TCM software

[Guest guest]

In response to Todd and Brian re questions about RMHI's TCM Herbal Tutor,

instructional design, and expert systems:

 

In a nutshell:

 

* We are currently working on the next version of the Herbal Tutor

databases and self-testing software, and it will incorporate important

information from the latest materia medica published by Bensky (Chinese

Materia Medica), Chen and Chen (Chinese Medical Herbology and

Pharmacology), and Zhu (Chinese Materia Medica: Chemistry, Pharmacology and

Applications). Both Bensky and Chen supplement each other, I'm glad I have

both on hand; as far as print textbooks, I recommend serious herbal

students obtain both.

 

* The Herbal Tutor will allow each user to choose which language or

combination of languages he or she is tested in (syndrome names, herb

names, formulas): Chinese characters, PinYin, common English, Wisemanese,

Latin pharmaceutical.

 

* Our current version of Herbal Tutor actually uses a minimal expert

systems algorithm to decide how many points to reward the user based on how

clever they are in figuring out the patterns being generated. As Todd

points out in his article, below, one of the most important features of the

software is its random generation of an almost infinite number of clinical

pattern simulations. The software rewards users according to two criteria:

(1) determining the correct answer as soon as an optimal number of clues

are given, just enough to differentially eliminate close possibilities

(i.e., distinguishing Spleen-Damp-Heat from Liver-GB-DampHeat,

Spleen-Dampness, or Damp Heat of Triple Burner); (2) how quickly they

conclude the right answer.

 

* We are currently working on an expert-systems program that will

incorporate a similar algorithm to do automated assessment of complex cases

with multiple syndromes. (Cookbook methods using if-then type logic do not

work very well for assessing such cases. If you have used the Herbal Tutor

syndromes games for any length of time, this should become obvious.)

 

 

----------------------

 

Some comments:

 

MATERIA MEDICA UPDATES:

In a previous posting, Todd pointed out that any database can only be as

good as the basic data that is included. For many years I've noted that

many toxic and dangerous herbs have been included in published English

materia medicas (Strychni, S [ma~ qian/ zi~]; Momordicae, S [mu\ bie- zi~];

Bufonis, Venenum [chan/ su-]; Realgar [xiong/ huang/]; Cinnabaris [zhu-

sha-]; etc.) with what I've considered barely adequate information, such as

acute and chronic toxicology data, preparation methods, contraindications,

and a historical perspective on toxicity; for example, while arsenic

compounds might have understandably have been used for syphilis, we now

have much better alternatives. Likewise, there is no excuse for using

Cinnabaris in formulas for insomnia associated with Deficiency of Yin

(i.e., Tian- Wang/ Bu~ Xin- Dan-). Until now I've advised my own students

to avoid Chinese herbs with skimpy entries consisting of a few brief TCM

functions and dosages but no toxicology information, unless they know that

the herb is either edible or otherwise in common use and safe.

Since late last year we've been steadily updating and expanding our

materia medica database to include toxicology information, phytochemistry,

pharmacology, and antimicrobial data, as well as clarifications and updates

in TCM indications. I now feel that the available English literature

finally fills in many previous gaps in information.

Here is one illustration of the type of information I've found useful:

Recently I had a client who suffered from chronic Spleen Qi Deficiency with

a bit of Spleen Dampness, especially triggered by eating wheat products. He

had most of the classic symptoms of these patterns, except that he would

have periodic outbreaks of extreme watery diarrhea, no fever or excessively

foul smell, with generally weak pulses except for slippery and full in

R-guan and tight-bowstring in L-chi. The usual formulas for tonifying

Spleen and transforming Dampness did not work (herbs like bai zhu, hou po,

fu ling, huo xiang). As this person had done a lot of backpacking and

foreign travel, I suspected something like giardia or amoebas, which can

periodically recur like this, but bai tou weng and qing hao added to the

formula did not work. So I tried doing a search of our latest database (in

progress) for antiamoebic herbs that would be compatible with the patterns

and came up with Rx Dichroae (chang shan) and Fr Bruceae (ya dan zi). I

decided to try using Rx Dichroae first, as it seemed less toxic alternative

from the description of side effects. 36 hours after starting to take the

herb, in addition to previous formula, the watery stools completely

normalized.

Although pattern matching (bian-zheng) will always remain my starting

point for analysis, I believe that the antimicrobial information can often

provide useful fine-tuning. I've had many instances where this data

provided the final tweaking that produced clear results. Parasitic and

microbial infections can underly a wide range of TCM syndromes, not just

Excess-Heat patterns.

 

 

INSTRUCTIONAL DESIGN:

Todd's article has some interesting points that may defy " conventional "

wisdom. One is the observation that video games may actually be responsible

for an increase in intelligence levels over the past few decades, in spite

of a general deterioration ( " dumbing-down " ) in public education. Since

almost 20 years ago, I've read studies that suggested that interactive

learning is far more effective that passive learning. Passive learning

includes: watching TV shows, viewing videotapes, and listening to college

lectures; all are essentially passive, requiring the student to sit still

while someone else entertains them or pretends to educate. Interactive

learning includes: Socratic-style dialogue (question-and-answer,

dialectical discourse, which requires students to think and respond to the

instructor's ideas), video games, problem-based learning (PBL). Much of the

variability in results regarding interactive and computer-based learning I

suspect is due to the wide range in quality of the software. One will

likely not obtain the potential benefits of PBL simply by using any old

computer software. The very worst of this software simply transfers boring

and unimaginative multiple-choice style questions from paper to computer

screens. This is not what PBL is about. Just as Socratic-style dialogue

requires an instructor who has mastered his subject or profession and can

think on his or her feet, PBL requires software designers who have mastered

a subject and who understand its inner logic.

There is a bias against computer-aided instruction among many TCM

educators, and I agree with Todd's comment that this bias historically

originates from the mid-19th century when America adopted the German model

(Wilhelm Wundt) of education that was designed to create a caste society.

95% of the population were to be educated using rote memorization, drill,

and reinforcement to obey orders without question; these folks would become

the factory workers, cannon fodder for future wars, and gullible victims of

demagogue politicians. 4% of the population were trained to become

competent administrators, narrowly competent within their professional

scope, but just as helpless as the 95% outside their specialization. Only

1% of the population were intended to be trained to think broadly, on an

interdisciplinary scope, so that they would be competent at guiding the

society as a whole; these are the scientific and adminstrative elite

described by Zbigniew Brzezinski in his book " The Technotronic Era " . The

legacy of this type of education has been a century of world wars,

conflicts of historic proportion, and a population that has become

dangerously apathetic, naive, and helpless in the face of adversity.

 

 

EXPERT SYSTEMS:

There is an undercurrent of fear in many professions that people will

eventually be replaced by computers in many areas. That is certainly true

for any type of task that is repetitive, invariant, and subject to being

described by mathematical or logical relationships. The tragedy of typical

TCM education is that students are being trained to do those very things

that computers do better:

* memorize by rote long lists of data before one ever experiences their

uses in a clinical and practical context (searcbable databases will replace

this activity)

* follow cookbookish routines for choosing herbal formulas

* translating Chinese literature

 

All three of these activities are already being performed by computer

software, with decreasing amounts of human interaction required.

 

At the same time, many students are not receiving training in higher level

skills at which people are better. The one area that remains most

challenging for computers is complex, context-dependent pattern recognition

- the same type of skills that a ground-based robot requires to navigate a

rocky hillside. Real people will remain dominant at these types of skills

for some time - but only if they exert the required effort at learning

these skills; extensive internships, apprenticeships, OR problem-based

learning are the only ways to really learn these well. As Todd points out,

computer simulation software allows one to experience simulated clinical

situations (i.e., Ying- and Xue-stage Heat, Pericardium-stage Phlegm-Fire,

Collapse of Yang, etc.) that might otherwise take many years of internship

to encounter. This is why airline pilots train for many hundreds of hours

in simulators before being allowed to practice on a real airplane - better

to practice navigating a thunderstorm or engine failure on a simulator many

times before flying a real plane and risking a crash.

 

In the Herbal Tutor software, we've put a great deal of thought and design

into the self-testing games, especially the games that test TCM

symptom-pattern-recognition skills ( " diagnosis " ). Since the software has

come out, its most enthusiastic users, with few exceptions, have been

physicians. And it's definitely **not** because we've toned down the TCM

stuff to make it more " respectable " to medical people; I use terms like

Ascending Yang, Heat Evils, etc., without hemming and hawing. I suspect the

real reason for this is that during the last decade, many physicians have

already been exposed to PBL-style learning environments, either at medical

school or in continuing education courses. Many TCM educators are still

stuck in the 19th century, when German bureaucrats and socialist

intellectuals infiltrated both the Chinese and American educational

systems.

 

 

Roger

 

---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

 

 

 

> " " <

>IDT article

>

>I have a new full length article on Instructional Design and Technology in

>TCM available at

>http://.org/articles/idt_tcm.shtml

>

>Todd

 

 

>Brian Hardy <mischievous00

>Re: Re: Acupuncture and TCM software

>

>Todd:

>

>What is the expert version of HT that you are referring to that Roger is

>working on.

>

>Thanks

>Brian

>

> < wrote:

>It is the use of wizards that make for the best electronic Performance

>support Systems. An

>example is turbotax or HRblock's online program. I believe Roger is

>currently working on an

>expert systems version of HT, so don't drop your money elsewhere too

>quick. Perhaps he can

>comment. The best EPSSs have as close to day one usability as possible.

>Acuexpert

>embraces this idea; if they pull it off, fantastic.

>

>Todd

 

 

 

---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]

, rw2@r... wrote:

 

> INSTRUCTIONAL DESIGN:

> Todd's article has some interesting points that may

defy " conventional "

> wisdom. One is the observation that video games may actually be

responsible

> for an increase in intelligence levels over the past few decades, in

spite

> of a general deterioration ( " dumbing-down " ) in public education. Since

> almost 20 years ago, I've read studies that suggested that interactive

> learning is far more effective that passive learning.

 

 

Again with the caveat of garbage in, garbage out. Simulations are

widely used in WM for case managment training and they have become

quite sophisticated. And don't be seduced by the multimedia facade of

many popular video games. Some strategy games like starcraft have

thousands of pages of hyperlinked text and archived searchable messages

that players access during and between games to aid decision making

plus interactive audiovisual tutorials when appropriate. The games are

played in multiplayer online environments. So while the nature of the

tasks seems somewhat insane, the elements are exactly what are evolving

in online education all over the world. Authentic problem solving

simulations in collaborative environments with access to vast amounts

of stored knowledge in various forms. While something like Starcraft is

clearly surreal, others like the Sims are supposedly quite realistic,

engrossing and apparently quite wholesome if you want them that way. I

don't indulge in this stuff myself for entertainment yet, but the

possibilities that this medium has created for creating authentic PBL

environments are clear and significant.