SHEN MEN: A CRITICAL ASSESSMENT
THROUGH ADVANCED AURICULAR THERAPY
By Bryan L. Frank, M.D., Richardson, Texas
and Nader Soliman, M.D., Rockville, Maryland
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; 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.
Acupuncture, Aricular Acupuncture, Shen
Men, Paul Nogier
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 fourth
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.
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 thc upper aspect of the ear, including
thc 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 thc 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 thc presentation of the original "inverted fetus" (Figure
1 ). Phase 2 corresponds to degenerative conditions, and thc
"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 (Figure 2)
While it is now known that illness progresses
from 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 (Figure 3) Phase 3,
to Phase 2, to Phase I (1,3).
Several organs in the Chinese auricular system differ from the
French system because of the focus on functional observations.
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 (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 stale. 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
Another example in 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 the
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 lo 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 nulti-phase anatomic evaluation is
The Chinese Shen Men point has been recognized
for its application in many pain and dysfunctional conditions.
With pain conditions, Men is often considered to be a primary
poinl for treatment. Neuropsychoemotionally, it is considered
to alleviate apprehension, fear, anxiety, and to help regulate
the sympathefic 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 physicians to know what the Shen Men point
really represents. Shen Men is not a mystical, mysterious point
such as the impression Chinese ear acupuncture charts give us.
The Chinese acupuncturists noticed the presence of a point here
usually active in painful condi-tions, 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 into 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 in-teractions
of hepatobiliary physiology, it is not surprising that subacute
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 treat-ment of properly identified points. Physicians
should properly identi-fy and treat auricular points on a true
medical rnodel, rather than a cur-sory technical approach.
- Bourdiol R. Elements
of auriculothcrapy. Maisonneuve: Sainte-Rufiine, FR 1982.
- Huang H (Translator).
Ear acupuncture: a Chinese medical report. Rodale Press, Inc.,
Emmaus, PA 1974.
- Nogier PFM. From
auriculotherapy to auricular medicine. Maisonneuve: Sainte-Ruffine,
- Kropej H. The fundamentals
of ear acupuncture. Karl F. Haug Publishers, Heidelberg 1987.
- Nogier PFM. Handbook
to auriculotherapy. Maisonneuve: Sainte-Ruffine, FR 1969.
- Nogier PFM and Nogier
R. The man in the ear. Maisonneuve: Sainte-Rufiine, FR 1985.
- Hlms JM. Acupuncture
energetics: a clinical approach for physi-cians. Medical Acupuncture
Publishers, Berkeley 1995.
- Oleson TD, Kroening
R J, and Bresler DE. An experimental evalua-tion of auricle diagnosis:
the somatotopic mapping ofmusculoskele-tal pain at ear acupuncture
points. Pain, Vol. 8/No. 2, 1980; 217-229.
- Oleson TD. Auriculotherapy
manual: Chinese and Western sys-tems of ear acupuncture. 2nd Edition.
Health Care Alternatives, Los Angeles 1996.
- Soliman NE and Frank
BL. Atlas of auricular therapy and auricular medicine. Integrated
Medicine Publishers, Richardson, TX 1999.
- Wen HL and Cheung
YC. Treatment of drug addiction by acupuncture and electrical
stimulation. Asian J. Med., 1973; 9:138-141.
- Wexu M. The ear:
gateway to balancing the body. A Modern Guide to Ear Acupuncture.
Aurora Press, Santa Fe 1975.
Dr. Bryan L. Frank is an Anesthesiology/Pain Medicine specialist
in Richardson, Texas. He serves as President of the American Academy
of Medical Acupuncture. He has taught at the Academy's Annual
Symposium, other national and international medical acupuncture/brutus,
and is a Clinical Instructor for the UCLA Medical Acupuncture
for Physicians program. Dr. Frank is President, Integrated Medicine
Seminars, which specializes in offering intermediate and advanced
medical acupuncture courses.
L. Frank, M.D.*
P. O. Box 831111
Richardson, TX 75083-1111
Phone: 972-489-4286 · Fax: 972-437-9644 ·
Dr. Nader Soliman
is Director of the Washington Alternative Medicine and Integrated
Pain Management Center in Rockville, Maryland. He serves as a
Clinical Instructor for the UCLA Medical Acupuncture for Physicians
program. He has taught physicians auricular medicine, with particular
interest in integrating auricular medicine into biomedical and
medical acupuncture practices. Dr. Soliman is President, Integrated
15001 Shady Grove Rd. #100
Rockville, MD 20850
Phone: 301-251-2335 · Fax: 301-972-4671 ·
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