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Shen Men
A Critical Assessment through
Advanced Auricular Therapy
by Bryan L. Frank MD and Nader Soliman, MD

Abstract: Shen Men, or the Chinese "heavenly gate" point on the ear, is situated at the apex of the triangular fossa. It is one of the most recognized auricular points and is used in the treatment of most ailments. Shen Men is known to have a powerful influence in treating various conditions, including pain, sedation, addiction treatment, and inflammation. While Shen Men is universally recognized in the auricular acupuncture world, it is not associated with any specific organ, as the Chinese auricular points were derived from observation of functional effects, and not necessarily with respect to organs and anatomy. The Nogier French auricular system, however, was developed with anatomic and embryological consistency to localizations of the points or zones. Through understanding the anatomic and embryological characteristics of an auricular zone, the physician will more completely understand the patient's pathophysiology and generally experience more enduring clinical results in treatment of these auricular zones.

Key Words: acupuncture, auricular acupuncture, auricular therapy, auricular medicine, Zero Point, Paul Nogier
Introduction: Auricular acupuncture was developed as a formal sotamotopic system through the discoveries of Dr. Paul Nogier, of France.1,2,3 With the initial recognition in 1951 that the "sciatic point" in fact correlated with the 4th lumbar vertebra rather than sciatica as an ailment, Dr. Nogier discovered the primary correspondence of the body on the auricle in an "inverted fetus" presentation.4,5,6 This observation led to the eventual identification of the body's anatomic or structural correspondence with zones in the auricle.

The Chinese learned of Dr. Nogier's work through a German medical acupuncture article that arrived in China via Japan. The Chinese followed with thousands of clinical observations and developed auricular mappings which were similar to the early French system, though with some differences noted. This correspondence system was easy to teach "barefoot doctor" acupuncture technicians to readily assimilate into their paramedical practices.

Developmental Perspectives:
Dr. Nogier's original discovery led to the identification of the body mapping on the auricle which presented remarkable consistency with respect to anatomic and embryological considerations. Thus, the "inverted fetus" presents with the musculoskeletal (mesodermal) projections in the upper aspect of the ear including the antihelix, scaphoid fossa, and triangular fossa.1,5,7,8 Visceral (endodermal) organs present in the concha, and the head's (ectodermal) structures are located in the lobule in the earliest somatotopic mappings.9

Dr. Nogier eventually recognized that various organs' pain and dysfunction would present in different auricular zones, depending on the stage of the ailment. Phase 1 auricular zones correlate to normal physiology or acute pathology and is the presentation of the original "inverted fetus".(See figure 1) Phase 2 corresponds to degenerative conditions, and the "inverted fetus" is then transformed into an upright position. Phase 3 corresponds to subacute and chronic conditions, and the homunculus is in the transverse presentation with the head in the central auricle or concha. The location of a particular organ or anatomic structure's point will thus be identified in one or more locations depending on the stage of the disease process.3

The respective embryological tissues will shift in their auricular representation based on their Phase status. For example, the mesodermal structures occupy the upper ear in Phase 1, followed by the concha in Phase 2, then the lobule in Phase 3.(See figure 2)

While it is now known that illness progresses form Phase 1 to Phase 3 then to Phase 2, Phase 2 was discovered second and therefore was labeled "2". Recovery progresses in a reverse fashion, from Phase 3 to Phase 2 to Phase 1.1,3(See figure 3)

Because of the focus on functional observations, several organs in the Chinese auricular system differ from the French system. Further, the Chinese identified various points which had functional or metaphorical names, rather than anatomic descriptions. One notable example of this disparity is the placement of the organ heart. Commonly placed between the lungs on the Chinese charts, this placement does not conform to anatomic and embryological considerations. The French charts will place the Phase 1 heart on the antihelix along the region which corresponds to the upper thoracic vertebrae.(See figure 4) This placement respects the nature of the heart as a mesodermal organ in its location for normal physiology or acute pathology.

It is not surprising that the Chinese functional observations place the heart in the inferior concha, as that is the region for Phase 2 mesodermal structures. Patients with functional heart disease are likely to present with coronary arteriosclerosis, a degenerative condition of the coronary vessels, and thus in a Phase 2 state. Given that there may be clinical or sub-clinical manifestations as well, an active auricular point will likely be identified along the antihelix Phase 1 heart zone, as well. Phase 3 subacute or chronic heart conditions may be found in the lobule; any condition may present in one or more Phase locations.

Another example of the disparity of French and Chinese points is that of degenerative arthritis of the knee. In Phase 1, the knee is represented in the middle of the triangular fossa. A Phase 2 degenerative knee is represented in the inferior concha, while that of the chronic Phase 3 knee is in the lobule.10 It is important, therefore, to understand that the zone near the Chinese heart point may in fact have no correlation to a heart ailment; rather it may represent a degenerative knee condition! Clearly the diagnostic and treatment implications are critical to correct understanding of these different presentations.

It is this understanding of advanced auricular acupuncture which the Chinese system, developed through a functional correlation, has never integrated into their mappings on the ear. There is no consideration of the different phases based on stage of illness, nor is there strict conformity to point correlation based on anatomy and embryology. Often the physician's confusion regarding the presence of an active auricular point will become clear when the multi-phase anatomic evaluation is considered.

Shen Men:

The Chinese Shen Men point has been recognized for its application in many pain and dysfunctional conditions. With pain conditions, Shen Men is often considered to be a primary point for treatment. Neuropsychoemotionally, it is considered to alleviate apprehension, fear, anxiety, and to help regulate the sympathetic nervous system. Shen Men is regularly employed in addiction treatments.11 It is also recognized for its role in the treatment of inflammation. The presence of an electrically active or tender Shen Men is regarded by the Chinese auricular acupuncturist as an indication of neurasthenia or the presence of pain.12

As it became common for practitioners to look for Shen Men and to treat it for many conditions indiscriminately, it is important for us, as physicians, to know what the Shen Men point really represents. Shen Men is not a mystical, mysterious point as the impression on Chinese ear acupuncture charts give us. The Chinese acupuncturists have noticed the presence of a point here that is usually active in painful conditions, in many inflammatory conditions, and in cases of addiction. As a result, the name Shen Men was assigned for its functional qualities of electrical activity and clinical efficacy in numerous conditions.

As Shen Men is a functional designation, the nature of the point and its representation of body organs and systems is not recognized. An anatomic and phase understanding will give us a clear understanding to the nature of Shen Men. In Phase 1, the Shen Men area corresponds to the Spleen zone. This mesodermal organ will functionally deal with inflammatory cellular elements and thus this zone is often seen in acute ailments. In Phase 2, the Shen Men zone corresponds to the representation of the ectodermal thalamus. As a significant central nervous system structure, it is not surprising that this zone would be seen in chronic degenerative and painful conditions and in patients suffering from chronic addictions.

Finally, the Shen Men zone corresponds to the Phase 3 liver. Again, given the extensive interactions of hepatobiliary physiology, it is not surprising that subactue or chronic ailments would be identified in this zone.

The significance of Shen Men may be more specifically recognized when the physician understands the anatomic and embryological implications, rather than simply the functional importance of this zone.5,10 Additionally, this advanced auricular acupuncture approach will lead to clearer diagnostic interpretation of a presenting illness as it is represented in one or more areas on the auricle. Ultimately, more enduring clinical effects may be realized with treatment of properly identified points. Proper identification and treatment of auricular points is encouraged for the physician to treat the patients' auricle in a true medical model rather than in a cursory technical approach.

1. Bourdiol, R. Elements of Auriculotherapy. Maisonneuve: Sainte-Ruffine, FR, 1982.
2. Huang, H (Translator). Ear Acupuncture: A Chinese Medical Report. Rodale Press, Inc., Emmaus,PA, 1974.
3. Nogier, PFM. From Auriculotherapy to Auricular Medicine. Maisonneuve: Sainte-Ruffine, FR, 1983.
4. Kropej, H. The Fundamentals of Ear Acupuncture. Karl F. Haug Publishers: Heidelberg, 1987.
5. Nogier, PFM. Handbook to Auriculotherapy. Maisonneuve: Sainte-Ruffine, FR, 1969.
6. Nogier, PFM and Nogier, R. The Man in the Ear. Maisonneuve: Sainte-Ruffine, FR, 1985.
7. Helms, JM. Acupuncture Energetics: A Clinical Approach for Physicians. Medical cupuncture Publishers: Berkeley, 1995.
8. Oleson, TD, Kroening, RJ, and Bresler, DE. An experimental evaluation of auricle diagnosis: he somatotopic mapping of musculoskeletal pain at ear acupuncture points. Pain, Vol. 8 No. 2, 1980;217-229.
9. Oleson, TD. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. 2nd Edition. Health Care Alternatives: Los Angeles, 1996.
10. Soliman, NE and Frank, BL. Atlas of Auricular Therapy and Auricular Medicine. Integrated Medicine Publishers: Richardson, TX, 1999.
11. Wen, HL and Cheung, YC. Treatment of drug addiction by acupuncture and electrical stimulation. Asian J. Med., 1973;9:138-141.
12. Wexu, M. The Ear: Gateway to Balancing the Body. A Modern Guide to Ear Acupuncture. Aurora Press: Santa Fe, 1975.

Reprinted with permission from the American Academy of Medical Acupuncture. This article originally appeared in Medical Acupuncture, the journal of the American Academy of Medical Acupuncture.
Images are reprinted from the Atlas of Auricular Therapy and Auricular Medicine.
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