with the fetal representation of the knee in the auricle. Auriculotherapy following Nogier’s theory uses the ear to help determine whether the right and left hemispheres of the brain are functioning as a dynamic whole, whether there are specific neurological, musculo-skeletal or organ systems that are in imbalance, and whether there are any blockages to treatment, such as scar tissue or emotional disorders and it should be a new diagnostic system too (2,3). Then Dr Nogier noticed that there was a distinct change in the amplitude and dimension of the pulse when certain points on the auricle were stimulated. This occurs consistently and is both repeatable and measurable by modern equipment. Dr Nogier called it the Vascular Autonomic Sign (VAS) (3). Being able to detect the VAS on the radial pulse of the patients’ left hand enables the practitioner to precisely determine the location of a point, whether there is a pathology in the region of the body that relates to specific points, and whether certain substances are indicated. Accurate employment of the VAS would be essential in diagnosis and treatment following the principles of Nogier’s auricolomedicine. Nogier collaborated with a group of medical colleagues who, in a spirit of cooperation and discovery, shared their experiences. One of those colleagues, Dr Jacques Niboyet, convinced Nogier to introduce his discoveries to the Congress of the Mediterranean Society of Acupuncture in February of 1956. Attending that Congress was Dr Ge´ rard Bachmann who published Nogier’s research, translated into German, in a Acu- puncture journal in 1957. This journal had an interna- tional circulation and it was not long before Japanese acupuncturists became familiar with Nogier‘s reflex system. The discovery of the system spread to China and led to intensive research by the Chinese medical authorities at a time of renewed interest in Traditional Chinese Medicine. After learning about the Nogier ear charts in 1958, a massive study was initiated by the Nanjing Army Ear Acupuncture research Team. This Chinese medical group verified the clinical effectiveness of the Nogier approach and assessed the conditions of over 2000 clinical patients, recording which ear points corresponded to specific diseases. The outcome of that research was very positive and resulted in the utilization of this therapy by the ‘Barefoot Doctors’ of the Cultural Revolution. In China was published an Ear Chart remarkably similar to that of Dr Nogier in 1958 (4). Nogier acknowledged that Chinese traditional medicine had been using ear points for acupuncture prior to his discovery, but these had been considered empirical points for particular treatments and were not associated with a somatotopic representation of the homunculus in the ear. This oversight appears to have inhibited awareness of options laid open to recognize and treat other points eCAM 2007;4(S1) 15 in the ear following an anatomical relationship to the points already known at the time. Ear Acupuncture and Evidence Based Medicine Later the American physician TD Oleson has published a very important paper that is a real milestone in ear acupuncture (5). To experimentally evaluate the claims by French and Chinese ear acupuncture that a somatotopic mapping of the body was represented in the external ear, 40 patients were examined to determine areas of their body where there was musculoskeletal pain. Each patient was draped with a sheet and a physician conducting the auricular diagnosis had no prior knowledge of the patient’s medical condition, but simply examined the patient’s ear for areas of elevated skin conductivity or tenderness. The concordance between the established medical diagnosis and the auricular diagnoses was 75.2% (5). These results thus supported the hypothesis that there is a somatotopoic organization of the body represented upon the human auricle, but represented following definite areas not meridian lines or other energetic concepts. In the last years modern clinical and basic research is confirming the efficacy of ear acupuncture mostly in the treatment of pain both acute and chronic (6–9), and of anxiety related disorders (10–12). While the treatment of irritable bowel syndrome, obesity, smoke cessation, alcohol withdrawal and other types of substance abuse disease is still waiting definitive confirmation (13–17). Basic research is trying to explain the effect of therapeutic reflexes induced by ear acupuncutre so behavioral analgesia produced by auricular acupuncture can be blocked by the opiate antagonist naloxone, indicating the role of endorphinergic systems in under- standing the underlying mechanisms of auriculotherapy analgesia (18); and ear stimulation in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on the site of stimulation and period of observation (19). Auricolotherapy is a treatment diffusing in all over the world, and its patterns follow the principles of Chinese acupuncture, revised and updated, with Chinese maps of the ear; the principles of Paul Nogier and also the principles of reflexology basing on somatotopic maps that do not recognize energetic-based stimulation, while just the evocation of a reflex stimulating precise areas of the ear; moreover are used for stimulation of ear skin many different tools: finger acupressure, laser, electricity, different types of needles, magnetic balls, seeds. Actually one of the many methodological problems with auricular acupuncture is that there are so many maps of the ear and little agreement exists regarding point location, lacking definitive anatomic study on ear