Nogier Reflex: Physiological and Experimental Results in Auricular Medicine-A New Hypothesis

Reflex Auriculo-Cardiac (RAC) Induced by Auricular Laser and Needle Acupuncture: New Case Results Using a Smartphone

The reflex auriculo-cardiac (RAC), dynamic pulse reaction (Nogier reflex), or vascular autonomic signal was proposed by Nogier. It refers to the pulse changes that can occur in the radial artery immediately after auricular acupuncture is performed. RAC is helpful for the clinical practice of auricular acupuncture, but there is a lack of objective verification methods. Photoplethysmography (PPG) has been used to objectively calculate radial artery blood flow. This study used PPG via a smartphone to measure RAC induced by auricular acupuncture. Thirty subjects without major diseases were recruited to receive traditional needle and laser acupuncture. The Shen Men ear point and control points were stimulated for 20 s. PPG was continuously measured during the acupuncture. The PPG data were tested for differences with a paired t-test. The results showed that there were no statistical differences in the frequency and amplitude of PPG obtained before and after acupuncture, either with a traditional needle or laser acupuncture. However, interestingly, it was found that one patient with insomnia, one patient with viral respiratory symptoms, and two menstruating females exhibited changes in PPG within five seconds of needle placement. We hypothesized that RAC might be induced by auricular acupuncture and could be quantified by PPG, even among subjects suffering from mild diseases; however, auricular acupuncture might not induce a measurable RAC in totally healthy subjects.

Laser Acupuncture and Dynamic Pulse Reaction Quantified by Smartphone:Two Experimental Examples

The dynamic pulse reaction (Nogier reflex), Reflex-Auriculo-Cardiac (RAC), or vascular autonomic signal is a physiologic phenomenon that is not fully accepted and widely understood in contemporary medical practice. In order to provide appropriate scientific evidence for better understanding, qualitative and-above all-quantitative research in this area is necessary. In this short report, 2 recordings of dynamic pulse reactions based on an analysis performed on a modified smartphone are demonstrated during laser acupuncture experiments using stimulation at ear acupuncture points.

Analgesic effect of auricular point acupressure for acute pain in patients with dementia: study protocol for a randomized controlled trial

Background

Common and frequent as acute pain is, it is often underestimated and undertreated in older people with dementia in nursing homes and inadequate pain management remains an issue.

Methods

The study is designed to be a randomized, sham-controlled trial and is underway in nursing homes located in China. A total of 206 dementia patients are being recruited from nursing homes in Yinchuan, China. They are randomly allocated to an intervention or a controlled group in a 1:1 ratio. The intervention group will be treated with true APP therapy, while the other group will receive APP at sham point stimulation therapy. The patients will be assessed at baseline (T0), at 5 min during performing the intervention (T1), and at 5 min after completion of the intervention (T2). The primary outcome is the level of pain relief at T1 and T2. Physiological parameters, side effects and additional use of analgesics during the procedure, satisfaction from caregivers, and acceptance of patients are evaluated as secondary outcomes.

Discussion

The results of this study are expected to verify the analgesic effect of APP for acute pain in patients with mild dementia in nursing homes. It has the potential to prompt APP therapy to be implemented widely in dementia patients with acute pain in nursing homes.

Trial registration

Chinese Clinical Trial Registry ChiCTR2100047932. Registered on 27 June 2021. Currently, patient recruitment is ongoing. Recruitment is expected to take place from December 2020 to December 2021.

Effect of Auricular Acupressure on Acute Pain in Nursing Home Residents with Mild Dementia: A Single-Blind, Randomized, Sham-Controlled Study

Introduction

Acute pain is a prevalent problem for dementia residents in nursing homes. A variety of intervention strategies have been applied to address this problem. However, there remains an issue of inadequate pain control. This study aims to explore the analgesic efficacy of auricular acupressure (AA) for dementia residents with acute pain in nursing homes.

Methods

A multicenter, single-blind, randomized, and sham-controlled clinical trial was performed in three nursing homes in Yinchuan, China. All of the 206 eligible patients with acute pain were randomly divided into two groups for real AA therapy or sham AA (at sham point stimulation) therapy. The primary outcome was measured with a face pain scale revised (FPS-R) score before the procedure, 5 min after the start of the intervention, and 5 min after finishing the procedure. Secondary outcomes covered three physiological parameters, adverse reactions observed, satisfaction level of caregivers, acceptance of patients, and additional use of analgesics.

Results

There was a significant difference in pain scores based on FPS-R between the two groups (p < 0.01). Pain score in the true AA group was 1.84 ± 0.23, compared with 2.22 ± 0.81 in the sham AA group. No adverse events were found during the whole procedure for all patients. The satisfaction level of caregivers and acceptance of patients in the real AA group were significantly higher than those in the sham AA group.

Conclusion

This study shows that real AA was an alternative analgesic modality in reducing acute pain in patients with mild dementia.

Traditional Chinese Medicine Pulse Diagnosis on a Smartphone Using Skin Impedance at Acupoints: A Feasibility Study

In traditional Chinese medicine (TCM), pulse diagnosis is one of the most important methods for diagnosis. A pulse can be felt by applying firm fingertip pressure to the skin where the arteries travel. The pulse diagnosis has become an important tool not only for TCM practitioners but also for several areas of Western medicine. Many pulse measuring devices have been proposed to obtain objective pulse conditions. In the past, pulse diagnosis instruments were single-point sensing methods, which missed a lot of information. Later, multi-point sensing instruments were developed that resolved this issue but were much higher in cost and lacked mobility. In this article, based on the concept of sensor fusion, we describe a portable low-cost system for TCM pulse-type estimation using a smartphone connected to two sensors, including one photoplethysmography (PPG) sensor and one galvanic skin response (GSR) sensor. As a proof of concept, we collected five-minute PPG pulse information and skin impedance on 24 acupoints from 80 subjects. Based on these collected data, we implemented a fully connected neural network (FCN), which was able to provide high prediction accuracy (>90%) for patients with a TCM wiry pulse.

The History of Ear Acupuncture and Ear Cartography: Why Precise Mapping of Auricular Points Is Important

The current author had the opportunity to present a study on the history of ear acupuncture at the International Summit Forum on Clinical Application of Acupoints in August 2018 (from August 25 to August 27), in Beijing, China, and to introduce the latest ear chart by Frank R. Bahr, MD, there. This article is based on that presentation and includes more historical facts. Although the relationship between the ear and meridians was discussed previously in the famous book, The Internal Classic of the Yellow Emperor (Huang Di Neijing), the first auricular map was published in 1888 by Zhenjun Zhang in his book Essential Techniques for Massage (Lizheng Anmo Yaosu). This map was a drawing of the posterior aspect of the ear showing areas of the five Zang organs: Heart; Liver; Spleen; Kidney; and Lung. Paul Nogier, MD, discovered ear somatotopy, a representation of the whole person on the ear in the shape of a homunculus, or inverted fetus, on the ear. Dr. Paul Nogier's ear map was first published in 1957. A more-detailed presentation, the Loci Auriculomedicinae, elaborated by Drs. Paul Nogier and Bahr as well as René J. Bourdiol, MD, appeared in 1974. A new edition will soon appear in French. Auricular medicine is an excellent method, but only if the ear points are located precisely. Preconditions for this ability are excellent knowledge of the ear's anatomy, documented on a very detailed modern ear chart, such as the one recently created by Dr. Bahr, and constant practice of pulse palpation according to Dr. Paul Nogier with the vascular autonomous signal.