Development of new software for TCM Dx and Tx, esp in CHM

[Guest guest]

Phil, personally I believe your idea to be the great hope and salvation for

TCM.

Such a system and the internet could complete the process of bringing theory

and clinical practice into main stream acceptance. Peer review and

acceptable standards of practice would go far to bring TCM out of the Dark

Ages. Imagine Practioner all over the world able to discuss and argue their

case.

 

A noble catalyst.

I wish you success and offer any help I can be.

 

Ed Kasper L.Ac., Acupuncturist & Medicinal Herbalist

417 Laurent St. Santa Cruz, CA. 95060

(831) 425-8801 toll-free 1-888-425-8827

http://HappyHerbalist.com eddy

Thu, 13 May 2004 09:53:35 +0100

" " <

Development of new software for TCM Dx and Tx, esp in CHM

 

Hi Z'ev, & All,

 

As Todd and Z'ev said, access to powerful TCM/CHM databases

would be a quantum leap for practitioners and researchers.

[Guest guest]

Phil,

 

I'm definitely interested in keeping in touch regarding possibilities for future

development. For the moment, we are in the midst of preparing to come out with a

new version of the software with pictures of each herb and an ability to do

self-quizzing in the language of one's choice (PinYin, Chinese, or English/Latin

pharmaceutical). Also the herbal action vectors will be added. We are constantly

adding refinements and welcome suggestions from users.

 

Both Curt Kruse, my co-developer, and I have training in TCM herbology and in

computer science and expert systems. We gain a lot by bouncing ideas off each

other. What we have both noticed is that the majority of people in the TCM

community are: initially, resistant to what we are doing; secondly, after they

come to see that it might be useful, they have visions of accumulating lots of

data in databases without much idea of how it will be sifted and processed.

Years ago, people in the TCM community told us that what we've done could not be

achieved without lots of money and an army of programmers. We decided to move to

Montana where we could live cheaply (we both like the outdoors and dislike

cities, so this was not really much of a sacrifice). Our most enthusiastic

customers now are foreign physicians. The TCM community-at-large in the U.S.

still does not understand the potential, and when they do begin to see, they do

not necessarily understand the priorities.

 

I respect your insights into this problem, as you are one of the few who

understands where this may all lead. (When you wrote a paper that was presented

at a Taiwan conference in 1998 (?), I saw it on the Internet, and decided to

follow many of your recommendations. We were in the middle of project

development at that time.) However, I also suspect that it would become an

unproductive nightmare if the TCM community at large got into the act and tried

to administer this. I have seen too many bureaucracies in the U.S. become mired

in delusions. I'm reminded of a Chinese piano concerto written in the 60's by a

committee of Communist cadres. It was a monument to mediocrity, quite unbearable

to listen to. Books are written by inviduals or small groups of individuals

because they have an idea they feel worthwhile developing. Software is no

different. If people like what we've put together, that's great, maybe we can

work together later. If some find specific errors, that's fine too, these can be

easily corrected in subsequent versions. However, regarding the software design,

we welcome suggestions, but it really takes intimate knowledge in expert systems

to design and implement the overall structure and to decide what will work the

best. Our experience to date has been that people will recognize what works only

in hindsight; we have to create the implementation first. Most of what we have

done so far, people told us would never work or would be too difficult.

 

The next phase that Curt and I are working on is the expert systems aspect - now

that we have a database of information, the idea is to do automated assessment

of patterns with associated probabilities and magnitudes, based on the input of

symptoms and signs by the user. At this phase, such will require some careful

thought and testing, rather than large amounts of data and information. In other

words, the algorithm is crucial, the data can always be expanded and refined

later.

 

Regarding whether computers will be able to have the knowledge or

decision-making capacity of an expert: humans have unique capabilities and

potential far beyond any computer, but the problem is that only a small

percentage of the population even attempts to develop and use these abilities.

For example, the skills of a Native American animal tracker are phenomenal when

one considers all of the pattern recognition skills involved. Likewise, the

skills of some TCM herbalists I have studied with, such as Yat Ki Lai, were such

that they could analyze a complex case with multiple syndrome patterns and

design a tailored herbal formula from scrath all within a few minutes, and it

usually worked. Unfortunately, I see that in many cases, a computer can do a

better job than people, because many students and practitioners of TCM do not

even attempt to develop these skills. Instead, they memorize lots of stuff from

textbooks. The crux of the matter is developing pattern recognition skills,

which we've embodied in a set of games that come with our databases. A lot of

work went into designing these games so that they would simulate as closely as

possible the types of limited information one might see in the clinic. What

we've noticed is that many students who have previously attended TCM college

think they already know these skills, when they don't. On the contrary, they

often come with bad habits such as making assumptions about the significance of

specific symptoms based on textbook theory, which may not even apply in the case

under consideration; instead, one must constantly weigh all of the possible

interpretations, and then ask directed questions of the client that will further

narrow down the possibilities. I address some of these issues in the following

article:

 

http://www.rmhiherbal.org/review/2002-2.html

Computer-aided instruction in TCM clinical analysis and decision-making

skills

 

Much of the information in TCM textbooks I feel is redundant, and the trick is

to boil it down to its essence, and then to recognize when truly new insights

and information comes along, rather than information that seems new, but is

merely old stuff dressed up in new clothing.

 

It is a basic principle of information theory and operations research that

continual refinements of a basic set of data will yield progressively

diminishing returns. I see this happening in the TCM community. Consequently, I

frequently see practitioners, including my own students, attempt to refine an

herbal strategy or formula, when some glaring toxic environmental or dietary

aspect needs to be addressed. I feel that the next order-of-magnitude

breakthroughs in TCM will be in understanding and integrating knowledge of:

 

* Environmental health issues analyzed from a TCM perspective, and using

numerical estimation methods to use TCM pattern recognition algorithms in

detecting epidemics and environmental health problems at the earliest stages;

* Understanding the toxic effects of many food additives - ancients

texts are of little use here, as many of these technologies, chemicals, and

processes have never been seen before in history;

* Understanding the effects of electromagnetic radiation and sound on

the body, from a TCM perspective;

* Developing new methods for dealing with heavy metal toxicity,

essentially enlarging the TCM strategies, as happened when the epidemics of the

13th centuries stimulated Chinese herbalists to develop the theory of WenBing

illnesses in response to this crisis. (Standard TCM procedures are relatively

ineffective in dealing with heavy metal toxicity.)

 

Such will require development of numerical algorithms for analysis based on TCM

clinical methods, not necessarily lots more data from ancient texts.

 

As an example of some research that really needs to be done:

Any experienced TCM herbalists knows that doing traditional syndrome

differentiation ( " TCM pattern diagnosis " ) yields far better results than giving

some standard formula based only on an allopathic disease indication. In fact,

this latter approach oftens results in side effects, followed by medical experts

denouncing Chinese herbs as dangerous. Yet when I tried to find research papers

that demonstrated, statistically, with controlled clinical studies, that

superior results were achieved by the traditional method, I could not find any.

(If anyone has a specific reference that does show this, I would like to know

about it.) To do this research, there are established statistical methods than

can handle multi-parameter experiments, but to date I have not seen any studies,

even Chinese, that use such methods.

 

In my textbooks I give details and examples of how these numerical methods would

work. I do not have the resources to do the actual research, however; others

need to carry out this work. If would not require any more money than is already

wasted on poorly designed research of dubious clinical value that is reported in

many modern Chinese TCM journals.

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

 

 

 

 

> Thu, 13 May 2004 09:53:35 +0100

> " " <

>Development of new software for TCM Dx and Tx, esp in CHM

>

....

>

>Many years ago I saw the potential of IT (based on powerful

>Boolean search engines) and good computer databases in

>advancing CAM (homeopathy, CHM, AP, etc). Computers are ideal

>for complex " pattern recognition " . Indeed they are far more powerful

>that most human brains at this task; they can be programmed with

>data - millions of pages - that we could not read, let alone

>assimulate and retrieve effectively, in a lifetime.

>

>Unfortunately, computers work on the GIGO Principle - Garbage In

>= Garbage Out! The data entered into the software would have to

>be acceptable to an international panel of experts. Alternatively,

>each data statement would need a " weighting score " (1-10), where

>1=claimed but dubious, and 10=total agreement of the expert panel.

>

>IMO, the ideal database for CHM would have the following

>components, all updateable as new data emerge:

>

>1. THESAURUS + DICTIONARY: A searchable list of all terms and

>synonyms used in the database.

>

>Where possible, the language in the main databases [(2) to (5),

>below].should be " standardised " to the most commonly used term

>for each concept.

>

>2. SYNDROMES: All the main Syndromes listed in the classical

>texts and in modern commentaries and clinical articles should be

>included. Each essential characteristic of the Syndrome should be

>listed. Occasional (non-essential) characteristics and variants

>should be listed also. The listings should include S & Ss, Pulse,

>Tongue and other diagnostically useful info, for example as in

>Roger Wicke's (RMHI) software.

>

>3. SINGLES Database: with all relevant data, including dosage,

>indiactions, contraindications, etc

>

>4. FORMULAS Database:with all relevant data, including dosage,

>indiactions, contraindications, etc

>

>5. Herb-Drug interactions and Cautions / Contraindications

>Database.

>

>6. A powerful DATA ENTRY Page, with extensive Drop Down

>Menus to guide users through the relevant questions on present

>and past S & Ss, likes & dislikes, psychological/mental profile, etc

>from WM AND TCM viewpoints

>

>Use of buttons and tick-boxes would obviate the need for

>unnecessary typing (and spelling errors).

>

>7. FInally, the software would need a powerful Boolean Search

>Engine to enable data entry that might not be covered adequately

>in the drop-down menus (6, above).

>

>The Engine would pick up spelling errors and prompt alternatives

>automatically. It would then pick up the synonyms from the

>Thesaurus. Then it would display the DATA from (6) and (7) for

>tweaking before doing its search of databases (2 to 5), above.

>

>The HITS for Syndromes, Singles and Formulas, respectively,

>would be scored (1-100), where 1 = 1% fit and 100=100% fit.

>

 

....

 

 

 

 

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

Phil,

 

I almost didn't see your post, as I do not check the TCM group postings as

closely as CHA. Did you intend to post this to CHA?

 

We are definitely interested in keeping in touch regarding possibilities for

future development. For the moment, we are in the midst of preparing to come out

with a new version of the software with pictures of each herb and an ability to

do self-quizzing in the language of one's choice (PinYin, Chinese, or

English/Latin pharmaceutical). Also the herbal action vectors will be added.

 

Both Curt Kruse, my co-developer, and I have training in TCM herbology and in

computer science and expert systems. We gain a lot by bouncing ideas off each

other. What we have both noticed is that the majority of people in the TCM

community are: initially, very resistant to what we are doing; secondly, after

they come to see that it might be useful, they have visions of accumulating lots

of data in databases without much idea of how it will be sifted and processed.

Years ago, people in the TCM community told us that what we've done could not be

achieved without lots of money and an army of programmers. We decided to move to

Montana where we could live cheaply (we both like the outdoors and dislike

cities, so this was not really much of a sacrifice). Our most enthusiastic

customers now are foreign physicians. The TCM community-at-large in the U.S.

still does not understand the potential, and when they do begin to see, they do

not necessarily understand the priorities.

 

I respect your insights into this problem, as you are one of the few who

understands where this may all lead. (When you wrote a paper that was presented

at a Taiwan conference in 1998 (?), I saw it on the Internet, and decided to

follow many of your recommendations. We were in the middle of project

development at that time.) However, I also suspect that it would become an

unproductive nightmare if the TCM community at large got into the act and tried

to administer this. I have seen to many bureaucracies in the U.S. become mired

in their own delusions.

 

The next phase that Curt and I are working on is the expert systems aspect - now

that we have a database of information, the idea is to do automated assessment

of patterns with associated probabilities and magnitudes, based on the input of

symptoms and signs by the user. At this phase, such will require some careful

thought and testing, rather than large amounts of data. In other words the

algorithm is crucial, the data can always be expanded and refined later.

 

Regarding whether computers will be able to have the knowledge or

decision-making capacity of an expert: humans have unique capabilities and

potential far beyond any computer, but the problem is that only a small

percentage of the population even attempts to develop and use these abilities.

For example, the skills of a Native American animal tracker are phenomenal when

one considers all of the pattern recognition skills involved. Likewise, the

skills of some TCM herbalists I have studied with, such as Yat Ki Lai, were such

that they could analyze a complex case with multiple syndrome patterns and

design a tailored herbal formula from scrath all within a few minutes, and it

usually worked. Unfortunately, I see that in many cases, a computer can do a

better job than people, because many students and practitioners of TCM do not

even attempt to develop these skills. Instead, they memorize lots of stuff from

textbooks. The crux of the matter is developing pattern recognition skills,

which we've embodied in a set of games that come with our databases. A lot of

work went into designing these games so that they would simulate as closely as

possible the types of limited information one might see in the clinic. What

we've noticed is that many students who have previously attended TCM college

think they already know these skills, when they don't. On the contrary, they

often come with bad habits such as making assumptions about the significance of

specific symptoms based on textbook theory, which may not even apply in the case

under consideration; instead, one must constantly weigh all of the possible

interpretations, and then ask directed questions of the client that will further

narrow down the possibilities. I address some of these issues in the following

article:

 

http://www.rmhiherbal.org/review/2002-2.html

Computer-aided instruction in TCM clinical analysis and decision-making

skills

 

Much of the information in TCM textbooks I feel is redundant, and the trick is

to boil it down to its essence, and then to recognize when truly new insights

and information comes along, rather than information that seems new, but is

merely old stuff dressed up in new clothing.

 

It is a basic principle of information theory and operations research that

continual refinements of a basic set of data will yield progressively

diminishing returns. I see this happening in the TCM community. Consequently I

frequently see practitioners, including my own students, attempt to refine an

herbal strategy or formula, when it is some glaring toxic environmental or

dietary aspect that needs to be addressed. I feel that the next major

order-of-magnitude breakthroughs in TCM will be in understanding and integrating

knowledge of:

 

* Environmental health issues analyzed from a TCM perspective, and using

numerical estimation methods to use TCM pattern recognition algorithms in

detecting epidemics and environmental health problems at the earliest stages;

* Understanding the toxic effects of many food additives - ancients

texts are of little use here, as many of these technologies, chemicals, and

processes have never been seen before in history;

* Understanding the effects of electromagnetic radiation and sound on

the body, from a TCM perspective;

* Developing new methods for dealing with heavy metal toxicity,

essentially enlarging the TCM strategies, as happened when the epidemics of the

13th centuries stimulated Chinese herbalists to develop the theory of WenBing

illnesses in response to this crisis. (Standard TCM procedures are relatively

ineffective in dealing with heavy metal toxicity.)

 

Such will require development of numerical algorithms for analysis based on TCM

clinical methods, not necessarily lots more data from ancient texts.

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

 

 

 

>

>Message: 4

> Thu, 13 May 2004 09:53:35 +0100

> " " <

>Development of new software for TCM Dx and Tx, esp in CHM

>

>Hi Z'ev, & All,

>

>As Todd and Z'ev said, access to powerful TCM/CHM databases

>would be a quantum leap for practitioners and researchers.

>

>In the 1980s, a Med School (Harvard, I think) developed diagnostic

>software for physicians. Initially, many professors and consultants

>were outraged - how could a machine have the knowledge or

>decision-making capacity of an expert?

>

>The answer is simple: if the system has accurate and fairly

>complete data, the computer can pick up any pattern matches,

>and score their degrees of fit. The benefits for novice doctors are

>abvious. They could quickly shortlist the most probable Dxs, and

>double-check their probabiliy by other means. Through regular use,

>novices honed their diagnostic skills much more quickly than they

>would have done without the software.

>

>FREE online diagnostic software is available today for vets - see

>the Cornell Consultant. It is great but NOT perfect, because some

>of its data are incomplete, or ignore some causes for specific

>S & Ss that non-USA vets KNOW to be valid in their countries.

>

>Jim Skoien, our main teacher at the IVAS-BeVAS TCM herb

>course, taught that accurate Dx (esp Pattern DIfferentiation) was

>the key to effective selection of herbs or formulas.

>

>I have >30 years experience of using AP in humans and animals,

>but I am a relative newcomer to CHM In my experience, AP is far

>easier to learn and to use than CHM.

>

>IMO, there are two main types of human memory: " link memory "

>and " photographic memory " . IMO, if one cannot use digital

>memories, those with the strongest personal " link memories " make

>better acupuncturists than herbalists. IMO, this is because good

>AP does not require as much knowledge of the minutiae of

>classical Pattern Differentiation as good CHM does, .

>

>I know that many CHAers look down on Cookbook AP, but it works

>very well for many cases, esp those with few S & Ss and in

>functional rather than serious organic diseases. That said, (and

>although it has not been adequately researched in clinical trials),

>IMO, the more one knows of TCM & Pattern Differentiation, the

>better one's results may be.

>

>In contrast CHM requires enormously powerful " photographic "

>memory. That is probably why I am so slow to begin using herbs;

>my memory for the minutiae is simply not good enough, especially

>if I forget to take my Ginkgo!

>

>Many years ago I saw the potential of IT (based on powerful

>Boolean search engines) and good computer databases in

>advancing CAM (homeopathy, CHM, AP, etc). Computers are ideal

>for complex " pattern recognition " . Indeed they are far more powerful

>that most human brains at this task; they can be programmed with

>data - millions of pages - that we could not read, let alone

>assimulate and retrieve effectively, in a lifetime.

>

>Unfortunately, computers work on the GIGO Principle - Garbage In

>= Garbage Out! The data entered into the software would have to

>be acceptable to an international panel of experts. Alternatively,

>each data statement would need a " weighting score " (1-10), where

>1=claimed but dubious, and 10=total agreement of the expert panel.

>

>IMO, the ideal database for CHM would have the following

>components, all updateable as new data emerge:

>

>1. THESAURUS + DICTIONARY: A searchable list of all terms and

>synonyms used in the database.

>

>Where possible, the language in the main databases [(2) to (5),

>below].should be " standardised " to the most commonly used term

>for each concept.

>

>2. SYNDROMES: All the main Syndromes listed in the classical

>texts and in modern commentaries and clinical articles should be

>included. Each essential characteristic of the Syndrome should be

>listed. Occasional (non-essential) characteristics and variants

>should be listed also. The listings should include S & Ss, Pulse,

>Tongue and other diagnostically useful info, for example as in

>Roger Wicke's (RMHI) software.

>

>3. SINGLES Database: with all relevant data, including dosage,

>indiactions, contraindications, etc

>

>4. FORMULAS Database:with all relevant data, including dosage,

>indiactions, contraindications, etc

>

>5. Herb-Drug interactions and Cautions / Contraindications

>Database.

>

>6. A powerful DATA ENTRY Page, with extensive Drop Down

>Menus to guide users through the relevant questions on present

>and past S & Ss, likes & dislikes, psychological/mental profile, etc

>from WM AND TCM viewpoints

>

>Use of buttons and tick-boxes would obviate the need for

>unnecessary typing (and spelling errors).

>

>7. FInally, the software would need a powerful Boolean Search

>Engine to enable data entry that might not be covered adequately

>in the drop-down menus (6, above).

>

>The Engine would pick up spelling errors and prompt alternatives

>automatically. It would then pick up the synonyms from the

>Thesaurus. Then it would display the DATA from (6) and (7) for

>tweaking before doing its search of databases (2 to 5), above.

>

>The HITS for Syndromes, Singles and Formulas, respectively,

>would be scored (1-100), where 1 = 1% fit and 100=100% fit.

>

>Development of such comprehensive software will require huge

>investment of time, money, but especially, professional and

>international expertise. It will require cooperation from authors and

>publishing houses, some way to satisfy copyright laws and

>royalties, etc. I am prepared to help others who want to progress

>this. It has been a dream of mine for many years, and I have

>assembled some data (much not edited properly yet) from WWW

>and other sources. They could act for starters.

>

>Roger Wicke has discussed his idea of having " action vectors " with

>a numerical score for each, for each SINGLE and FORMULA.

>Roger's data could be of great value in constructing formulas from

>scratch to meet any combination of data entered into the system.

>Roger, would you cooperate in a larger, more international,

>development of such software? Jim Skoien has HUGE amounts of

>data on his personal database. Jim, would you cooperate? Any

>other takers?

>

>IMO, if permission were to be granted from authors / publishers, we

>have MORE than enough data available in English to develop such

>software now, especially if Roger and others, who have much data

>digitised already, were to cooperate.

>

>We would need a panel of experts to vet the data on the way in and

>to agree on the terminology and synonyms in the thesaurus /

>dictionary. It would be great if the Wiseman & Ye's PD could be a

>main part of the system.

>

>Many TCM/CHM purists deride these ideas. IMO they need not do

>so. Each user will still retain the FINAL decision on Dx and Tx. The

>software is only a prompt to the user to consider possibilities that

>he/she might not have considered otherwise. Also, the initial

>software would NOT be immutable; it would merely be a first

>attempt, a beginning in the CHM revolution. The software could be

>updated regularly, as new or conflicting data emerge.

>

>Maybe the task is too complex and practically impossible to do.

>But if it could be done, it would put EXPERT CHM at the fingertips

>of many more practitioners for a long time to come.

>

>

>Best regards,

>

>Email: <

>

>WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

>Mobile: 353-; [in the Republic: 0]

>

>HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

>Tel : 353-; [in the Republic: 0]

>WWW : http://homepage.eircom.net/~progers/searchap.htm

>

>

>______________________

>______________________

>

>

>Membership requires that you do not post any commerical, swear, religious, spam

messages,flame another member or swear.

>

>

http://babel.altavista.com/

>

>

and adjust

accordingly.

>

>If you , it takes a few days for the messages to stop being

delivered.

>

>------

>

[Guest guest]

Phil

 

that's exactly it. and I have no patience for those who detract from

this. Using a computer database to search for " possibilities " and

scoring their degree of fit is exactly what one does when one uses

books. the ONLY difference is that using books to search massive

databases is tedious, laborious and ultimately stupid. Anybody ever

hear the expression, work smart, not hard. I would never support the

use of any technology that diminished TCM, only those that made it even

better. Anyone who disputes that a boolean database does just this is

probably not familiar with using such search engines. Medline would be

useless without such an engine.

 

On May 13, 2004, at 1:53 AM, wrote:

 

>

> The answer is simple: if the system has accurate and fairly

> complete data, the computer can pick up any pattern matches,

> and score their degrees of fit. The benefits for novice doctors are

> abvious. They could quickly shortlist the most probable Dxs, and

> double-check their probabiliy by other means. Through regular use,

> novices honed their diagnostic skills much more quickly than they

> would have done without the software.

>

>

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

Phil, Z'ev, et. al.

 

On May 13, 2004, at 1:53 AM, wrote:

 

>

> 2. SYNDROMES: All the main Syndromes listed in the classical

> texts and in modern commentaries and clinical articles should be

> included. Each essential characteristic of the Syndrome should be

> listed. Occasional (non-essential) characteristics and variants

> should be listed also. The listings should include S & Ss, Pulse,

> Tongue and other diagnostically useful info, for example as in

> Roger Wicke's (RMHI) software.

 

 

While I agree that there is some missing data of clinical relevance

available in english, I believe it to be minute. Not minute in volume,

but minute in further clinical relevance. And I am just talking about

data here (herbs, formulas and syndromes). Not essays, case studies,

modern research and journal articles, all of which have vital roles to

play. In addition, most people are already making due only with what

is available in English and despite idealistic visions from some, I can

assure you that will NEVER change. Each succeeding class of students

is far LESS likely to take on the this serious task. There has been a

definite downturn in the caliber of students and I see no end to this,

either. The MTV generation has finally caught with TCM. If it can't

be conveyed in a slick 30 second sound bite, it is beyond the

comprehension of most high school grads under 25 years old. So it

makes no sense to wait until some international committee decides what

is right or wait for the day that we have all the data others think we

need. that day will never come. Right now, people are plodding

through books and missing a huge range of " possibilities " already. How

this not be improved in a major way through digitization NOW. While

Z'ev may have already absorbed everything in english and now needs to

move on to the Chinese, I have not. And looking at what I have read

and what still remains to be read and what will be published in the

interim, I am hard pressed to see that I will ever exhaust the english

language literature. Having managed or personally treated about 50-70

patients a week for the past four years (after 7 years of about 20

pt/week), I find the existing english data leads to superb results in

the vast majority of cases. I can also say unequivocally that those

case that do not respond well to my dumbed down version of TCM are not

treated any more successfully by either chinese speaking americans or

native chinese themselves. Ironically, the cases I fail with are

usually best treated with things like orthopedics, PT and

pyschotherapy. In my opinion, such cases are not amenable to pure TCM.

And again, to be clear,I am not referring solely to my own

limitations, but also my close and continuous observation of my fellow

clinical supervisors, many of who practice quite differently than I.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

All,

 

On May 13, 2004, at 5:07 PM, rw2 wrote:

 

> However, I also suspect that it would become an unproductive

> nightmare if the TCM community at large got into the act and tried to

> administer this.

 

I am with Roger here. CHA has no interest in working with the

mainstream TCM community at large on this project. They have

demonstrated nothing but stupidity and inertia in this area, as with

research. Future CHA projects in this area will be developed within

the organization and offered to those likeminded members of the

community for their use and participation. If the community cannot

deal with this type of approach, we will go elsewhere, possibly

including NOMAA, the new organization I suspect would be very

interested in such projects. We would also approach western medical

organizations.

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

On May 14, 2004, at 9:53 AM, wrote:

 

> Phil, Z'ev, et. al.

>

> On May 13, 2004, at 1:53 AM, wrote:

>

>>

>> 2. SYNDROMES: All the main Syndromes listed in the classical

>> texts and in modern commentaries and clinical articles should be

>> included. Each essential characteristic of the Syndrome should be

>> listed. Occasional (non-essential) characteristics and variants

>> should be listed also. The listings should include S & Ss, Pulse,

>> Tongue and other diagnostically useful info, for example as in

>> Roger Wicke's (RMHI) software.

 

To me, the important thing is usability. Infomaniacs often put together

resources of vast amounts of material, it may be searchable and even

sortable, but the interface needs to be intuitive too.

 

These are not just buzzwords coined by software marketers. The database

needs to fill a need, once that need is identified, it can be

configured by default around that need.

 

For me, I need a quick way to take a chief complaint, get a list of the

possible syndromes that can cause that chief complaint and then some

differentiating signs and symptoms. Once I've decided on a syndrome,

I'll need the treatments available.

 

This is one reason I like the Maclean/Lyttleton Clinical Handbooks of

Internal Medicine. They provide exactly this sort of information in

pretty much the format that I need it as a practitioner who doesn't

have time to look up this information in ten different books.

 

So, make this database help me to save time in the clinic and I'll be

very enthusiastic.

 

As a teacher, mechanisms play an important role too. I think that it

helps me as a practitioner as well, but given a really well rounded

list of syndromes, I don't usually have to fall back on pathomechanisms

outside of the clinical teaching arena. Still, that would be a really

wise sort of related database for all these signs and symptoms that may

be listed. Just a brief note that can explain the mechanism would

really help to deepen the understanding of the big picture at play

here, beyond locating treatment protocols from within a database.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Al

 

On May 14, 2004, at 10:48 AM, Al Stone wrote:

 

> Just a brief note that can explain the mechanism would

> really help to deepen the understanding of the big picture at play

> here, beyond locating treatment protocols from within a database.

>

>

 

 

such a database is not meant to sub for training and intelligence and

knowledge of PMs. I believe your concerns actually are more magnified

by those who exhibit the weaknesses you describe when using textbooks.

While I love the Maclean book, the fact is you can't compare and

contrast the patterns for multiple chief complaints simultaneously in

ANY printed format. Hypothetically, would you feel the Maclean book

was even more useful if the entire contents were put in a boolean

database. Same data, different acces.

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

Al,

You've raised a good question here, and I have a few questions of my

own to ask the group.

 

1) What do we mean by 'chief complaint'?

 

In other words, are chief complaints what Phillipe Sionneau describes

in his " Treatment of Disease in TCM " ? For example, head heat,

headache, deviated mouth and eyes, or vexation and agitation?

 

What if the 'chief complaint' is shoulder pain? Isn't that a different

issue than if the chief complaint is rheumatoid arthritis?

 

2) What is the Chinese equivalent of 'chief complaint'?

 

3) As Todd points out in his response, most patients have multipattern

disorders. Would a database that just addresses one symptom or group

of symptoms truly be helpful to the patient?

 

4) Roger Wicke in his article on computer aided instruction in TCM

claims that most textbooks impose " rigid thinking induced by

hierarchical classes of information, and that modern TCM education does

not teach the skills to write prescriptions that treat the entire

disease pattern. How does this jive with the 'treat the chief

complaint' ideal taught at most TCM colleges?

 

Finally, a few months ago, we had a discussion comparing xing/typing

with zheng/patterns. Volker Scheid concludes in his book that many

practitioners confuse xing/type with zheng/patterns. Basically,

xing/types are simplified categories of diseases without much detail, a

tool to categorize diseases. Whereas zheng/patterns are more complex,

and include a larger constellation of symptoms and signs.

 

Are chief complaints a form of 'typing'?

 

 

 

On May 14, 2004, at 10:48 AM, Al Stone wrote:

 

> For me, I need a quick way to take a chief complaint, get a list of the

> possible syndromes that can cause that chief complaint and then some

> differentiating signs and symptoms. Once I've decided on a syndrome,

> I'll need the treatments available.

[Guest guest]

In order to produce such a database with embedded boolean logic, we

need to greatly increase the data set beyond what present-day TCM

databases include. Otherwise, the built-in limitations will make such

a format useless for sophisticated practice.

 

Anyone who wants to examine the possibilities and the lack of

development of such tools in the CM world should just take a look at

MacRepertory for homeopathy.

 

 

On May 14, 2004, at 9:32 AM, wrote:

 

> Phil

>

> that's exactly it. and I have no patience for those who detract from

> this. Using a computer database to search for " possibilities " and

> scoring their degree of fit is exactly what one does when one uses

> books. the ONLY difference is that using books to search massive

> databases is tedious, laborious and ultimately stupid. Anybody ever

> hear the expression, work smart, not hard. I would never support the

> use of any technology that diminished TCM, only those that made it even

> better. Anyone who disputes that a boolean database does just this is

> probably not familiar with using such search engines. Medline would be

> useless without such an engine.

>

 

>

> On May 13, 2004, at 1:53 AM, wrote:

>

>>

>> The answer is simple: if the system has accurate and fairly

>> complete data, the computer can pick up any pattern matches,

>> and score their degrees of fit. The benefits for novice doctors are

>> abvious. They could quickly shortlist the most probable Dxs, and

>> double-check their probabiliy by other means. Through regular use,

>> novices honed their diagnostic skills much more quickly than they

>> would have done without the software.

>>

>>

>

> Chinese Herbs

>

>

> FAX:

>

>

>

[Guest guest]

On May 14, 2004, at 11:14 AM, wrote:

 

> Al

>

> On May 14, 2004, at 10:48 AM, Al Stone wrote:

>

>> Just a brief note that can explain the mechanism would

>> really help to deepen the understanding of the big picture at play

>> here, beyond locating treatment protocols from within a database.

>>

>>

>

>

> such a database is not meant to sub for training and intelligence and

> knowledge of PMs. I believe your concerns actually are more magnified

> by those who exhibit the weaknesses you describe when using textbooks.

> While I love the Maclean book, the fact is you can't compare and

> contrast the patterns for multiple chief complaints simultaneously in

> ANY printed format.

 

Perhaps not, though sometimes focusing on one chief complaint will give

you a list of possible syndromes, then adding a second or third

complaint will give you a second or third list of possible syndromes.

Where the syndromes overlap, you've probably got a good place to start

your treatment. This could be done with some simple logic that

software could achieve. I can see the logic in my head and it isn't

that strange, I just wouldn't necessarily know how to write it in

boolean terms. This may also be something that you need to address in

your database. Buttons that add that logic for you such as " find

overlapping syndromes " for CHIEF COMPLAINT.

 

Then, perhaps a " see also... " type link where you can list the complex

syndromes that may feature two or more different chief complaints

searched.

 

> Hypothetically, would you feel the Maclean book

> was even more useful if the entire contents were put in a boolean

> database. Same data, different acces.

 

Well that is my concern, the access. Look at the flow of logic in the

Maclean text. You begin with a chief complaint and on the first first

page of that section, you get a list of excess syndromes that can cause

that complaint as well as a list of deficiency syndromes. From this

little bit of information, plus a few other cool charts if necessary,

you can get to the syndrome that is most likely causing that chief

complaint. Following the mechanisms described in the syndrome are

treatment protocols, formulas, modifications, and patent formulas.

Probably a few more things too that I'm not thinking about.

 

The point is this: they created a sort of pyramid of logic here. At

that top is the chief complaint which is where, as a clinician, I'll

always start. Next is to pick a syndrome of which there are generally

no more than eight. Then you've got the pathomechanism which is sort

of an insurance policy against making a bad syndrome differentiation,

followed by the actual treatment protocols of which you're still given

a few options. This order is consistent with my needs as a

practitioner. Take the chief complaint, determine the syndrome

involved, arrive at a treatment protocol, and then cross your fingers.

 

What I would want of a database is the ability to roughly follow that

same flow of logic by default. Certainly a database such as what

you're proposing could be bent and shaped into many other useful tools,

and that might be part of your job, to determine all the different

potential users of this database and then with a click of a button on a

welcome screen, be taken to the interface that features this particular

set of functions.

 

My big concern for you is that you don't try to do too much. One

problem that we're all aware of is the different levels of medical

terminology used by even the people on this list. I think that we

don't have to include " tummy ache " as a chief complaint, but if you

want to have a field whereby people input their search criteria, you'll

need to be ready for " gastralgia " , " abdominal pain " , " epigastric pain " ,

" stomach bi " , or " stomach ache " , all pointing to pain in the stomach's

area. That's why I'm in favor of drop-down menus that may be organized

by part of the body, or organ systems or both. This " fill in the

blanks " for searches is also problematic for those who don't spell the

same as we do such as in Australia or those from out of town who's

second or even third language is English. Drop-down menus address that

problem.

 

I think that the only weakness of the Maclean text is that they

organize chief complains by the five Zang organ systems. This is really

not that important and the only bit of logic that I don't think needs

to be imported into one's thinking. One could easily just start out

with the chief complaint of " lower back ache " and not necessarily go to

the Kidney area as there are going to a few syndromes that point to

non-Kidney issues such as damp-heat or Qi stagnation.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Here is the web site for software that I use. It's good but could always be

better. It would be nice to have software that includes different questionaires

that the patient can fill out and be entered into the software to help with the

ddx and dx.

The software is called acuvision and acuscalp.

http://www.archibel.com/vhs/English/index_en.htm

 

Brian

 

<zrosenbe wrote:

In order to produce such a database with embedded boolean logic, we

need to greatly increase the data set beyond what present-day TCM

databases include. Otherwise, the built-in limitations will make such

a format useless for sophisticated practice.

 

Anyone who wants to examine the possibilities and the lack of

development of such tools in the CM world should just take a look at

MacRepertory for homeopathy.

 

 

On May 14, 2004, at 9:32 AM, wrote:

 

> Phil

>

> that's exactly it. and I have no patience for those who detract from

> this. Using a computer database to search for " possibilities " and

> scoring their degree of fit is exactly what one does when one uses

> books. the ONLY difference is that using books to search massive

> databases is tedious, laborious and ultimately stupid. Anybody ever

> hear the expression, work smart, not hard. I would never support the

> use of any technology that diminished TCM, only those that made it even

> better. Anyone who disputes that a boolean database does just this is

> probably not familiar with using such search engines. Medline would be

> useless without such an engine.

>

 

>

> On May 13, 2004, at 1:53 AM, wrote:

>

>>

>> The answer is simple: if the system has accurate and fairly

>> complete data, the computer can pick up any pattern matches,

>> and score their degrees of fit. The benefits for novice doctors are

>> abvious. They could quickly shortlist the most probable Dxs, and

>> double-check their probabiliy by other means. Through regular use,

>> novices honed their diagnostic skills much more quickly than they

>> would have done without the software.

>>

>>

>

> Chinese Herbs

>

>

> FAX:

>

>

>

[Guest guest]

Do you have the title, etc. for the Maclean book.

Thanks

Brian

 

Al Stone <alstone wrote:

 

On May 14, 2004, at 11:14 AM, wrote:

 

> Al

>

> On May 14, 2004, at 10:48 AM, Al Stone wrote:

>

>> Just a brief note that can explain the mechanism would

>> really help to deepen the understanding of the big picture at play

>> here, beyond locating treatment protocols from within a database.

>>

>>

>

>

> such a database is not meant to sub for training and intelligence and

> knowledge of PMs. I believe your concerns actually are more magnified

> by those who exhibit the weaknesses you describe when using textbooks.

> While I love the Maclean book, the fact is you can't compare and

> contrast the patterns for multiple chief complaints simultaneously in

> ANY printed format.

 

Perhaps not, though sometimes focusing on one chief complaint will give

you a list of possible syndromes, then adding a second or third

complaint will give you a second or third list of possible syndromes.

Where the syndromes overlap, you've probably got a good place to start

your treatment. This could be done with some simple logic that

software could achieve. I can see the logic in my head and it isn't

that strange, I just wouldn't necessarily know how to write it in

boolean terms. This may also be something that you need to address in

your database. Buttons that add that logic for you such as " find

overlapping syndromes " for CHIEF COMPLAINT.

 

Then, perhaps a " see also... " type link where you can list the complex

syndromes that may feature two or more different chief complaints

searched.

 

> Hypothetically, would you feel the Maclean book

> was even more useful if the entire contents were put in a boolean

> database. Same data, different acces.

 

Well that is my concern, the access. Look at the flow of logic in the

Maclean text. You begin with a chief complaint and on the first first

page of that section, you get a list of excess syndromes that can cause

that complaint as well as a list of deficiency syndromes. From this

little bit of information, plus a few other cool charts if necessary,

you can get to the syndrome that is most likely causing that chief

complaint. Following the mechanisms described in the syndrome are

treatment protocols, formulas, modifications, and patent formulas.

Probably a few more things too that I'm not thinking about.

 

The point is this: they created a sort of pyramid of logic here. At

that top is the chief complaint which is where, as a clinician, I'll

always start. Next is to pick a syndrome of which there are generally

no more than eight. Then you've got the pathomechanism which is sort

of an insurance policy against making a bad syndrome differentiation,

followed by the actual treatment protocols of which you're still given

a few options. This order is consistent with my needs as a

practitioner. Take the chief complaint, determine the syndrome

involved, arrive at a treatment protocol, and then cross your fingers.

 

What I would want of a database is the ability to roughly follow that

same flow of logic by default. Certainly a database such as what

you're proposing could be bent and shaped into many other useful tools,

and that might be part of your job, to determine all the different

potential users of this database and then with a click of a button on a

welcome screen, be taken to the interface that features this particular

set of functions.

 

My big concern for you is that you don't try to do too much. One

problem that we're all aware of is the different levels of medical

terminology used by even the people on this list. I think that we

don't have to include " tummy ache " as a chief complaint, but if you

want to have a field whereby people input their search criteria, you'll

need to be ready for " gastralgia " , " abdominal pain " , " epigastric pain " ,

" stomach bi " , or " stomach ache " , all pointing to pain in the stomach's

area. That's why I'm in favor of drop-down menus that may be organized

by part of the body, or organ systems or both. This " fill in the

blanks " for searches is also problematic for those who don't spell the

same as we do such as in Australia or those from out of town who's

second or even third language is English. Drop-down menus address that

problem.

 

I think that the only weakness of the Maclean text is that they

organize chief complains by the five Zang organ systems. This is really

not that important and the only bit of logic that I don't think needs

to be imported into one's thinking. One could easily just start out

with the chief complaint of " lower back ache " and not necessarily go to

the Kidney area as there are going to a few syndromes that point to

non-Kidney issues such as damp-heat or Qi stagnation.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

 

 

 

Chinese Herbal Medicine offers various professional services, including board

approved continuing education classes, an annual conference and a free

discussion forum in Chinese Herbal Medicine.

 

 

 

 

 

 

[Guest guest]

One of the questions I would ask first about the English language

literature is how much of it is really high quality. For a long time,

it seemed like the profession was cranking out the same book over and

over again. Look how few advances on the Bensky materia medica have

emerged, even after twenty-plus years. Even less with the Formulas and

Strategies text. We are still talking about 'syndromes', 'tonification

and sedation' in a majority of texts.

 

Furthermore, how can we digitize materials that use a wide variety of

English terms without Chinese and/or Pinyin equivalents? It will just

be a confusing soup.

 

Finally, Bob Felt has been working with Nigel and others for several

years on a data base of several thousand Chinese medicinals. This

would clearly go beyond anything in the English language, could be tied

in directly to Chinese source databases, and have translational tools.

Therefore, a database could not only carry what is in the English

language literature, but expand the possibilities into Chinese.

 

I think students will 'bite' on the importance of medical Chinese if we

provide seamless tools that effortlessly allow them to access the

Chinese data in this way.

 

 

On May 14, 2004, at 9:53 AM, wrote:

 

> While

> Z'ev may have already absorbed everything in english and now needs to

> move on to the Chinese, I have not. And looking at what I have read

> and what still remains to be read and what will be published in the

> interim, I am hard pressed to see that I will ever exhaust the english

> language literature. Having managed or personally treated about 50-70

> patients a week for the past four years (after 7 years of about 20

> pt/week), I find the existing english data leads to superb results in

> the vast majority of cases.

[Guest guest]

On May 14, 2004, at 11:48 AM, wrote:

 

> Al,

> You've raised a good question here, and I have a few questions of

> my

> own to ask the group.

>

> 1) What do we mean by 'chief complaint'?

 

The chief complaint is what the patient will come in and ask you to

change or remove. in the ECTOM teaching clinic, this can vary widely

from the nebulous to specific. In my clinic I generally treat a

specific thing that hurts or isn't working right.

 

" Stress " is not a chief complaint, it is an etiology. Neck and shoulder

tension is a chief complaint.

 

> In other words, are chief complaints what Phillipe Sionneau describes

> in his " Treatment of Disease in TCM " ? For example, head heat,

> headache, deviated mouth and eyes, or vexation and agitation?

 

Yes, these are all chief complaints, though not likely to be

articulated as such by our patient population. Rather, my patients

will complain of fever or restlessness or anxiety. This is where the

clinician has to be flexible in terms of how to interpret the patient's

description of their symptoms and find them in a book such as the

Sionneau texts.

 

For instance, I had a patient the other day whose chief complaint was

sleep paralysis. This is a condition in which when he wakes up, he

can't move his body for up to a minute. It is, in biomedicine,

considered a disorder in the brain stem where motor signals from the

brain are prevented from entering the body so when we're dreaming,

we're not actually moving our body. However when we wake up, the

signals should again be let through. In this patient, the signals are

not immediately let through.

 

So, even though sleep paralysis is a western differentiation of sorts,

it is also a reasonably clear chief complaint. " When I wake up, I can't

move my body for a minute " . However it didn't exactly show up in either

of the Maclean texts. So, knowing from my past experience with this

patient that he has a real phlegm-damp accumulation problem, I chose to

look into dizziness and vertigo to locate a treatment principle,

formula, and point prescription that would address phlegm misting the

heart and sensory orifices. Its kind of a stretch, but I had to start

somewhere.

 

I don't know how well a database can anticipate situations such as

this. Do Todd's source texts include anything about sleep paralysis or

will we have to call this acute fatigue or something other than what it

is? This is another reason that I favor a drop-down menu to quicken

the search for answers because I don't know how this database would

label " sleep paralysis " .

 

> What if the 'chief complaint' is shoulder pain? Isn't that a different

> issue than if the chief complaint is rheumatoid arthritis?

 

Nope, RA is a diagnosis. Wouldn't you treat RA differently in the knee

than in the shoulder? Certainly a few different points, that's for

sure, but still is it migrating, heavy, fixed, aggravated by cold,

damp, heat, etc... ?

 

> 2) What is the Chinese equivalent of 'chief complaint'?

 

I dunno. TCM doesn't start out with a patient who says " something

hurts " or " I'm sick " ?

 

> 3) As Todd points out in his response, most patients have multipattern

> disorders. Would a database that just addresses one symptom or group

> of symptoms truly be helpful to the patient?

 

Perhaps not, but I'm mostly concerned about the interface, it needs to

be workable for an industry who at this time lags behind the curve in

terms of computer know-how. Perhaps Todd's MTV generation will make

better use of his plans than the FM generation.

 

> 4) Roger Wicke in his article on computer aided instruction in TCM

> claims that most textbooks impose " rigid thinking induced by

> hierarchical classes of information, and that modern TCM education does

> not teach the skills to write prescriptions that treat the entire

> disease pattern. How does this jive with the 'treat the chief

> complaint' ideal taught at most TCM colleges?

 

I'm not entirely sure, but I can say that one of the things that I

stress in my clinical supervising role at ECTOM is " Its the chief

complaint, stupid! " . I can't tell you how many times someone comes in

with knee pain and gets treated for their relationship with their third

grade teacher.

 

Practically every one of my interns sits down with me, gives me the sex

and age of the patient, followed by a litany of signs and symptoms. It

doesn't help me to get this information in this order. I need the chief

complaint, THEN, the signs and symptoms will either support or not

support a potential diagnosis and guide our treatment.

 

As for multiple chief complaints, this will fall into one of two

categories. 1) Many symptoms all belonging to one pattern. 2) Many

symptoms belonging to more than one pattern in which case, choices will

need to be made as to how much of the treatment we want to focus on the

most superficial and easiest issues to resolve or the deepest and most

dangerous issues, etc...

 

> Finally, a few months ago, we had a discussion comparing xing/typing

> with zheng/patterns. Volker Scheid concludes in his book that many

> practitioners confuse xing/type with zheng/patterns. Basically,

> xing/types are simplified categories of diseases without much detail, a

> tool to categorize diseases. Whereas zheng/patterns are more complex,

> and include a larger constellation of symptoms and signs.

>

> Are chief complaints a form of 'typing'?

 

I'm not 100% sure. I'm not sure what a " category of disease " is. Bi

syndromes is a category? Using your RA example above, I would say to

call it a " bi syndrome " would not be enough to treat it effectively,

though it certainly is an effective means to get the student intern

going in the right direction. Bi means " pain " , this doesn't help too

much. However differentiating the pathogenic factor or functional

disharmony will take us to a more specific pattern where we can

actually treat the branch as well as the root.

 

-al.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

What might be more exciting and useful would be if one could type in (input)

your

own cases and treatment with diagnosis. I could imagine that after a time one

would

get very aware of one's own tendencies and biases and be able to compare to them

to

the exsisting " correct " database. Finally, these " individual " databases could be

traded

with others to create a " practical/clinical' database with successes and

failures.

Alon?

doug

 

> Finally, Bob Felt has been working with Nigel and others for several

> years on a data base of several thousand Chinese medicinals. This

> would clearly go beyond anything in the English language, could be tied

> in directly to Chinese source databases, and have translational tools.

> Therefore, a database could not only carry what is in the English

> language literature, but expand the possibilities into Chinese.

>

> I think students will 'bite' on the importance of medical Chinese if we

> provide seamless tools that effortlessly allow them to access the

> Chinese data in this way.

>

>

> On May 14, 2004, at 9:53 AM, wrote:

>

> > While

> > Z'ev may have already absorbed everything in english and now needs to

> > move on to the Chinese, I have not. And looking at what I have read

> > and what still remains to be read and what will be published in the

> > interim, I am hard pressed to see that I will ever exhaust the english

> > language literature. Having managed or personally treated about 50-70

> > patients a week for the past four years (after 7 years of about 20

> > pt/week), I find the existing english data leads to superb results in

> > the vast majority of cases.

[Guest guest]

" correct " database. Finally, these " individual " databases could be traded

with others to create a " practical/clinical' database with successes and

failures.

Alon?

>>>>Doug if you are asking for my opinion I think its a no brainier. Such data

bases are extremely useful and should not be viewed as cookbook instructions.

After all, what else does one have to go on when making any decision. An

electronic database just makes it easier to excess the available information

alon

 

 

[Guest guest]

, " Alon Marcus " <alonmarcus@w...>

wrote:

Such data bases are extremely useful and should not be viewed as cookbook

instructions.

After all, what else does one have to go on when making any decision. An

electronic

database just makes it easier to excess the available information

 

 

For those who do not believe this is the way to go, I can see

you in my rear view mirror. Its already happening. Its just one more thing we

can either

do right or see someone else do it and coopt the profession in its wake. I have

made my

case. for anyone who cannot see that searching a database is the EXACT same

thing as

plodding through books looking for entries that correlate to certain keywords, I

guess you

never will.

 

When I open a book, I am looking for the diseases, patterns and symptoms that

make up

my working dx. Perhaps others don't do it that way and thus the database idea

makes no

sense. In a laborious process, I finally end up with a number of options.

Granted, this has

become much easier for those complaints I see regularly and for which no

references are

necessary. But it was my novice method and still applies in complex cases. It

is also the

method I teach my students at PCOM - a method that was decided in a joint

process

involving all the herb teachers at all 3 of our campuses over a 9 month period

involving

about 150 emails.

 

Once I have narrowed the field, I can then explore the 5-10 options more deeply,

including pathomechanisms and obscure confirming sx. From this, I craft my

formula. In

the most extreme scenario, this could take up to 45 minutes or more for a

student and

require the use of a dozen books spread out all around you. Since the

information was

found using keywords like patterns and sx, what conceivable difference would it

make if

one accessed the same " possibilities " using a single keyword search and then

displaying a

summary of all the results on one screen. It would make one difference and one

alone. It

would cut that 45 minutes down to around 10. for me, it cuts a 10-15 minute

process to

5 minutes or less.

 

While one can certainly use a computer as a cookbook, I believe this even more

likely with

printed texts due the search limitations in that media. time is of the essence

for busy px

and many students tell me that it is very much this factor that prevents them

from doing

tailored prescribing.

 

[Guest guest]

I agree 100%.

 

Now, how do we go about deciding what info to include in such a

database as the best reference materials?

 

What is agreed upon by committee in modern TCM?

 

A particular author?

 

The major difficulty I foresee is determining what to include and what

not to. Ideally, a objective and unbiased approach may sound best.

However, this could lead to a overload of data for any search with

minor, but potentially important differences in opinion depending on

reference sources.

 

It would also probably necessitate a huge inbuilt glossary and synonym

directory to enable practitioners from varying educational backgrounds

to use the database with their learnt terminologies. To my knowledge no

complete listing of synonym's exists.

 

Of course we will never get anywhere unless we start, but the more I

think about the intricacies of such a project............the more

intimidating such a undertaking begins to become in my mind.

 

Best Wishes,

 

Steve

 

On 16 May 2004, at 2:10 AM, wrote:

 

> , " Alon Marcus "

> <alonmarcus@w...> wrote:

> Such data bases are extremely useful and should not be viewed as

> cookbook instructions.

> After all, what else does one have to go on when making any decision.

> An electronic

> database just makes it easier to excess the available information

>

>

> For those who do not believe this is the way to go, I can see

> you in my rear view mirror. Its already happening. Its just one more

> thing we can either

> do right or see someone else do it and coopt the profession in its

> wake. I have made my

> case. for anyone who cannot see that searching a database is the

> EXACT same thing as

> plodding through books looking for entries that correlate to certain

> keywords, I guess you

> never will.

>

> When I open a book, I am looking for the diseases, patterns and

> symptoms that make up

> my working dx. Perhaps others don't do it that way and thus the

> database idea makes no

> sense. In a laborious process, I finally end up with a number of

> options. Granted, this has

> become much easier for those complaints I see regularly and for which

> no references are

> necessary. But it was my novice method and still applies in complex

> cases. It is also the

> method I teach my students at PCOM - a method that was decided in a

> joint process

> involving all the herb teachers at all 3 of our campuses over a 9

> month period involving

> about 150 emails.

>

> Once I have narrowed the field, I can then explore the 5-10 options

> more deeply,

> including pathomechanisms and obscure confirming sx. From this, I

> craft my formula. In

> the most extreme scenario, this could take up to 45 minutes or more

> for a student and

> require the use of a dozen books spread out all around you. Since the

> information was

> found using keywords like patterns and sx, what conceivable difference

> would it make if

> one accessed the same " possibilities " using a single keyword search

> and then displaying a

> summary of all the results on one screen. It would make one

> difference and one alone. It

> would cut that 45 minutes down to around 10. for me, it cuts a 10-15

> minute process to

> 5 minutes or less.

>

> While one can certainly use a computer as a cookbook, I believe this

> even more likely with

> printed texts due the search limitations in that media. time is of

> the essence for busy px

> and many students tell me that it is very much this factor that

> prevents them from doing

> tailored prescribing.

>

 

>

>

>

>

[Guest guest]

Clinical Handbook of Internal Medicine - The Treatment of Disease with

Traditional

 

Volume 1 is the Lung, Kidney, Liver and Heart. ISBN: 1-875760-93-8

 

Volume 2 is the Spleen and Stomach. ISBN: 0-9579720-0-8

 

There is a Volume 3 in the works, but I have no idea when to expect it

in print.

 

 

-al.

 

On May 14, 2004, at 12:19 PM, Brian Hardy wrote:

 

> Do you have the title, etc. for the Maclean book.

> Thanks

> Brian

 

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

On May 15, 2004, at 9:21 AM, Steven Slater wrote:

 

> The major difficulty I foresee is determining what to include [in a

> TCM database] and what

> not to. Ideally, a objective and unbiased approach may sound best.

> However, this could lead to a overload of data for any search with

> minor, but potentially important differences in opinion depending on

> reference sources.

 

I share your concern, but perhaps for a different reason.

 

Adding too many sources of information to a database will render it

unusable when we take a problem such as Shao Yang headache and locate,

according to ALL the books, about a million different points to treat

this. Perhaps if the reason for the points usage were included, it

could help to guide the practitioner, but more information is not

necessarily more useful and often times actually less usable.

 

I'm reminded of one of four herb courses I took in school. This one

quarter, the class was taught by someone who was good at collecting

data from a wide variety of sources, but lousy at prioritizing them.

So, for each herb, we had 20 friggin' functions to wade through

according to Bensky, Heung, Bong Dal Kim, Darmananda, etc, etc, etc.

As a student, this was a huge waste of my time. As a practitioner this

might be interesting, but not very practical unless the information can

be somehow qualified so that I can cut the fat from the meat.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

, Al Stone <alstone@b...> wrote:

 

>

> Adding too many sources of information to a database will render it

> unusable when we take a problem such as Shao Yang headache and locate,

> according to ALL the books, about a million different points to treat

> this. Perhaps if the reason for the points usage were included, it

> could help to guide the practitioner, but more information is not

> necessarily more useful and often times actually less usable.

 

I think you eliminate this problem by doing a relevancy based search such as

Phil

described. You take any number of texts, say 100, and score the relevancy of a

symptom

based upon how many texts it appears in. This means that only symptoms that

have

general consensus will come up in the top ten responses or so. Obsure symptoms

would

be ranked at 1% confidence. The program could be easily set to only list hits

that had

above a certain confidence level. But it would also allow those so inclined to

search

outside mainstream consensus. I think consensus between multiple sources, all

of high

caliber, would surely trump the content of any single work.

[Guest guest]

On May 14, 2004, at 1:16 PM, Al Stone wrote:

 

>

>

> I don't know how well a database can anticipate situations such as

> this. Do Todd's source texts include anything about sleep paralysis or

> will we have to call this acute fatigue or something other than what

> it

> is?  This is another reason that I favor a drop-down menu to quicken

> the search for answers because I don't know how this database would

> label " sleep paralysis " .

 

 

One always has to be able to reframe a condition in order to access it

in the TCM literature. A database could include information on

reframing. I have extensive lists cross referencing western and TCM

diseases that was translated from chinese sources by Bob Damone. But I

still don't really understand the concern. If you can't find it in a

book, how are you worse off if you also can't find it in a database?

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

Rather than debate at length the merits of whose data and how many tons of it to

include in a database, I'd be interested in the following question:

 

For those of you who have been practicing as an herbalist for many years, or

have been teaching for many years: What are the most common reasons that you

feel your clinical results (or those of your students) have fallen short of what

you believe should be possible?

 

The answers to that question will lead directly to how much of what type of data

is needed.

 

For example, the most revealing experiences are those in which an initial

oversight or error was made, leading to either side effects or disappointing

results. In such cases, what was done, either by you or another practitioner,

that eventually made the difference, and what type of information or correction

was involved in this action? Then, how could this type of information be

integrated into a database?

 

C.S. Cheung, M.D., has been a teacher and colleague of mine for many years, and

the most valuable information from Chinese sources he has translated is of the

following format:

A case study appears in some Chinese journal in which the initial

herbalist makes a mistake, albeit a reasonable one that seems to follow

established guidelines. The complexity of the case is such that a panel of

experts is called in to debate the matter. Each herbalist proposes an analysis

of the symptom pattern, a summary of his or her assessment, followed by a

recommended herbal strategy. The head of the committee then decides on a course

of action, and the results are reported. (Though I do not advocate such

committees for the writing of software or piano concertos, they are great for

brain-storming difficult clinical cases.)

 

For those of you unfamiliar with Dr. Cheung's work:

 

http://www.rmhiherbal.org/hscc/index.html

 

The inclusion of cases studies in much of his work, especially the more recent

material, makes his translations considerably more meaningful than abstract

theories and speculations. These types of cases are worth their weight in gold.

For those of you who do translating, if someone compiled a book of several

hundred of such cases, I'd recommend or require it for each of my students. I've

carefully analyzed several hundreds of such cases from Chinese hospitals, and

the conclusions I drew from these were surprising to me. As a result, I changed

even more radically the way I taught:

 

* I decided that students were wasting their time studying too many

herbs and formulas.

 

* 90 or so herbs is quite enough for beginners. Even experts use these

90 herbs as 85-95% of all the ingredients in their formulas. Knowing 50 formulas

inside-out is far better than a dilettantish knowledge of 300.

 

* Students were not spending nearly enough time **playing** with

symptom-pattern analysis. Not just memorizing, but playing with them in their

minds, doing what-if types of games. Instead of spending hours searching for

just the right herbs, I recommended they spend hours analyzing the symptoms of a

clinical case and their possible significance, which is much like assessing the

positions of chess pieces on a board and the potential moves available. (Our

current CD-ROM software includes extensive sets of such games, in addition to

Boolean-searchable databases.)

 

Combining these Chinese cases with my own observations in America reinforced my

opinion that Americans do not suffer from a deficiency of 1000's of Chinese

herbs, but instead suffer because their practitioners do not educate them in the

toxicity of a typical American diet and what to do about it. That is the number

#2 reason for lack of results, after incorrect syndrome-pattern assessment. I

now include in my course material a checklist of 40 distinct sources of general

toxicity in people's diet, as well as how to do individually tailored diet

recommendations; microwaves, Aspartame, and genetically engineered foods are not

discussed in traditional Chinese diet texts. Also, I include information on how

to do a complete top-to-bottom home visit in which every room of the house is

inspected for chemical, biological, and electromagnetic pollution, with special

attention to kitchen, bath, and garage. I am continually amazed to discover how

many people's homes are toxic waste disasters that are chronically eating away

at their health, and there are often simple ways to alleviate or reduce many of

these problems. While these home inspections may be more time-consuming that

ordinary office visits, in many cases they pay off greatly for the client.

 

 

 

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

, Al Stone <alstone@b...> wrote:

 

>

> What I would want of a database is the ability to roughly follow that

> same flow of logic [as in Maclean/Lyttleton] by default.

 

I think this would be the simplest form to create, but not much more functional

than the

text itself. A database becomes most useful when:

 

1. it can search for relevancy by comparison of many texts simultaneously

 

2. it can search for the overlapping syndromes in those with numerous so-called

chief

complaints and multiple patterns underlying.