In the first part of this article, which appeared in the September 2004 issue, I provided the reader with a list of clinically effective formulas for the treatment of 26 common diseases.

In the second part, which appeared in the December 2004 issue, I summarized the energetics of core acupuncture points so that readers could appreciate their role in auricular prescriptions. In this third and final part, I will discuss treatment modality options.

The practitioner has numerous auricular techniques to choose from, depending upon the practitioner's mode of preference, styles the practitioner may have been taught, or patient compliance. The table presented below summarizes these techniques. Please refer to my text or other ear acupuncture manuals for more detailed information on these 15 modalities and their contraindications.

Auricular Modalities
Modalities	Conditions
1. Massage	Massage can be applied by the therapist or the patient after the patient is instructed on where and how to massage the ear. Mark the spot to be massaged with a pellet or sterile marking pen.
2. Needles	Needling is the most common auricular therapeutic modality. Needles can be inserted into any point. Insert - get qi - then tonify or disperse. Heat is the most desired stimulus of qi arrival. Note: I tend not to needle the Heart or Brain point because of their strong effect. For this point, I substitute pellets. However, it is not contraindicated to needle.
3. Ear seeds and herbal plasters	Semen vacarria provide a good stimulus due to their size and density. However, if they are not sterile, they can increase the risk of infection. Herbal deposits on the seeds can impart herbal therapeutic benefits.
4. Ear pellets - gold, silver or other metals	Pellets are a good-sized modality for auricular treatment. They provide a perfect stimulus and have the added benefit of being sterile. Additionally, pellets are available in various metals. Therefore pellets can also be used for their metallurgic properties.
5. Ear tacs	Tacs come in various sizes - extra small, small, medium, and large. The bigger the tac, the stronger the stimulus, so consider patient tolerance when choosing tac size. There can be a higher risk of infection with ear tacs if patients do not have the tacs removed at the proper time.
6. Intradermal needles	Intradermal needles are used for areas such as the fingers or vertebral areas. Do not use in depressions in the ear such as the scaphoid fossa. The intradermal needle will not go into a depression easily and may break. Intradermal needles need to be placed on points on a ridge or flat area. Intradermals are available in various lengths. Select the appropriate length based upon the size of the point to be treated.
7. Magnets	Magnets need to be removed at bedtime or if the stimulus becomes too strong for the patient. They are reusable on the same patient. Magnets do not pierce the skin, thus the risk of infection is reduced.
8. Electroacupuncture	Electricity is good for anaesthetizing a point due to the electrical machine's ability to achieve high frequencies that stimulate the point. Do not clean the ear with alcohol prior to using the point detector for diagnosis, as this will change the ear pathology and the electrical resistance of the ear.
9. Bleeding	Bleeding is used to reduce heat/fire, subdue yang, stimulate qi and blood, or to move stagnant qi and blood.
10. Moxibustion	Moxa use is limited but specific to treat earache or the common cold and other conditions. It can be applied indirectly over the point or with an incense-size moxa stick.
11. Incisions/Sutures	Incisions/sutures are a technique that is typically not employed in the United States because an incision is considered a surgical technique. An incision provides a constant stimulus to the point. Chances of infection are increased using incisions.
12. Injections	Injections can be applied to the point with a hypodermic needle. Common injections include saline, vitamin B12, certain Chinese herbal formulations, lidocaine, procaine, and placenta. This procedure is slightly painful due to the small size of the point, the size of the hypodermic needle, and the nature of the substance injected.
13. Laser	Laser therapy is one of the newest modalities. It is painless and infection is not an issue. Ease of administration also makes it a good choice in treatment.
14. Staples	Like incisions and sutures this is an old technique used to stimulate points. Seeds or pellets are commonly used now in the place of staples.
15. Plum-blossom needling	This modality may be applied to points of the lobe such as the Eye, as well as being used as a method to induce bleeding in the ear.

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