential of platinum exceeds that of gold, although this makes little difference in practice. The sedating effect is not in any way different from that of the golden needle.

The energetic potential of molybdenum lies somewhere between gold and steel. It is gently sedating and particularly well suited for treating inflammatory and rheumatoid processes.

One has to make sure that the effects of the metals used are appropriate to the individual condition. It would be a great mistake to sedate when there is lack, and tone when there is energetic excess.

When in doubt, the therapist should always use steel needles since this material is energetically neutral and the body will always respond positively to intervention, i.e. in a regulatory manner. .

In view of the general fear of infection, we recommend the use of so-called “one-way” needles. They are sterile and used only once. They come in the required sizes and types such as steel, gold or silver needles, or in various other metals.

For some practitioners, re-usable needles are only an alternative. However, all needles that are to be re-used should be both disinfected and sterilised. First, needles should be cleaned and disinfected using ordinary chemical agents. Then, they must be sterilised. A hot-air sterilizer will suffice.

Another type of needles are the so-called permanent needles which are, as their name suggests, placed in the ear for a longer period of time. These are administered for addiction acupuncture or in instances of acute pain. They are quite small and are inserted into the tissue so that they are hardly noticeable.  Therefore, a patient who wants to quit smoking is not required to walk around with an “antennae” in his ear. As a rule, needles are delivered together with an injector. Since the localisation of acupuncture points must be very precise, only those systems are appropriate which allow accurate placement of needles. Visual control is required in order to reassure that the permanent needle has indeed been inserted into the epicentre of the point in question.  In practice, the ASP system has proven to be very efficient.

Permanent needles have been available as golden needles, (i.e. with a gold coating). The question arises as to whether gold promotes better healing over the longer run compared to the regular use of steel needles.

In order to manipulate ear points over a longer period of time, one can use various auxiliary means, for instance millet grains, which may be fixed on an acupuncture point using small band-aids. The patient can then manipulate this point himself as required.

Currently, small steel pellets (Japan) are also being used with similar effects. Many professionals believe that stronger energetic input would enhance healing effects. . As a result, the use of magnetically “tuned” metal pellets has developed.  In my opinion, such devices "bias" the body through one-sided,  constant stimulation thus impeding self-regulation..

Devices That Locate Acupuncture Points

• Active ear points can be seen!

Ear points that indicate bodily disturbances can often be seen. A red pimple, a rough and deeply retracted pore, a spot etc., hint at changes and suggest a disturbance in the target organs which are represented by those points. However visual diagnosis discovers only a fraction of existing bodily symptoms. Indeed, something is always changing within the body and therefore within the ear. Many points which are “disturbed” in different ways also tend to indicate the relative involvement of different areas in the body.   These patterns need to be recognized, understood and treated.

• Active ear points can be palpated!

Disturbed points are tender which is evident during palpation. The quality of the pain as reported by the patient provides information about the virulence of the events in the body.

In order to gather such information, ear acupuncturists use very simple instruments. In principle, a thick knitting needle is sufficient.  But perhaps that may not be sufficiently professional! The pressure palpator is also used to gather information. The pressure palpator is an instrument consisting of a stylus and mobile point that exerts constant pressure (120 to 150 grams) which is generated by a spring mechanism. During examination, the degree of sensitivity of disturbed points is determined by the thinness of the diagnostic specillum.

Point location devices made of glass or metal (but without mobile points) are sufficient in the hands of an experienced therapist. For instance, some suppliers offer “stuffers” (as used by dentists) whose ballpoint is suitable for both point location and massage.

• Active points can be measured!

Disturbed points may also have a different skin resistance when compared to the rest of the ear (differences in a potential to its environment). These can be discovered and measured by electronic point detectors. When locating points, the therapist touches the patient with these simple devices in order to establish an energy circle which is necessary for measuring skin resistance. Device (as source of power), patient and therapist thus form a closed circuit of energy. Naturally, the amount of energy that flows is so minimal that it does not interfere. The device will then be adjusted to areas of the skin that are unaffected.  Thus, normal rates of skin resistance can be identified, and the device can be tuned in such a way that no current will flow in a “normal” state. The lower or altered skin resistance of disturbed points functions like a switch. When lowered, current can flow and a bulb lightens.

All devices function along the same line. However they are more or less comfortable to use. Generally, simple devices are sufficient with manual adjustment to skin resistance (Messrs. AkuOkkult) or automatic adjustment (Messrs. SVESA), exclusively visual display, and fixed point.

“Pointmaster plus” and “akutron 202” are examples of more sophisticated devices for locating  points as well as for administering  electro-therapy (Messrs. Reimers & Jansen). However, such devices are becoming rare because limited demand for such high-quality products create excessive entrepreneurial risk. .

Therapeutic Instruments

Although needle application is the basic and most natural form of acupuncture therapy, needles are not the only instruments used in ear acupuncture. Other procedures frequently used  are electro-acupuncture (Bahr, Vol 1) and laser beams. Without precluding chapter III.3 (“Treatment via the ear”) I would like to make a few comments about these devices.

Electro-Acupuncture

A simple yet suitable device that utilizes alternating current is the “akutron 202” mentioned above. Ranging after VOLL or SCHIMMEL, multi-functional devices like “Multitest 4D” (Messrs. Reimers & Jansen) are good instruments with differentiated measuring scales. 

These instruments can be applied only to a certain extent in ear acupuncture therapy because self-regulation of the body causes needles to be rejected after the required energy has been obtained for a given acupuncture point. In such cases, it would be practical to influence specific, disturbed zones or points in an organotropic or energetic manner.

Lasers

First of all, I would like to emphasize that lasers are excellent for treating the ear. In some cases there is no better method of treatment, especially when diseases involving high-sensitivity are encountered such as polyarthritis, alcoholism etc. Here, patients are energetically “blocked” and nothing "works" due to an aversion to strong stimuli. As a rule, this tends to aggravate the situation. I have seen cases where laser treatments of only 2 mW have caused patients unbearable pain. Some mobile lasers are wholly inappropriate for treatment purposes because they are too strong (30 mW, 50 mW and more) and current strength cannot be controlled.  A blunt stylus also makes laser beams uncontrollable! It will be impossible to access the concha properly and the resulting distance to the point in question causes the beam to disperse, affecting the entire area. .

Thus, a suitable laser should be construed in such a way that the beam can be controlled and precisely directed upon each acupuncture point in the ear.

Laser strength should range from 0.5 to 20 mW.  Lasers should be accessible for NOGIER, BAHR and have free programmable frequencies.

Presently there is at least one device available that meets the requirements of ear acupuncture and can be recommended. This is the "trion" mobile laser manufactured by Messrs. Reimers & Jansen.

Suggested Basic Equipment

These specifications have been outlined for those who are seriously interested in acupuncture therapy. .

Treatment Table

A table with an adjustable headpiece is required. It is advisable to secure an older model of dentist chairs. They are ideal for ear acupuncture purposes.

Point Detectors

The point detectors used for examination should be chosen individually. Purists use a simple search pen, like the “stuffer” used in dentistry, a simple metal point detector or a pressure palpator.  In any case, the point should be 3 mm. Remember: The thinner the probing stylus, the more sensitive the response from the disturbed point.

An electronic point detector makes the search easier. Simple devices are available as well.  First, there is the “AKUTRON” which was originally developed by G. LANGE.  It is indestructible but must be adjusted by hand. The more sophisticated electronic point-searching pen from Messrs. Sveso is convincing with its automatic skin adaptation and is an excellent device. Other more challenging designs are available but are not really necessary.

Needles

All beginners should start with one-way steel needles. Gold, silver or other metal needles should be used only after accumulating considerable experience in ear acupuncture therapy. Steel needles are most suitable since this metal has a neutral energetic effect, and the body normally integrates this intervention in a positive manner.  As one-way needles they can be handled without problems and are sterile.

Needles should have the format of 0.25 to 0.30 (needle diameter) x 10 or 15 mm (length of needle shaft). A sufficient shaft length is important. Those who have experience in working with ear acupuncture will know what I am talking about.  Being too close to the ear with your fingers will block point visibility!

For permanent needle systems, I would recommend needles with magnet and injector from ASP. Other systems may be equally effective after some practice. Especially “Chinese ear needles” (which must be applied to the ear like tiny drawing pins with a band-aid) require extraordinary skill on the part of the therapist. The proof of the pudding is in the eating!

Those practitioners who prefer to re-use needles must pay special attention to sterilisation and disinfection. In addition to appropriate disinfecting lubricants, at least 2 Petri double-dishes and/or glass dishes are required which have steel lids and are heat proof. A hot air sterilizer with time switch, temperature meter and insertion basket is required for sterilisation purposes. .

Lasers

All truly qualified ear acupuncturists need  an alternative to needles. Lasers are the best alternatives that I am familiar with.  Accordingly, I feel that a suitable laser instrument should be included in all basic equipment inventories.

For ear acupuncture therapists generally, the “trion” mobile laser (655 nm/10mm or 785nm/20mW) of Messrs. Reimers & Jansen is the most appropriate device. Using this instrument, acupuncture points can be both measured (point detector) and treated. This simplifies treatment procedures considerably since NOGIER and BAHR frequencies are automatically saved and thus absolutely easy to apply.

What Else Is Needed?

• Tri-flanged needles for “mini-bloodletting” at the back of the ear
• Tweezers
• Waste disposal containers for canulas, needles, swabs (ideally, alcohol swabs)
• Disinfectants (for instance “Helipur H plus”) for disinfecting instruments and “Sterillium” for disinfecting hands
• A good ear acupuncture chart preferably placed so that it can be seen while working
• Ear band-aids with millet grains or steel pellets

Total costs for basic equipment including sterilizer, a medium-priced electronic measuring device, and the laser and needles mentioned above currently amount to approximately € 2,500 to 3,000. This is the absolute minimum investment required. However, this is actually quite reasonable and not really much “dough” if one considers the amount of good that can be done as a result.