In this report, the results of a study of the "live" ("active") ear reflex points ultrastructure are represented. Small pieces of auricle skin were taken from healthy tissue at the surgical edges of the specimen corresponding to the ear reflex points. Those points were detected before surgery, using vascular autonomic signal and verified by electron detection. The surgical material from the four patients was fixed, treated in the usual way, and examined with light and electron microscopy. No specific ultrastructure of the "live" ("active") human auricular points was found in this study.

Key words: ear reflex points, morphology, vascular autonomic signal

The investigation of the morphological basis of the auricular reflex has remained a topical issue ever since Nogier's first discovery of the organs' representation in the skin of human auricle. Is there a very specific structure or ultrastructure of the auricular projection? This problem has been studied only on the macroscopic level: sensory innervation of the human auricle. A review of serious literary sources of the past decades shows that ear point morphology has been diplomatically omitted. There were just a few publications in which the authors categorically deny the existence of the ear points' own substratum.

The only exception was an article by Heine (DZA, 1993, 36: 99-103). According to this experienced morphologist, the substratum is an innervated collagen body (about 0.1 mm in diameter, 5 per 1 mm2, and 10000 per auricle). Heine's findings raise several questions.

First, it was not clear whether the skin samples from the cadaver auricles examined by the author corresponded to ear points, since the points location was based on Chinese ear acupuncture chart.

Second, comparison between the morphological structure of the points and the neutral parts of the skin was not carried out.

Finally, the author arrives at categorical conclusions having researched just a few of the so-called auricular points using light microscopy alone (the thickness of the semithin is 1 micron and maximal magnification up to 1000).

Being impressed by Heine's work, Dr. Dvorkin decided to study on "live" ("active") human auricular points based on skin samples from surgical material. Those samples corresponded to ear points that would be detected before surgery, using vascular autonomic signal and verified by electron detection.To carry out the study, Prof. L. Malinovsky and Dr. E. Dvorkin founded in 1994 the interdisciplinary group for study of "live" ("active") ear reflex points, including auriculotherapists, plastic surgeons, morphologists.

The results of our study of the ultrastructure of five "live" ear points and neutral skin sample are represented in this report.

Small pieces of auricle skin were taken from healthy tissue at the surgical edges of the specimen corresponding to

- the left thalamic point, in the case of a 60-year-old woman suffering from diabetes mellitus and operated for basal cell carcinoma at the internal face of the left antitragus;

- the antidepressive point, in the case of an 81-year-old woman operated for hyperkeratosis of the right ear lobe;

- the right allergy and Darwin points, in the case of a 79-year-old man operated for hypertrophic solar keratosis of the right auricle;

- the left frustration point, in the case of a 75-year-old man operated for old keratosis of the left auricle. A neutral part of auricle skin of this patient was also taken for examination (Fig. 1).

Fig. 1. The examined auricular points and free skin sample.

A. Case 1: t - left thalamic point

B. Case 2: a - antidepressive point

C. Case 3: a - right allergy point, d - right Darwin point

D. Case 4: f - left frustration point, n - neutral part

The material was fixed, treated in routine manner, and examined with light and electron microscopy. It must be emphasized that the possibilities of human material examination with electron microscopy are limited, as small tissue samples are used. For this reason, we could not study the sensory innervation of epidermis and hair, as well as the nerve plexuses' vessels.

Light microscopy examination of semithin sections of all the studied zones was important in order to gain general information. There were found thick nerve bundles with myelinated and non-myelinated fibers, numerous thick vessels, and hair follicles. In our opinion, Heine's collagen bodies are mere collagen fibers knots without a demarcation from their surroundings.

Electron microscopy examination of ultrathin sections of all the studied zones revealed the following findings:

1. Thick nerve bundles with myelinated as well as non-myelinated nerve fibers resembling "penicillate structures" (Fig. 2).

Fig. 2. Thalamic point: cross section through a thick nervous bundle. C - capsule, F - fibrocyte, M - myelinated nerve fiber, NM - non-myelinated nerve fibers, Schwann cell. x 7,000

2. Solitary thin bundles of non-myelinated nerve fibers (Fig. 3).

Fig. 3. Frustration point: longitudinal section through a solitary small bundle non-myelinated nerve fibers. CF - collagenous microfibrils, TA - terminal parts of axon with light and dense microvesicles, NM - non-myelinated nerve fibers, MC - mast cells. x 33,000

3. Mast cells were found in all zones, either solitary or in small groups, often related to blood vessels and nerves. Direct innervation of these cells was not observed. The cells contain different forms of numerous dark granules, small clear vesicles, vacuoles and some organelles. Mast cells of all the studied zones do not differ in their ultrastructure (Fig. 4).

Fig. 4. Darwin point: a group of mast cells in dermis with dark granules and several clear vesicles. x 12,000

4. Numerous veins without innervation (Fig. 5).

Fig. 5. Thalamic point: cross section through a vein. The wall consists of one layer of endothelial cells. E - endothelial cell, ER - erythrocyte. x 10,000

5. Solitary arteries without innervation.

6. A rich occurrence of somatic hairs with assumed sensory innervation (Fig. 6).

Fig. 6. Thalamic point: cross section through a somatic hair with follicular surrounding layers. FC - follicular cell, SH - somatic hair. x 11,600

7. No significant ultrastructural differences were found between active ear reflex points and their nearest surroundings, as well as free skin sample. Our findings agree with those of some animal studies (in rabbits, rats, and dogs). Does a "live" ("active") ear reflex point have its own morphological substratum?

No specific ultrastructure was found in this study. In summation, at the risk of reaching hasty conclusions, our group is uncertain at this time of the existence of a unique ear reflex point ultrastructure, and leans more towards the conclusion that structure of these points are merely a temporary structure. We prefer to continue further research in the field.

BIBLIOGRAPHY

1. Elias J. Lehr- und Praxisbuch der Ohrakupunktur, Sommer-Verlag, Teningen, 1990, p 14

2. Heine H. Morphologie der Ohrakupunkturpunkte. DZA 1993; 36: 99-103

3. Editorial. IJAM 1995; 2: 4

4. Malinovsky L, Dvorkin E, D'Andrea V. Some comment on new ''collagen bodies'' described in human auricular skin. IJAM 1995; 2: 5-7

5. Malinovsky L, Dvorkin E, Hanzlova J, Mayer I, Malinovska V, Dubinsky G, D'Andrea V. Ultrastructure of the thalamic representation in the human auricle. IJAM 1996; 1: 6-16.

6. Malinovsky L, Dvorkin E, Cavallotti C, Hanzlova J, Mayer I, Felman G, Malinovska V, Dubinsky G, D'Andrea V. Ultrastructure and relation of mast cells to "active" auricular zones (points) in the human auricle. IJAM 1996; 2: 11-22.

7. Stepanov R, Dvorkin E, Dubinsky G, Felman G. Ultrastructure of the "active" ear reflex points in the human auricle. Coherence 2000; 1 In preparation.

8. Layroutz A. Ohrakupunkturpunkte des Hundes und ihre Morphologie. DZA 1995; 38: 103-113.