Auricular Point Acupressure Therapy: A Safe and Effective Treatment for Postsurgical Abortion Recovery

Surgical abortion is a common remedial measure following contraceptive failure and is one of the primary methods for early termination of pregnancy. Globally, approximately 73 million induced abortions (IA) occur annually, with 61% of unintended pregnancies and 29% of all pregnancies ending through surgical abortion¹. This trend has shown a rising incidence in recent years due to changing reproductive attitudes and social perceptions of fertility².

As an invasive intrauterine procedure, surgical abortion can lead to a variety of short- and long-term complications, including abdominal pain, excessive or prolonged vaginal bleeding, and intrauterine infection, as well as menstrual irregularities, intrauterine adhesions, pelvic inflammatory disease, and infertility. These complications can seriously affect women's physical and psychological health³. Therefore, effective control of postoperative bleeding, prevention of infection, and promotion of reproductive function recovery are essential for improving postoperative outcomes.

Conventional postoperative management typically includes antibiotics for infection prevention, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control, and hormonal therapy to regulate the menstrual cycle and support uterine recovery⁴. However, these approaches may be associated with adverse effects such as antibiotic resistance, gastrointestinal irritation or renal impairment caused by NSAIDs, and thromboembolic risks resulting from hormonal imbalance^5,6,7. As a result, postoperative patients often face the dual challenges of side effects and treatment-related burden.

Auricular acupressure therapy, a traditional and characteristic modality in Chinese medicine, offers a non-pharmacological, cost-effective, and practical alternative for postoperative recovery. This technique involves applying medicinal seeds -- most commonly Semen Vaccariae (the dried mature seeds of Vaccaria hispanica, a Caryophyllaceae plant) -- to specific auricular acupoints. These seeds are traditionally believed to promote blood circulation, relieve pain, and reduce local swelling. By pressing or massaging the attached seeds, stimulation is transmitted through meridians to regulate the function of internal organs, harmonize the flow of Qi and blood, and alleviate pain^8,9. Treatment usually begins immediately after surgery or on the first postoperative day and continues for five to seven days. Patients are instructed to press the seeds two to three times daily for one to five minutes per session, with the duration adjusted according to recovery progress. However, this therapy is contraindicated in individuals with ear diseases, severe systemic disorders such as cardiac or hepatic-renal dysfunction, serious postoperative complications, or allergies to treatment materials.

Auricular acupressure therapy is often used in combination with other therapeutic modalities and has demonstrated significant efficacy in gynecological disorders such as dysmenorrhea, menstrual irregularities, and perimenopausal syndrome. Building on this foundation, our research team applied auricular acupressure to postoperative care following surgical abortion and observed promising outcomes. This article provides a detailed description of the therapeutic procedure and key considerations to facilitate its standardized clinical application

All procedures of this study were conducted in accordance with clinical trial registration and approved by the Ethics Committee of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Approval No. 2022SL-015). All patients involved in the study provided informed consent for the use of data, images, and related videos by the researchers during the trial period.

1. Patient selection

1. Inclusion criteria
   1. Confirm early intrauterine pregnancy (gestational age ≤ 10 weeks) and confirm that the patient has undergone surgical abortion.
   2. Ensure the patient has been informed about the study, signed informed consent, and is willing to complete the intervention process.
   3. Confirm the absence of ear infections, trauma, or other auricular diseases that may interfere with therapy.
2. Exclusion criteria
   1. Exclude patients with serious systemic diseases such as severe heart disease, liver or kidney dysfunction, or malignancies.
   2. Exclude patients who experience severe complications after abortion, such as uterine perforation or post-operative infections.
   3. Exclude patients with known allergies to the study's materials or medications.
   4. Exclude patients with severe cognitive or communication disorders.
3. Exclusion, dropout, and termination criteria
   1. Exclude patients who deviate from the treatment protocol, have incomplete data, or receive conflicting treatments during the trial.
   2. Consider as dropouts those lost to follow-up or who voluntarily withdraw after enrollment.
   3. Terminate patients from the study if severe adverse events occur.

2. Preparation before treatment

1. Prepare the materials (see Figure 1 and Table of Materials). Gather a metal probe, forceps, sterile cotton swabs, 75% alcohol, and auricular point adhesive (Vaccaria segetalis seeds on 0.5 cm × 0.5 cm medical tape).
2. Prepare the patient. Seat the patient comfortably in a relaxed position with ears fully exposed.
3. Ensure the practitioner disinfects hands and inspects the patient's auricular skin. Proceed only if no redness, swelling, or ulceration is observed.
   NOTE: If allergic to adhesive tape, use an alternative. Do not initiate treatment if auricular abnormalities are present.

3. Experimental procedures

1. Auricular acupoint operation
   1. Select six acupoints: Liver (CO12), Spleen (CO13), Kidney (CO10), Uterus (TF2), Ovary (AT4), and Endocrine (CO18) (see Figure 2).
   2. Massage both front and back of the auricle 3-5x, from earlobe to apex (front), and apex to earlobe (back), until both ears are reddened (Figure 3).
      NOTE: Massage promotes Qi and blood flow in auricular points.
   3. Locate sensitive acupoints. Pull the auricle upward and backward to expose the selected acupoint zones. Use the probe to detect sensitive points and mark them (Figure 3).
      NOTE: Sensitive points elicit more pain or tenderness and are therapeutically preferable. If none found, use standard point locations.
2. Auricular point acupressure treatment
   1. Disinfect the auricle with a sterile cotton swab dipped in 75% alcohol to clean the treatment area (Figure 3). Wait until dry.
      NOTE: Alcohol enhances adhesion by removing skin oils. Use iodine tincture if allergic.
   2. Expose the treatment area. Ensure the auricle is fully visible and clean (Figure 3).
   3. Use forceps to place the Vaccaria seed adhesive precisely at the marked acupoint. Confirm placement with the patient (Figure 3).
   4. Press and knead the seed adhesive between the thumb and index finger from both sides of the auricle (Figure 3). Maintain a steady rhythm until the patient feels soreness, numbness, fullness, pain, or warmth.
      NOTE: These sensations indicate "De Qi," which reflects effective stimulation. Monitor patient comfort.
   5. Ask the patient to press each acupoint for 1-2 min, 3x daily (morning, afternoon, evening) for 5 consecutive days.
3. Postoperative care and adverse reaction management
   1. Keep the ear clean and dry. Replace the adhesive if it detaches.
      NOTE: The adhesive does not interfere with activities like bathing.
   2. Offer emotional support to reduce anxiety.
   3. If pain occurs, advise reducing pressure. Remove the adhesive if pain is severe.
   4. If redness, itching, or exudation appears, remove the adhesive and apply topical antihistamine if needed.
   5. If the patient experiences dizziness, chest tightness, or sweating, stop treatment immediately, monitor vitals, and administer appropriate care.
4. Observation indicators and evaluation criteria
   1. Record the duration and volume of postoperative vaginal bleeding.
   2. Assess menstrual status by tracking the time to first menses, duration, and volume. Criteria are >50% change from baseline volume defines increase/decrease.
   3. Evaluate TCM symptoms and signs, and monitor dizziness, fatigue, palpitations, sweating, abdominal/lumbar discomfort, and assess complexion, tongue, pulse.
   4. Record complications. Track infections, need for repeat curettage, or other adverse events.
      NOTE: Use the PBAC chart to assess menstrual and bleeding volume.
5. Data processing
   1. Data collection: Conduct all assessments by trained researchers using a double-entry method to ensure data accuracy.
   2. Statistical analysis
      1. For normally distributed continuous data, express results as mean ± standard deviation (SD) and perform paired t-tests for within-group comparisons and independent sample t-tests for between-group comparisons. If variances are unequal, apply the t′ test for between-group comparisons.
      2. For non-normally distributed continuous data, express results as median (P25, P75) and use the Wilcoxon rank-sum test for between-group comparisons.
      3. For categorical data, present results as frequencies and percentages and perform chi-square tests for between-group comparisons.
      4. Use paired t-tests for pretreatment and posttreatment comparisons. Apply two-tailed hypothesis testing and consider differences statistically significant at P < 0.05.

In this clinical study, routine B-ultrasound was performed preoperatively to determine the gestational age and the location of the pregnancy sac. Electrocardiogram (ECG), blood and urine routine tests, and vaginal discharge examinations were conducted, and if no abnormalities were detected, the patients proceeded with the surgical abortion. A total of 216 subjects were enrolled in the study.

The patients had been randomly divided into a control group and a treatment group, with 108 patients in each group. All patients underwent vacuum aspiration under intravenous propofol general anesthesia. In the control group, postoperative treatment consisted of routine oral cefdinir capsules, 0.1 g, twice daily for 3 days. The treatment group received the same drug regimen in combination with Vaccaria segetalis seed auricular plaster therapy.

All 216 patients completed the treatment and follow-up observations, with no cases of exclusion, dropout, or discontinuation. The control group included patients aged 18-43 years, with a mean age of 27.6 years. The number of pregnancies ranged from 1 to 5, and the number of births ranged from 0 to 4. There were 11 cases with a history of cesarean section, 13 with a history of dysmenorrhea, and 8 with menstrual irregularities. The treatment group included patients aged 18 to 45 years, with a mean age of 28.8 years. The number of pregnancies ranged from 1 to 6, and the number of births ranged from 0 to 3. There were 13 cases with a history of cesarean section, 11 with a history of dysmenorrhea, and 10 with menstrual irregularities. There were no statistically significant differences between the two groups in terms of age, pregnancy history, delivery history, cesarean section rates, or menstrual status (P > 0.05) (Table 1).

Compared with the control group, the treatment group experienced significantly less vaginal bleeding and a shorter duration of bleeding. The difference between groups was statistically significant (P < 0.05). Additionally, the treatment group had a significantly lower Traditional Chinese Medicine (TCM) symptom score than the control group (P < 0.05) (Table 2).

In terms of menstrual recovery, the time to first menstrual return and the duration of menstruation were both significantly shorter in the treatment group compared to the control group (P < 0.05). Furthermore, the proportion of patients whose menstrual volume returned to normal was significantly higher in the treatment group, while the incidence of abnormal menstrual volume was significantly lower (P < 0.05). There was no significant difference between the groups in the incidence of irregular menstrual cycles (P > 0.05) (Table 3).

During follow-up over three menstrual cycles, no major adverse events were observed in either group. However, the incidence of postoperative complications was significantly lower in the treatment group compared to the control group (P < 0.05) (Table 4).

Figure 1: Preparation of items used for auricular therapy. (A) Metal probing stick, (B) Tweezers, (C) Sterile cotton swabs, (D) 75% alcohol, and (E) Auricular plaster. Please click here to view a larger version of this figure.

Figure 2: Locations of auricular acupuncture points used in the treatment. (1) Liver (CO12): Located at the lower posterior part of the auricular pavilion, behind the stomach and duodenum reflex zones, at the midpoint between the pancreatic point and the external abdominal point, in the auricle 12 zone. (2) Spleen (CO13): Located below the BD line, in the upper posterior part of the auricular cavity, in the auricle 13 zone. (3) Kidney (CO10): Located at the auricular helix, below the bifurcation of the upper and lower branches of the auricle, near the lower posterior part of the helix, at the midpoint between the hemostasis point 2 and the small intestine point, in the auricle 10 zone. (4) Uterus (TF2): Also known as the internal reproductive organ point, located at the lower third of the anterior part of the triangular fossa, in the inner depression at its base, in the triangular fossa 2 zone. (5) Ovary (AT4): Located at the lower third inner side of the ear tragus, at the midpoint between the intertragic notch and the base of the tragus, on the inner line from the apex of the tragus to its base. This location is above the endocrine point, also known as the "subcortical" point, and corresponds to the testicle point. (6) Endocrine (CO18): Located in the intertragic notch, at the bottom of the auricular cavity, in the auricle 18 zone. This diagram is based on the National Standard of the People's Republic of China, Auricular Point Names and Locations (GB/T13734-2008), and uses red letters to indicate the point locations10. Please click here to view a larger version of this figure.

Figure 3: Procedural steps for auricular plaster therapy. (A) Massage the auricle. (B) Stimulate auricular reflex zones using a metal probe. (C) Disinfect the auricle. (D) Expose the auricle fully. (E) Apply the auricular plaster. (F) Massage the auricular plaster. Please click here to view a larger version of this figure.

Table 1: Baseline characteristics of the study groups.

Table 2: Comparison of vaginal bleeding duration and TCM syndrome scores between the two groups after treatment. Vaginal bleeding duration was defined as the number of days from surgery to complete cessation of bleeding; durations under 24 h were converted proportionally (e.g., 7 days and 12 h = 7.5 days). The TCM syndrome score was used to evaluate postoperative symptoms, with lower scores indicating better improvement.

Table 3: Comparison of menstrual recovery after treatment in the two groups. Abnormal menstrual volume was defined as a change of ≥50% compared with the patient's typical volume.PBAC score ≥100 was defined as menorrhagia (excessive bleeding), and PBAC < 5 as hypomenorrhea (scanty bleeding). An irregular menstrual cycle was defined as a cycle shorter than 21 days or longer than 35 days.

Table 4: Comparison of postoperative complications between the two groups.

Abortion is an effective method for terminating an unintended pregnancy, encompassing both medical and surgical options. Among these, vacuum aspiration (VA) is the most commonly used and recommended surgical procedure for early pregnancy termination. This method involves the insertion of a rigid or flexible plastic cannula through the cervix to evacuate the uterine contents under negative pressure¹¹. VA includes two approaches: manual vacuum aspiration (MVA) and electric vacuum aspiration (EVA). Although many women are able to resume daily activities shortly after the procedure, complications such as infection, bleeding, acute hematoma, and retained tissue are common^12,13. Persistent or increased vaginal bleeding following surgery is often attributed to the rapid, repetitive suction used during the procedure¹⁴.

Prophylactic antibiotics are recommended by the American College of Obstetricians and Gynecologists and the World Health Organization to reduce infection risk after surgical abortion. Hormonal interventions, including short-acting oral contraceptives and estrogen-progestogen sequential therapy, are used to promote endometrial repair¹⁵. However, some studies suggest that these medications may increase the risk of abnormal uterine bleeding, thrombosis, and breast cancer¹⁶. Therefore, post-abortion care is a critical aspect of female reproductive health management.

In Traditional Chinese Medicine (TCM), abortion-related symptoms are categorized under broader TCM disease patterns such as "Duo Tai" (miscarriage), "Chan Hou Fu Tong" (postpartum abdominal pain), and "Chan Hou E Lou Bu Jue" (postpartum lochia retention). From a modern TCM perspective, surgical abortion is an invasive procedure that disrupts the uterus and its blood vessels, disturbing the balance of the Chong and Ren meridians and leading to blood stasis (Yu Xue). Thus, TCM treatment focuses on activating blood circulation and resolving stasis.

Auricular point therapy, particularly seed-pressing techniques, offers a simple and effective method to activate acupoints that improve Qi, nourish blood, promote circulation, relieve pain, and support recovery by regulating autonomic nervous function, enhancing blood flow, and balancing hormonal activity¹⁷. According to the Ling Shu chapter of The Yellow Emperor's Inner Canon, the ear is a convergence point of the Zong Mai (ancestral meridian) and connects with the body's internal organs, limbs, and joints through the meridian system.

This traditional theory aligns with modern research. In 1957, Dr. Paul Nogier, a French physician, proposed the "inverted fetus theory," suggesting that the shape of the auricle resembles an inverted fetus and that internal organs are mapped onto specific auricular regions. Follow-up studies confirmed that physiological and pathological changes in the body are reflected in these regions¹⁸. Neuroanatomical research has shown that the auricle is richly innervated and vascularized, and that its nerves connect with the central nervous system, jointly regulating somatic and visceral functions¹⁹. Further studies suggest that auricular stimulation modulates central nervous system activity, affects sympathetic and parasympathetic tone through the thalamic system, and activates non-specific defense mechanisms. It may also regulate hormone secretion through the thalamo-hypophyseal axis, thereby maintaining endocrine homeostasis and contributing to clinical effects²⁰.

Based on this foundation, the present study applied auricular acupressure using Vaccaria seeds to assess its efficacy in promoting recovery after surgical abortion. Six acupoints were selected in accordance with TCM principles and modern ear mapping: Liver (Gan), Spleen (Pi), Kidney (Shen), Uterus (Zigong), Endocrine (Neifenmi), and Ovary (Luanchao). Each point reflects the physiological state of its corresponding organ and meridian.

The Liver point is linked to the liver organ and meridian, which in TCM stores blood and governs the smooth flow of Qi. Stimulating this point promotes circulation, relieves pain, and supports reproductive health, as the liver meridian passes through the lower abdomen and genitals. The Spleen point, associated with digestion and blood control, helps regulate menstruation and reduce postoperative nausea and vomiting. The Kidney point corresponds to essence storage and reproductive function, regulating the Chong and Ren meridians and supporting menstruation.

Combined stimulation of the Liver, Spleen, and Kidney points enhances the therapeutic effects of Qi regulation, pain relief, blood activation, and menstrual regulation. Research has shown that stimulating the Liver, Spleen, Subcortex, and Sympathetic points can influence vagal tone, regulate prostaglandin and β-endorphin secretion, and reduce pain duration and intensity^21,22. Auricular stimulation also increases norepinephrine release and upregulates irisin, UCP-1, and FNDC5 expression, contributing to anti-inflammatory effects²³.

Studies further confirm the impact of auricular therapy on menstrual regulation, including cycle normalization, flow volume control, and symptom relief²⁴. The Endocrine, Ovary, and Uterus points are central to this effect. The Endocrine point maintains hormonal balance by modulating the HPO axis, as shown in studies combining herbal and auricular therapies²5. The Uterus point promotes blood circulation and endometrial repair, while the Ovary point enhances estrogen secretion, supporting endometrial regeneration and pain modulation. Estrogen also acts as a neuromodulator, affecting sensory perception and contributing to pain relief^26,27.

Taken together, these findings indicate that auricular points regulating endocrine functions act synergistically, enhancing each other's therapeutic effects. The combined stimulation of multiple endocrine-related auricular acupoints helps modulate autonomic nervous system activity, restore hormonal balance, and promote homeostasis within the endocrine system²⁸. Therefore, the combination of the above auricular points can harmonize meridians, regulate the Chong and Ren vessels, promote menstrual recovery, and relieve pain.

The results of this study showed that auricular seed-pressing therapy significantly reduced post-abortion vaginal bleeding time and volume, alleviated symptoms such as dizziness and fatigue, and improved TCM symptom scores. Compared with the control group, the treatment group had a shorter time to first menstruation after abortion, fewer post-operative complications, and a faster recovery of reproductive function.

In conclusion, auricular seed-pressing therapy markedly improved postoperative recovery in women following surgical abortion by reducing bleeding, normalizing menstruation, and decreasing complications. These findings support auricular therapy as a safe, effective, and non-pharmacological option for managing post-abortion syndrome. However, generalizability remains limited due to the single-center study design. Future multi-center studies with larger, diverse populations are necessary to validate these results.

Several limitations should be acknowledged. First, the study did not assess long-term reproductive outcomes, and future research should explore the impact on fertility recovery. Second, the absence of a placebo or comparison with other non-TCM interventions may limit the interpretation of efficacy. Lastly, although physiological theories support auricular therapy, further laboratory and clinical studies are needed to clarify its mechanisms, particularly in hormonal regulation, neural pathways, and metabolic activity. Such evidence would strengthen the scientific foundation for broader clinical application.