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zero
point
Zero
Point:
A Critical Assessment Through
Advanced Auricular Therapy
Bryan Frank, MD
Nader Soliman, MD
ABSTRACT
Zero Point is situated at the junction
of the conchal ridge and the root of the ascending helix. It is
one of the most recognized auricular points and is used in the
treatment of many ailments. Zero Point is thought to have a powerful
influence in treating various conditions including pain, sedation,
addiction treatment, and inflammation. While Zero Point is universally
recognized in the auricular acupuncture world, it is not associated
with any specific organ. It was derived from observations of functional
effects, not necessarily with respect to the body's anatomy. However,
the Nogier French auricular system has developed with anatomical
and embryological understanding and consistency with respect to
localizations of the points or zones. Through this understanding,
the physician will more completely comprehend the patient's pathophysiology
and may experience better clinical results through proper stimulation
of auricular zones.
KEY WORDS
Acupuncture, Auricular Acupuncture, Auricular
Therapy, Auricular Medicine, Zero Point, Paul Nogier
INTRODUCTION
The somatotopic presentation of the body within
the ear was first recognized through persistent
clinical investigations of Dr Paul Nogier
of France.1,
2, 3
Nogier first recognized that the point commonly
known as "sciatic point" correlated to the
lower lumbar vertebral segments. With this
starting reference point, he hypothesized
and confirmed the primary auricular correspondence
system, known as the "inverted fetus"4,
5, 6, 7
(Figure 1). Early in the
development of the French auricular microsystem,
the Zero Point (Figure 2)
was recognized and identified on auricular
charts. Auricular Medicine practitioners'
understanding of the significance and meaning
of Zero Point has evolved through the years.
Most auriculotherapy practitioners continue
without these newer developments of Zero Point's
significance.
Developmental Perspectives
Nogier's identification
of the Zero Point initially occured because
of its perceived functional value. this point
served as reference point to "zero,"
or set the sensitivity of early auicular electrodiangnostic
devices. Within several years, however, this
point was recognized to be pathologic in many
patients. Thus, it does not serve well as
a reference point. 4
Nogier and colleagues continued to investigate
auricuolar correspondeces and pursue identifucation
of points through anatomical and embryological
understandings.
The original presentation of auricular correspondence
or the "inverted fetus" presentation came
to be recognized as a somatotype that corresponds
to normal physiology, acute pain, and dysfunction.
In this model, the musculoskeletal (mesodermal)
structures present in the upper aspect of
the ear, covering the helix, antihelix, scaphoid
fossa, and triangular fossa 1,
5,7, 8,
9 (Figure
3). Visceral organs (endoderm) are identified
in the concha, and the cephalic structures
(ectoderm) present in the lobule.10,11
In time, Nogier recognized
that chronic and degenerative conditions were
represented in alternate auricular presentations,
depending on the stage of illness. The respective
embryologic tissue layers will shift in their
auricular representation based on their phase
status.7
According to this model, degenerative conditions
are identified in phase 2 presentation, wherein
the fetus presentation "morphs" to an upright
position (Figure 3).3,
7 In phase 2, the
mesoderm presents in the concha, the endoderrn
in the lobule, and the ectoderm in the upper
ear (Figure 4). Degenerative
conditions are more dense in their pathological
presentation and represent the most serious
progression of pain or a functional problem.
Generally, progression to phase 2 will take
weeks to months from the onset of the injury
or illness.
Chronic conditions are identified as phase
3 auricular correspondences; phase 3 presents
with the mesoderm in the lobule, the endoderm
in the upper ear, and the ectoderm in the
concha (Figure 4). The
homunculus is now seen in a transverse presentation.
Chronic presentations will generally emerge
within several days or weeks of the initial
insult or injury. Depending on the stage of
a patient's illness, the pathology may be
identified in I or more loca- tions within
the ear. 3,7
As disease progresses, it is now known that
the auricular reflection will shift from phase
1 to 3 to 2. Phase 2 was recognized second,
and it is thus labeled "2," despite the fact
that phase 2 represents a condition more chronic
and degenerative than those seen in phase
3. Recovery of illness follows the reverse
pattern, from phase 2 to 3 to I (Figure
4). 1,3
Through extensive
clinical observation, Nogier and colleagues
also identified 7 zones of the auricle that
demonstrate favorable response to specific
frequencies of electrical stimulation (Figure
5). These zones are further influenced by
specific Master Points within the respective
zones, which exert generalized influence over
their zone. In this model, the concha is identified
as Zone "B" and includes the location of Zero
Point (Figure 6).1,3
Specifically, Zero Point corresponds to the
Master Point of Zone B and thus, has influence
over the entire concha. 
Often a physician's
confusion regarding the significance of an
auricular point will become clear when the
anatomy and embryology are considered within
these phase dynamics. Furthermore, a study
of the auricular neurology and an appreciation
of the influence of the zonal Master Points
may lead to greater understanding of the clinical
efficacy of various auricular points.
Zero Point
Functionally,
as noted above, the Zero Point was used early
as a reference site for auricular point electrodetection.
Zero Point has also been referred to as the
"umbilicus ... .. vitelline duct," or "solar
plexus" of the ear.1,
10 Its central physiologic
importance for many body functions is clearly
indicated.
Anatomically, Zero Point lies in an area of
innervation by the vagus nerve. Stimulation
of the point may yield a significant parasympathetic
effect that may be important for all endodermal
structures found in the concha. Included in
the superior concha are the phase 1 representations
of the abdominal viscera, including the small
and large bowels, gall bladder, pancreas,
etc. Within the inferior concha are the lungs
(Figure 7). This parasympathetic
effect has also been recognized to affect
the auricular energetics in general. Clinically,
the parasympathetic tone may be enhanced or
diminished depending on the specific direction
of auricular massage. A centrifugal massage
will diminish the parasympathetic tone as
a probe or rod is used to massage outward
from the Zero Point. Conversely, a centripetal
massage toward the Zero Point will enhance
the parasympathetic tone of the ear. I The
point has also been used to treat panic attacks
by needling the nondominant ear (generally
ipsilateral to the dominant hand).1
The location of Zero Point also corresponds
to the phase 2 cerebellum zone (Figure
8). Cerebellar functions include coordination
of somatic motor activity, regulation of muscle
tone, and mechanisms of equilibrium.12,13
Its positive effects on emotional status and
drug detoxification have been recognized among
auricular therapists. With such significant
impact on the body's fundamental coordinating
functions, it is not surprising that this
point may be identified as an active point
through electrostimulator detection in patients
with pain or functional problems.
The Zero Point location is also shared by
the phase 3 corpus callosum (Figure
9). The role of the corpus callosum as
neural relay is imperative for proper neurophysiological
function. Abundant fibers connect to the cortex
from the lower brainstern and spinal cord;
inte gration of information between the hemispheres
is vital to carry information that is essential
to proper brain function. Disturbances of
this neural integration may manifest as attention
deficit disorder/attention deficit-hyperactivity
disorder, stuttering, dyslexia, confusion
with directions, and visual and auditory processing
disturbances. Chronic pain or functional illness
may thus be represented at the Zero Point
location because of the disturbance of corpus
callosum.
Thus, practicing
advanced Auricular Therapy, with consideration
of phase dynamics rather than just the simple
"inverted fetus," will give further clarification
to the nature of the presenting pain or illness.
Specific and definitive identification to
the phase of presentation is made only through
the energetic techniques of Auricular Medicine
using the VAS of the radial pulse and the
EMF signal of the auricle.3
While futher detail of Auricular Medicine
is beyond the scope of this article, it is
important to note that these are the techniques
used to specifically identify the exact nature
of the disturbance. With advanced Auricular
Therapy techniques, clinicians have much greater
information to be able to recognize an active
auricular zone as a distubance in I of 3 phase
presentations, rather than as a single point
on the basic auricular somatotopic model.
CONCLUSION
The significance of Zero Point may be
more specifically recognized when the physician understands the
neurological, anatomical, and embryological implications, rather
than simply the functional importance of this zone.5,
6, 7 Additionally, this
advanced auricular acupuncture approach will lead to clearer diagnostic
interpretation of a presenting illness as it is represented in
I or more areas on the auricle. Ultimately, more enduring clinical
effects may be realized with treatment of properly identified
points. Proper identification and usage of auricular points is
encouraged to enable the physician to treat the patient's auricle
in a true medical model, rather than in a cursory technical approach.
REFERENCES
1. Bourdiol R. Elements of Auriculotherapy.
Ste Ruffine, France: Maisonneuve; 1982.
2.
Huang H, trans. Ear Acupuncture: A Chinese Medical Report. Emmaus,
Pa: Rodale Press Inc; 1974.
3.Nogier
PFM. From Auriculotherapy to Auricular Medicine. Ste Ruffine,
France: Maisonneuve; 1983.
4.
Kropej H. The Fundamentals of Ear Acupuncture. Heidelberg, Germany:
Karl F. Haug Publishers; 1987.
5.
Nogier PFM. Handbook to Auriculotherapy. Ste Ruffine, France:
Maisonneuve; 1969.
6.
Nogier PFM, Nogier R. The Man in the Ear. Ste Ruffine, France:
Maisonneuve; 1985.
7.
Frank BL, Soliman NE. Shen Men: a critical assessment through
advanced auricular therapy. Medical Acupuncture. 1999; 10(2):17-19.
8.
Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995.
9.
Oleson TD, Kroening RJ, Bresler DE. An experimental evaluation
of auricle diagnosis: the somatotopic mapping of musculoskeletal
pain at ear acupuncture points. Pain. 1980;8:217-229.
10.
Oleson TD. Auriculotherapy Manual: Chinese and Western Systems
of Ear Acupuncture. 2nd ed. Los Angeles, Calif: Health Care Alternatives;
1996.
11.
Soliman NE, Frank BL. Atlas of Auricular Therapy and Auricular
Medicine. Richardson, Tex: Integrated Medicine Publishers; 1999.
12.
Carpenter MB. Human Neuroanatomy. 7th ed. Baltimore, Md: Williams
& Wilkins; 1976.
13.
Raj PR, ed. Practical Management of Pain. 2nd ed. St Louis, Mo:
Mosby -Year Book Inc; 1992.
AUTHORS
INFORMATION
Dr Bryan L. Frank is an Anesthesiology/Pain Medicine specialist
in Richardson, Texas. He serves as President of the American Academy
of Medical Acupuncture, and has taught at the Academy's Annual
Symposia and other national and international medical acupuncture
forums. Dr Frank is a Clinical Instructor for the UCLA Medical
Acupuncture for Physicians program, and is President of Integrated
Medicine Seminars.
Bryan
L. Frank, MD*
P.O. Box 831111
Richardson, TX 75083-1111
Phone: 972-489-4286 - Fax: 972-437-9644 - E-mail: Bfrank@pol.net
Dr
Nader Soliman is Director of the Washington Alternative Medicine
and Integrated Pain Management Center in Rockville, Maryland,
is a Clinical Instructor for the UCLA Medical Acupuncture for
Physicians program, and is President of Integrated Medicine Seminars.
Dr Soliman has taught physicians auricular medicine, with particular
interest in integrating auricular medicine into biomedical and
medical acupuncture practices.
Nader
Soliman, MD
15001 Shady Grove Rd #100
Rockville, MD 20850
Phone: 301-251-2335 - Fax: 301-972-4671 - E-mail: Altmedctr@aol.com
*correspondence
and reprint requests
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