4.4 Antipsychogenic effect
Patients may experience fear and anxiety before surgery, and this psychological state may complicate the induction of anesthesia, leading to a poor disease outcome [94]. Romoli et al (1993) identified the Triple Heater (TH, Sanjiao) area of the Chinese map as the major area for diagnosing and treating a stress response related to important life events in order to reduce anxiety and depression[24]. Wang et al.
(2001) found that relaxation group is better than shenmen and sham groups in the State-Trait Anxiety Inventory–State Scale (STAI) in the chronic disorder [95]. Wang et al. (2001) evaluated the changes in STAI scores in preoperative patients after receiving AA(based on TCM) relaxation, and control groups. The results revealed that the relaxation group had significantly lower STAI scores than the control group, but not the AA group [9]. Kober et al. (2003) evaluated the effect of AA (relaxation group) in alleviating anxiety in the ambulance. The relaxation group lower scores on the Visual Analog Scale for anxiety, and anticipated pain reduction and improved
disease outcomes. The mechanism may trigger the release of endorphins and
neurotransmitters, serotonin, norepinephrine, and GABA in the brainstem, midbrain, and hypothalamus [96]. Wang et al. (2004) investigated the effect of AA on mothers and their children scheduled for surgery. The mothers and their children in the AA group reported a significant reduction in STAI scores and on the modified Yale Preoperative Anxiety Scale compared with the control group. Moreover, children in the AA group reported higher scores in the Induction Compliance Checklist compared with the control group [94]. Mora et al. (2007) examined the effectiveness of AA in alleviating anxiety in patients before receiving extracorporeal shock wave lithotripsy.
The results revealed a significant reduction in anxiety, reduction in pain and improved treatment outcome in the AA group[97]. Karst et al. (2007) investigated the
effectiveness of AA versus medication treatment on dental anxiety. The results revealed that AA and intranasal midazolam had similar effects in alleviating anxiety and raising compliance [98]. Black et al. (2011) examined the efficacy of AA in patients withdrawing from psychoactive drugs. The NADA protocol group did not report higher scores in reduced anxiety compared with the sham AA and control groups [99]. Michalek-Sauberer et al. (2012) examined AA efficacy in patients with dental diseases. The AA group reported lower anxiety scores compared with the sham group, whereas the control group reported increased anxiety [100]. Reilly et al. (2014)
investigated the efficacy of AA on anxiety levels in caregiver. The results revealed a significant decrease in STAI scores and higher Caring Ability Inventory scores in the AA group [101] . Gagliardi et al. (2014) enrolled 20 health volunteers (divided into real and sham groups) and assessed the anxiolytic-sedative effect of AA on health person. There was a significantly reduction of the numeric rating scale anxiety score ( p < 0.01) and State-Trait Anxiety Inventory State anxiety score values ( p < 0.005) in the real acupuncture group. The Bispectral Index System score did not change after 5 minutes, but a significant decrease in anxiety was noted in the real acupuncture
group[102].
Regarding patients with depression, Nixon et al. (2003) examined the efficacy of AA in treating depression in adolescents with repetitive self-injurious behavior (SIB).
The results revealed a significant decrease in SIB frequency 4 weeks after treatment, although the decrease in the urge to self-injure was nonsignificant [103]. Shi et al.
(2013) examined the effects of continuous auricular EA in patients with depression.
The results revealed a significant increase in HRV as well as lower scores on the Hamilton Anxiety Rating Scale (HAM-A), the Athens Insomnia Scale (AIS), and the Hamilton Rating Scale for Depression (HRSD), but the changes in heart rate and low frequency/high frequency ratio (LF/HF ratio) were nonsignificant [104]. Liu et al.
(2013) investigated the efficacy of auricular EA in rat models. The findings revealed a
significant reduction in blood pressure comparable to that achieved through VNS as well as a significant decrease in HRV in the EA in the auricular concha region (EA-ACR) group, but not in the other groups. EA-ACR groups experienced a significant reduction in plasma cortisol and adrenocorticotropic hormone (ACTH) levels. The effect of EA-ACR on depressed rats may be induced by the normalization of hypothalamic-pituitary-adrenal axis hyperactivity [105].
4.5 Insomnia
Insomnia affects many people of all ages and contributes to many disorders (e.g., fatigue, instability, depression, impaired daily function, anxiety, and substance abuse) [106]. Insomnia is diagnosed when the quality and amount of sleep is deemed
unsatisfactory, and when people have difficulty falling asleep, staying asleep, and waking up too early [107]. The mechanism of AA in insomnia may involve the regulation of melatonin [108]. Suen et al. (2002) evaluated the effects of auricular therapy on sleep promotion. The results revealed significant improvements in
nocturnal sleep time and sleep efficiency in all groups, but significant improvements in sleep behavior were found only in the magnetic pearl group [109]. One year later, Suen et al. (2003) reported long-term effects for magnetic pearl auricular therapy in treating insomnia in elderly people after identifying significant changes in nocturnal
sleep time and improvements in sleep behavior in 15 elderly patients, and this effect was retained 6 months after treatment [110]. Kim et al. (2007) examined the efficacy of AA in treating insomnia. The sleep state and sleep satisfaction improved
significantly, and the effect lasted for 2 weeks [107]. Sjöling et al. (2008) examined the effects of AA on patients with insomnia. The results revealed nonsignificant differences in total sleep time in both groups, as well as in the frequency of waking and ease in waking in the AA group. However, the other sleep parameters improved substantially in both groups during treatment [111]. Wu et al. (2014) conducted a pilot study to evaluate the effects of AA on hemodialysis patients with insomnia. The results revealed significant decreases in the scores of the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, sleep latency, sleep disturbance, daytime dysfunction, and reduced intake of medication [112]. Review articles were consistent in their conclusion that AA had an effect on insomnia, but the low methodological quality of these studies limited the validity of their findings [10, 106, 113, 114].
4.6 Obesity
Obesity was found to raise the risk of metabolic syndrome and cardiovascular and cerebrovascular diseases [115, 116]. The causes of obesity included an unbalanced diet, genetic heredity, socioeconomic factors, endocrine diseases, lack of exercise, and
emotional issues [116]. Asamoto et al. (1992) stimulated the rat inner auricular areas that represent the human pylorus, lung, trachea, stomach, esophagus, endocrine, and heart acupuncture points induced the action potentials in the hypothalamic
ventromedial nucleus (HVM), the satiety center. Needle implantation into any of these points reduced the body weight of rats. Stimulation of other acupuncture points did not induce HVM action potentials. If the HVM was destroyed, the AA had no effect on body weight. There were no effect of the AA on the lateral hypothalamus (LHA). Shiraishi et al. (1995) investigated whether the electrical auricular stimulation affected the activities of the LHA and HVM in rats. The results revealed reduced activity in LHA neurons and increased activity in VMH neurons after electrical auricular stimulation. Even the non-obese rats still have the effects of the AA on reducing body weight [118-120]. Kim et al. (2001) found that AA treatment in unfed rats can lower neuropeptide Y (NPY), whereas in fed rats it can increase NPY [121].
Cabioğlu et al. (2006) investigated EA on the Hunger and shenmen points of the auricle, and found that the points LI4, LI11, ST36, and ST 44 can alter the levels of biochemistry in obese women. The results revealed increased serum insulin and C-peptide levels in the EA group compared with the placebo group. A higher C-C-peptide level is positively correlated with a higher body mass index (BMI) [122]. Yeh et al.
(2008) investigated obesity-related parameters in non-obese and obese participants
after AA treatment. The results revealed a significant reduction in waist
circumference (WC) and hip circumference (HC) in non-obese subjects, but not in obese subjects [123]. Shen et al. (2009) described another mechanism, which differed from the involvement of NPY reduction. After 4 weeks of AA treatment, their body weight decreased in both the AA group and the control group. Sympathomimetic effects were noted in both groups and the effects are increasing the basal metabolism and reducing appetite temporarily [124]. Hsu et al. (2009) monitored the effects of AA on obesity-related parameters and hormone peptides. The findings indicated no change in body weight, BMI, and WC between both groups, but a significant increase in ghrelin and a decrease in leptin in the AA group [125]. Hsieh et al. (2010)
investigated the effectiveness of AA on body weight and serum lipid levels in obese adolescents. The BMI was significantly decrease in all groups but the total
cholesterol, triglycerides, high density lipids and low density lipids were all significantly increase [126] Ching et al. (2012) recruited 86 obese patients with schizophrenia, and randomly assigned them to an AA group and a control group. No differences were found between the AA group and the control group in body weight, WC, and body fat percentage after an 8-week intervention [127]. Abdi et al. (2012) hypothesized that the effects of AA on the reduction in body weight were related to the immune system or the inflammatory process. The results revealed a reduction in
anthropometric factors and anti-heat shock protein antibodies, but not in
high-sensitivity C-reactive protein levels in the AA group and indicated that the effects of AA are induced through immunomodulation [128]. Yeo et al. (2014) investigated the effect of different auricular acupoints in improving obesity. The results revealed significant differences in BMI, body weight, and body fat percentage between the treatment and control groups, but no differences between the five(i.e., shenmen, spleen, stomach, hunger, and endocrine)- and one(Hunger)-point groups [129].
Darbandi et al. (2014) examined the effects of different acupuncture methods on abdominal fat reduction. Body EA and AA were both found to have significantly reduced BMI, WC, HC, and trunk fat mass. Body EA was more effective in reducing WC compared with AA, whereas AA had a greater effect in reducing HC [130]. Kim et al. (2014) examined the effects of AA combined with Sinapsis alba seeds in treating obesity. They found a significant decrease in body weight and BMI in the AA group, but the changes in body fat percentage and waist-to-hip ratio were
nonsignificant [116]. Set et al. (2014) investigated the effects of AA in treating depression in obese women. The results revealed that the BMI and Beck Depression Inventory for Primary Care scores decreased following AA treatment [131]. He et al.
(2012) designed a randomized controlled clinical trial to compare the effect between both auricular acupressure and exercise, and exercise alone on obesity. They found
that both auricular acupressure and exercise for 4 weeks may produced greater effect than exercise alone for body weight reduction in Chinese women with primary obesity [132].
Conclusion
Auricular therapy is a convenient approach for treating diseases in areas lacking medical resources. Evidence on auricular therapy supports its efficacy for pain relief, in treating epilepsy, anxiety, as well as obesity, and in improving sleep quality, but not for treating substance dependence. The mechanism of auricular therapy warrants further study.
Conflict of Interest
The authors declare that they have no conflicts of interest.
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