Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 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. > >------ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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: > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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: > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 " 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 , " 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 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. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 , 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 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: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2004 Report Share Posted May 15, 2004 , 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. Quote Link to comment Share on other sites More sharing options...
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