expert systems and medical licensing

[Guest guest]

Here is a sampling of various expert medical systems out there.

http://www.computer.privateweb.at/judith/name_3.htm#gldr_name

 

the one called 5 GL doctor seems quite interesting. it is available

for free download at http://home.pacific.net.au/~med5gl/sftdocdl.htm

 

Expert systems allow one to narrow diagnosis options by inputting all

the case information into a boolean search engine that allows ors,

ands, nots, parentheses, etc. In TCM, the closest we get for herbology

are Acuvision and Roger Wicke's Herbal Tutor. In western med, things

are a lot further along. good programs can already outdiagnose 80-90%

of interns and residents. It is possible to envision a future where

routine western medicine (not surgery or gene therapy yet), is carried

out mainly by technicians using machines for diagnosis and computers to

actually decide the final diagnosis (if the computer beats the

residents 90% of the time, why take your chances). If this day comes,

a patient could hop in a scanner at the mall and essentially self treat

most complaints better than actually seeing 90% of residents.

 

Whether a computerized TCM diagnostic process can ever progress to a

reliable determination of complex patterns and spit out a matching rx

remains to be seen. But the narrowing of options already possible with

programs like the Herbal Tutor. It already allows you to identify

novel uses of formulas by matching functions and patterns and

indications of fomulas to previously unconsidered uses. This is

similar to the method suggested by Craig Mitchell in adapting shanghan

rx to modern practice at the CHA conference. If one understands the

pathomechanisms addressed by an SHL (or wen bing) formula, then one can

use it in a complaint of a different etiology. At the same time, Craig

bemoaned the fact that he could not recall more from rote memory and

thus his use of such applications was not as regular as it otherwise

might be.

 

Every named pattern in the wen bing xue and the shang han lun have

distinct pathomechanisms associated with them. Taiyang cold damage,

taiyang windstrike, heat in the blood level, etc. If one knows which

patterns goes with which pathomechanism, one can use herbal tutor to

search for the pattern name. However sometimes entering the symptom

complex will lead to a unexpected wen bing formula appearing high in

the search list. At which point, you may consider another

pathomechanism previously glossed over. Certainly this is more of an

issue with less experienced px and students. But SHL formulas are

often used to great effect in very precise situations and thus may be

overlooked by those predominantly trained to think about chronic

illness in zang fu terms alone (consider Mitchell's presentation of

dysmenorrhea being treated with ma huang tang. Something one might

also stumble across using the Herbal Tutor if your search was well

configured.

 

Let's assume merely treating conventionally for dysmenorrhea did not

work, so one needs to think outside the box a little. Consider how to

handle a case of pain in the lower jiao, perhaps due to cold in the

taiyang bladder channel; onset was acute many years ago, patient has

general bodyaches, shortness of breath, sneezing, heaviness in the

lower jiao, tight pulse. It seems like some kind of qi and yang

vacuity with internal cold damp at first glance, perhaps with liver qi

depression as either a result or cause (somethingis impairing menses so

the liver is affected). Now in order to consider ma huang tang, you

would have to have read the SHL and thus be aware that there is no

limit in the source text as to how long cold in the taiyang pattern

might linger and even a suggestion it could be indefinite. Mitchell's

case is from a classic SHL case text, BTW. Not just some fanciful

thinking on his part.

 

Entering the variables listed above in the context of searching for a

general fit and being open to such a patient having a longstanding

exterior condition did result in a high search ranking for ma huang

tang. However another formula that addresses taiyang level disorders

ranked even higher. Based upon one school of thought and evidenced in

CS Cheung's writings in the journal of ACTCM, other formulas since the

SHL can still be said to address the pathomechanism of windcold in the

taiyang. One example oftenused to treat this occurrence with

concurrent dampness is jiu wei qiang huo tang. While clearly an

exterior releasing formula, so is xiao chai hu tang. However, Qiang

huo actually lifts sinking spleen qi and dispels wind from the entire

bladder channel. While primarily used for the upper body, this is not

the limit of its effects. Fang feng also moves qi in the lower jiao

and courses the liver. Cang zhu and bai zhu are used for lower jiao

pain. In fact a famous ma huang tang variation with either cang zhu or

bai zhu is used today for chronic low back pain. Xi xin, while

currently banned, is used for lower jiao pain, as in du huo ji sheng

wan. Chuan xiong is a prime example of an herbs used to powerfully

disperse stagnation and pain due to cold, qi and blood in all jiaos.

Bai zhi is of course indicated for cold damp in the lower jiao. Huang

qin might clear heat that has accumulated with longterm cold and damp

stagnation. Sheng di protects the yin from the damage this longterm

pathogen may have caused by partial transformation to heat. It would

really be a simple matter to modify such a formula for the above case.

But it would not normally occur to me.

 

Ingredients, Dosages (qian/2-days):

Notopterygii, Rz et Rx [qiang- huo/]................................

1.5 qian

Ledebouriellae, Rx (= Sileris, Rx) [fang/ feng-]............ 1.5 qian

Atractylodis, Rz [cang-

zhu/]............................................ 1.5 qian

Asari, Hb cum Radice [xi\

xin-]........................................ 0.5 qian

Ligustici Wallichi, Rx [chuan- xiong-]...............................

1 qian

Angelicae, Rx [bai/

zhi~]...................................................... 1 qian

Scutellariae, Rx [huang/

qin/]............................................. 1 qian

Rehmanniae Glutinosae (dried), Rx [sheng- di\ huang/]..... 1 qian

Glycyrrhizae, Rx [gan-

cao~]............................................... 1 qian

 

 

 

 

 

Chinese Herbs

 

 

 

 

 

 

[Guest guest]

Todd:

 

Do you any information and/or names of the programs that are used by WM for

diagnosis

Thanks

Brian

 

< wrote:

Here is a sampling of various expert medical systems out there.

http://www.computer.privateweb.at/judith/name_3.htm#gldr_name

 

the one called 5 GL doctor seems quite interesting. it is available

for free download at http://home.pacific.net.au/~med5gl/sftdocdl.htm

 

Expert systems allow one to narrow diagnosis options by inputting all

the case information into a boolean search engine that allows ors,

ands, nots, parentheses, etc. In TCM, the closest we get for herbology

are Acuvision and Roger Wicke's Herbal Tutor. In western med, things

are a lot further along. good programs can already outdiagnose 80-90%

of interns and residents. It is possible to envision a future where

routine western medicine (not surgery or gene therapy yet), is carried

out mainly by technicians using machines for diagnosis and computers to

actually decide the final diagnosis (if the computer beats the

residents 90% of the time, why take your chances). If this day comes,

a patient could hop in a scanner at the mall and essentially self treat

most complaints better than actually seeing 90% of residents.

 

Whether a computerized TCM diagnostic process can ever progress to a

reliable determination of complex patterns and spit out a matching rx

remains to be seen. But the narrowing of options already possible with

programs like the Herbal Tutor. It already allows you to identify

novel uses of formulas by matching functions and patterns and

indications of fomulas to previously unconsidered uses. This is

similar to the method suggested by Craig Mitchell in adapting shanghan

rx to modern practice at the CHA conference. If one understands the

pathomechanisms addressed by an SHL (or wen bing) formula, then one can

use it in a complaint of a different etiology. At the same time, Craig

bemoaned the fact that he could not recall more from rote memory and

thus his use of such applications was not as regular as it otherwise

might be.

 

Every named pattern in the wen bing xue and the shang han lun have

distinct pathomechanisms associated with them. Taiyang cold damage,

taiyang windstrike, heat in the blood level, etc. If one knows which

patterns goes with which pathomechanism, one can use herbal tutor to

search for the pattern name. However sometimes entering the symptom

complex will lead to a unexpected wen bing formula appearing high in

the search list. At which point, you may consider another

pathomechanism previously glossed over. Certainly this is more of an

issue with less experienced px and students. But SHL formulas are

often used to great effect in very precise situations and thus may be

overlooked by those predominantly trained to think about chronic

illness in zang fu terms alone (consider Mitchell's presentation of

dysmenorrhea being treated with ma huang tang. Something one might

also stumble across using the Herbal Tutor if your search was well

configured.

 

Let's assume merely treating conventionally for dysmenorrhea did not

work, so one needs to think outside the box a little. Consider how to

handle a case of pain in the lower jiao, perhaps due to cold in the

taiyang bladder channel; onset was acute many years ago, patient has

general bodyaches, shortness of breath, sneezing, heaviness in the

lower jiao, tight pulse. It seems like some kind of qi and yang

vacuity with internal cold damp at first glance, perhaps with liver qi

depression as either a result or cause (somethingis impairing menses so

the liver is affected). Now in order to consider ma huang tang, you

would have to have read the SHL and thus be aware that there is no

limit in the source text as to how long cold in the taiyang pattern

might linger and even a suggestion it could be indefinite. Mitchell's

case is from a classic SHL case text, BTW. Not just some fanciful

thinking on his part.

 

Entering the variables listed above in the context of searching for a

general fit and being open to such a patient having a longstanding

exterior condition did result in a high search ranking for ma huang

tang. However another formula that addresses taiyang level disorders

ranked even higher. Based upon one school of thought and evidenced in

CS Cheung's writings in the journal of ACTCM, other formulas since the

SHL can still be said to address the pathomechanism of windcold in the

taiyang. One example oftenused to treat this occurrence with

concurrent dampness is jiu wei qiang huo tang. While clearly an

exterior releasing formula, so is xiao chai hu tang. However, Qiang

huo actually lifts sinking spleen qi and dispels wind from the entire

bladder channel. While primarily used for the upper body, this is not

the limit of its effects. Fang feng also moves qi in the lower jiao

and courses the liver. Cang zhu and bai zhu are used for lower jiao

pain. In fact a famous ma huang tang variation with either cang zhu or

bai zhu is used today for chronic low back pain. Xi xin, while

currently banned, is used for lower jiao pain, as in du huo ji sheng

wan. Chuan xiong is a prime example of an herbs used to powerfully

disperse stagnation and pain due to cold, qi and blood in all jiaos.

Bai zhi is of course indicated for cold damp in the lower jiao. Huang

qin might clear heat that has accumulated with longterm cold and damp

stagnation. Sheng di protects the yin from the damage this longterm

pathogen may have caused by partial transformation to heat. It would

really be a simple matter to modify such a formula for the above case.

But it would not normally occur to me.

 

Ingredients, Dosages (qian/2-days):

Notopterygii, Rz et Rx [qiang- huo/]................................

1.5 qian

Ledebouriellae, Rx (= Sileris, Rx) [fang/ feng-]............ 1.5 qian

Atractylodis, Rz [cang-

zhu/]............................................ 1.5 qian

Asari, Hb cum Radice [xi\

xin-]........................................ 0.5 qian

Ligustici Wallichi, Rx [chuan- xiong-]...............................

1 qian

Angelicae, Rx [bai/

zhi~]...................................................... 1 qian

Scutellariae, Rx [huang/

qin/]............................................. 1 qian

Rehmanniae Glutinosae (dried), Rx [sheng- di\ huang/]..... 1 qian

Glycyrrhizae, Rx [gan-

cao~]............................................... 1 qian

 

 

 

 

 

Chinese Herbs

 

 

 

 

 

 

 

 

 

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.