BASE of the MFAD method

ABBREVIATIONS MFAD – Multi Factorial Auricular Diagnostics AP – Auricular Point ASP – Auricular Signal Point LDP – Lobule Diagonal Plica As – Auriculae Asymmetry RSF – Reduction of the Scaphoid Fossa RAUC – Reduction of the Antihelix Upper Crus AA –  Aggression Area EA – Electrical Anomaly VC – Visible Changes PS – Pain Sensibility GA – General Anomaly EC – Electrical conductivity ML – Measuring Level ID – Indicator Drop Value (effect of “fall” the indicator arrows) units – conventional units of measurements (= point of  empirical scale)

The auricular diagnostics and therapy have a centuries-old history. The treatment of auricular points was used in countries of the Orient since extreme antiquity. The close ties of the auricle with all visceral organs postulated in ancient Chinese treatises were a basis for using these points for diagnostic and therapy. The first map of the projection zones and active points of the auricle dates back to the 5th century A.D. and to the name of Chinese doctor Sung Su Mao.

Many years have passed since, and auricular diagnostics and therapy, which are the parts of clinical reflex therapy, have been enriched with new clinical evidence and results of experimental studies (V.I.Kvirchshvili, 1966; V.G. Vogralik and M.V.Vogralik, 1978; F.G.Portnov, 1980; Y.S.Velkhover and V.G.Nikoforov, 1984; Y.S. Pesikov and S.Y.Rybalko, 1990; A.A.Mikhailova, 1992; Y.A. Tkachenko, 2000; H. Lu, 1975; H.Kropej, 1976). For this reason auricular reflex therapy has been considered for decades as one of promising lines of clinical assessment and improvement of the human health. Studies conducted in Russia have accurately ascertained the topography of auricular points and clinical indications for their treatment (D.M. Tabeyeva (1976, 1980); L.M. Klimenko (1976, 1990)). This research was based on the international classification of G.Konig and I. Wancura (1975) and helped significant progress in this field.

R.A. Durinyan has made a great contribution to the development of foundations of auricular reflex therapy (1982, 1983). It is well known by now that various diseases cause reflex signal reactions at certain auricular points. From the neuro-physiological point of view, this is explained by change in functional properties of the central neurons on which auricular and viscero-somatic afferents project, conducting abnormal impulses from visceral organs and affected sites of the body. These reflex reactions result in the formation on the auricle of hyperalgesic points with change in electrical resistance and the morphology of the skin, which is used in the original methodology of multifactorial auricular diagnostics (MFAD).

The MFAD methodology developed by Y.Y. Meizerov and M.V. Koroleva (2000) is significantly different from similar techniques used in comprehensive analysis of electrical conductivity, tenderness and morphological signs at signal points of the auricle.

In 2000, the MFAD method received the official registration of the Ministry of Health of Russian Federation [7].

It is accepted at present that MFAD allows integral health assessment, topical diagnostics of organ and system diseases, and compiling individualized reflex treatments and control of therapy. MFAD has a high diagnostic value and allows early identification of different disease processes, rapid diagnostics and a possibility of evaluating all organs in “one visual field”. Therefore, the use of auricular diagnostics is appropriate as a screening test of organ and system function and further work-up using direct diagnostic methods. This diagnostic modality can be also used for designing the individualized reflex treatment of auricular points and control of therapy. However, automated computer systems should add to this methodology for ensuring its high clinical efficiency.

1. Indications and Contraindications for MFAD Method Use

The use of auricular diagnostics is provided for health screening assessment and early detection of internal organs and system dysfunctions with a purpose of prescribing a relevant clinical diagnostic examination. This diagnostic method can be also used for compiling individual schemes of reflexive effect of auricular points and control of the therapy.

The auricular diagnostic procedure is contraindicated in the presence of the auricular inflammation and implanted cordial pacemakers.

Excessive sensibility to electrical current and mechanical pressure are the relative contraindications. With patients who have psychiatric disorders, the use of the MFAD is limited to the measurement of electrical conductivity and analysis of morphological signs at signal points of the auricle.

2. Diagnostics Conditions

Auricular diagnostics is carried out at medical centres. Diagnostic studies may be conducted at mobile stations during mass people health examinations. Only physicians, who have got the specialization of the traditional diagnostics at licensed educational institutions, may perform auricular diagnostics.

The physician should to wear a white coat and clothes made of natural fabrics during the diagnostic procedure. The physician should to put on a cotton or rubber gloves in order to exclude external influences on results of the acupunctural measurements. The diagnostics is accomplished in conditions of good illumination and desirably with the use of magnifying devices.

Diagnostic procedures are carried out at 70-80 percent humidity in the room and at air temperature +20 to +22 degrees centigrade. A patient must stay in the condition of quiet alertness for at least 10 minutes before the diagnostic examination. It is not recommended to perform the diagnostics immediately after meals, physical exercise, emotional arousal and during physiological discomfort. The study is carried out with the patient sitting or lying.

Before the examination the patient must take off jewellery, glasses and the watch, and wear clothes of natural fabrics not causing the effects of static electricity. The patient should be warned to remove any electronic mobile devices from him/her.

3. The Procedure and Choice of a Diagnostic Methods

3.1. Visible Changes

During the examination of the auricles, you should pay attention to their size, symmetry of location, proper shape, lines of the helix and the antihelix. Colour changes of the skin, the vascular net and the presence of morphological elements are determined in the auricular areas.

Possible colour changes:

    reddening – local hyperemia;

    pallor – local ischemia;

    pigmentation – pigmented spots.

Morphological changes:

    changes of the cartilage – subcutaneous mobile and immobile indurations that may occur as tubercles;

    vascular net – telangioectasia;

    punctate rash – sites of hyper secretion;

    desquamation – shed cells (scales) of the horny layer;

    nodule – a solid element prominent above the skin;

    vesicle – a hollow element with serous content;

    scar – an element forming as a result of lesion healing;

    ulcer – a deep defect of a derma.

The morphological elements on the auricles skin are divided into primary and secondary.

The Primary elements as a rule occur as the initial skin reaction to an acute disease process (a stimulus). Secondary elements form as a result of evolution of primary elements. Five secondary elements should be distinguished: a spot, a knot, an elevation, a blister and a pustule.

The spot (macula) is an element characterized by a change in the colour of the skin. Spots can be inflammatory, vascular, hemorrhagic and pigmented. Inflammatory spots occur because of dilation of vessels of the superficial layer of the derma. Their colour is pinkish-red, sometimes with a bluish hue. They can disappear at pressure. These spots completely regress or leave mild desquamation. The vascular spots occur as a consequence of persistent dilation of superficial skin vessels. They can be congenital or acquired, and differ from inflammatory spots by the presence of distinct outlines of dilated vessels seen as red convoluted strips. Ruptures of skin vessels or an increased permeability of their walls produce hemorrhagic spots. They change the colour, gradually resolve and can completely disappear with time. However, these spots do not disappear at pressure, which makes them different from inflammatory spots.

The knot (papule) is a solid elevation of the skin. The colour of papules can be pink-brownish and their size is pinball. Shapes of the papules can be spheroid and flat. As a papule resolves, desquamation of the skin appears without scar formation.

The Elevation (tubercle) is a solid prominence of the skin. The colour of the tubercle is yellow or brownish-red. It is lentil-sized and has a hemispheroid shape. With further progress the tubercle becomes necrotic in its centre with the formation of a lesion and scar. The main difference of the tubercle from the papule is its deeper location in the skin and the pattern of its evolution.

Blister (vesicula) is a hollow element with serous content and invariably acute inflammatory origin. The vesicle has a size of a hemp grain and a hemispheroid shape. With evolution, the vesicle either dries, covering with a scale, or opens, producing erosion that drops off without leaving a trace.

The pustule is a hollows element elevating over the skin. It contains pus and usually has an acute inflammatory origin. The pustule is pinball-sized and has a hemispheroid or flat shape. Pustules dry into a crust or open without leaving a scar.

Secondary morphological elements are scales, crusts, erosions, lesions, scars and secondary pigmented spots.

The Scales (squama) are shed cells of the horny layer appearing after the resolution of spots, papules and sometimes of tubercles and other primary elements.

The crust is a dried content of the vesicle or pustule, or dried secretion of an erosion or lesion.

The erosion is an epidermal defect forming after the opening of a vesicle or pustule.

The Lesion (ulcer) is a deep defect of the derma developing after necrosis of the tubercle.

The Secondary pigmented spots occur after inflammatory spots, papules and pustules as a result of an increase in the amount of pigment or a decrease of it at sites of former primary elements.

The colour of auricular skin areas, turgor, elasticity and the state of sweat and sebum secretion are noted during the examination. Analysis of morphological elements follows the general examination, with attention to their locations and nature – inflammatory or non-inflammatory. In the presence of inflammation symptoms, it should be established whether they are acute or non-acute. Bright redness, swelling and tenderness are characteristic of acute inflammation of the skin of the auricle. Primary and secondary morphological elements are determined and their characteristics signs, size, colour, outline (regular or irregular), shape (spheroid, flat), surface (desquamating, smooth), consistency (soft, dense, solid) are evaluated.

Thus hormonal and metabolic disorders often present with desquamation and sites of hypersecretion. Areas of hyperkeratosis can indicate endocrine hypofunction of an organ or system. The presence of vesicles and papules with different stages of development suggests an organic disease. White glossy or matted connective tissue scars may indicate a chronic disease and a history of disease. Subcutaneous elevating indurations with clear-cut boundaries changing at pressure and brown-grey indurations with indistinct boundaries not changing at pressure may be an indication of benign or malignant tumors of organs corresponding to auricle areas.

Analysis of visible manifestations provides guides about stages and phases of disease processes (See Table). It is accepted that the pattern of progress or the chronic nature of a disease become manifest at auricular points first as functional and later as morphological changes. The disease onset initially presents with reddening (hyperemia) and subsequently with pallor (vascular spasm) of respective auricular areas. Acute progress of a disease or an exacerbation of a chronic disease is accompanied by the formation of morphological elements occurring as vesicles, papules and pustules. Secondary pigmented spots, desquamation and a scar replacing a lesion occur in the presence of chronic diseases.

Table

Phases of pathologic process according to visible changes

3.2. Electrical Anomaly

The measurement of electrical conductivity at auricular points using alternating current has certain features. The use of the low-intensity alternating current provides a possibility of the measuring of the impedance (complete, reactive resistance) at points of the auricle.

A principle of the device operation as applied to the MFAD is based on the impedance measurement at signal points of the auricle. The impedance measurement results are represented in conventional units of electrical anomaly on the measuring instrument scale and/or on the graph displayed on the PC screen. As a rule, the instrument scale maximum corresponds to 100 units. During electro-acupuncture examination the gauge pointer deflection from normal electrical conductivity values in the range of 0-20 units is not considered. Deflection of 20-40 units corresponds to "low disease probability", deflection of 40-70 units – "clearly marked disease probability", deflection of 70-100 units – "high disease probability". For example, a pointer deflection in a range of 30-60 units may indicate some chronic inflammatory and degenerative processes in appropriate organs and systems. In case of acute inflammatory process and diseases accompanied with marked pain syndrome the pointer deflection is 80-100 units.

Ten and more points, where electrical conductivity values differ from normal values are revealed during the measurements. This greatly impedes determination of the main focus of lesion. Therefore in these cases correlation of electrical conductivity changes with other diagnostic factors allows to reveal a main pathologic process.

3.3. Pain Sensibility

Pain sensibility may be examined using the same probe as for measuring electrical conductivity. But more reasonable to use a special probe equipped with a pressure sensor. This allows to provide more exact examination of pain sensibility and to register both subjective indications and pressure values provoking pain sensations. The patient informs the doctor about appearance of pain sensations. In addition, a doctor himself (herself) may observe and estimate a patient`s reactions that can become apparent in the form of knitting a brow, closing eyelid(s), wince and groan.

Two gradations are conditionally defined for estimation of pain sensibility:

1)       Low-painful point – this gradation includes the cases when a patient feels low-intensive pain sensation of nagging, spinning or bursting nature while pressing the point with a probe. This gradation also includes the cases when tactile sensibility at the point under examination essentially differs from sensations at the neighbouring points.

2)       Painful point – when pressing the point with a probe provokes expressed painful sensation accompanied, as a rule, with a grimace on patient`s face; or when not very intensive painful sensations are of a nature of pungent, stabbing pain.

4. MFAD Results Interpreting Algorithms

In accordance with our observations not all changes revealed on the auricle have the same diagnostic value. Sum of all the changes revealed in a process of the diagnostics represents common anomaly of the auricular point evaluated in scores of anomaly, but portion of each diagnostic factor is different in different points

The general points` anomaly is processed by the Program with a special algorithm.

5. Electro-acupuncture Conclusion

After study and analysis of discovered change, doctor need to develop a conclusion, portably reflecting revealed breaches, containing diagnostic findings and recommendations.

The “Peresvet Auri” program automatically forms the preliminary conclusion.

The total conclusion must comprise of itself following:

 1) general information about patient and provided study;

 2) summary containing main discovered phenomena in signal auricular points;

 3) clinical interpretation of the discovered changes and recommendations.

It is very important that the conclusion should to contain the medical term and the notions understandable for a physician, who has no special training. For instance, installed changes in the auricular points correspond to high probability of disease of organs of the hepatobiliary zone. Hereinafter it should to indicate the official clinic-laboratory diagnostic methods required for acknowledgement probability of the disease.

6. Medical deontology in auricular diagnosis

The estimation of general and local changes in the auricle is very important for recognition of many pathologic processes. Auricular diagnostics opens potentialities for topical diagnostics of diseases. But many auricular changes are nosologically non-specific, e.g., different diseases can provoke similar changes of diagnostic parameters and so, this method is not yet able to solve independently complicated diagnostic problems. That is why auricular diagnostics may be used today in clinics by only specially trained specialists and only as auxiliary diagnostic method.

As to provide normal examination the active, not passive, patient participation in the examination is required. This is often difficult to do because of a negative attitude of a patient, which is a result of poor information about the method. So one of the possible approaches to get a patient to take part in examination is to give the patient full information about substance of the method, potential disorder of his/her health, additional diagnostic examinations, progress and expected results of the treatment, but without any advertising promises.

After completion of auricular diagnostics it is important not to do diagnose just immediately and definitely until the diagnostics is finally reliable. Changes discovered in the auricle don`t finally testify for pathology of the appropriate organ. For a certain time these changes are only inauspicious background for development of one or another disease. At the stage of screening test of a state of the organism`s organs and systems the diagnosis statements like "probable" or "possible" processes are preferable. It is important to know and remember that imprudent deliver of information may be a reason for iatrogeny.

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