The Role of Information Technology in fostering TCM in the West

 Phil Rogers MRCVS, Dublin, Ireland <philrogers@eircom.net>

 4th International TCM Conference 2004,

Manchester, June 11-13, 2004

ABSTRACT

Go to http://homepage.eircom.net/~progers/IT_in_TCM.htm to read this abstract, and the full-text online. That is more useful, because, that way, you can play with the links, and visit the sites discussed in the text.

Communications, information technology (IT) & areas of professional interest (review articles, clinical papers, research findings, etc) are changing fast. We need continuing professional development (CPD) to keep our expertise up-to-date. Ongoing CPD can be formal, informal, or both. Computer-aided learning is available. Intelligent use of modern IT gives the best prospects for rapid communication between professionals interested in all aspects of Vet Med, & Complementary / Alternative Med (CAVM) - acupuncture (AP), traditional Chinese medicine (TCM), herbal med & homeopathy, etc. 

IT also is the best way to influence sceptical & uncommitted scientific & academic professionals to take our clinical & research findings seriously. 

An earlier paper (3) discussed practical uses of modern IT as aids to research, study & clinical practice in TCM & AP in five areas of IT. Because many important topics discussed there must be omitted here, readers are referred to that paper for background information.

This paper will discuss the role of WWW, professional email discussion groups, Medline and other digital databases, distance-learning, etc. in fostering TCM and improving the expertise and knowledge-base of its students and practitioners, especially:

The paper is structured, as follows:

Summary | Introduction | New Meta Engines | Holistic & General Vet Links | Other Online Databases | Web advances in holistic & conventional data | AP Events | Software for Cookbook AP | Email Discussion Lists | Discussion & Conclusions | References

Introduction

The Law of Change is fundamental in traditional Chinese medicine (TCM) & acupuncture (AP). Adaptation to change in the interior & exterior environment is the key to healthy growth; inability to cope with change is a warning sign of extinction. 

Communications, information technology (IT) & areas of professional interest (review articles, clinical papers, new research findings, etc) are changing very fast. The list of life-science journals is extensive & growing. Parallel with developments in allopathic medicine, research & clinical publications on holistic medical areas are becoming more numerous. These complementary or alternative medical areas include physiotherapy, homeopathy, biofeedback, meditation techniques, hypnosis, etc. They also include AP, moxibustion & allied methods. The latter include trigger-point therapy, neural-therapy, transcutaneous electrical nerve stimulation (TENS), low level laser therapy (LLLT), phytotherapy & TCM. 

Medline indexes > 8000 journals. Their abstracts are available online free from the Medline Journal Browser. To remain technically competent, skilled professionals in medical & paramedical areas need to keep up to date with current knowledge in our areas of expertise. We live in an age of Information Overload. No one person could hope to master all these areas. Therefore we must be selective in our reading, & use efficient ways to locate the articles of interest to our expertise.

Keeping up-to-date, even in narrow areas, is very difficult. If one were to do nothing else but speed-read from morning to night, no one person, no matter how talented, could hope to read a fraction of the annual output in the total medical area. Then, having located & studied the material of interest, the major problem of human memory is accurate recall of the stored information, & making appropriate conceptual linkages between different "packages of memory-stored data". Most people have poor to only partial recall of data; only those with photographic memories can recall (and link) most of what they have read. 

In contrast, computer-memories do not "forget", unless there is disk-failure, or power-failure. Digital data on modern media (CD-ROMS, floppy disks, zip disks, etc) usually are retrievable. Modern technology offers fast, easy & total retrieval of stored data. In contrast to human memory, if the data are coded correctly, & if correct search terms are used, every reference to a particular data-string can be recalled. 

In the age of "information overload", we need a quick & easy way to filter out the data that we need. For example, the monumental work "A Practical Dictionary of Chinese Medicine" (5) has 945 pages of dense text on all aspects of TCM terminology, classical TCM Syndromes, AP points, herbal formulas etc. Assuming a rapid reading rate of 25 pages/h, & a study time of 2h/d, it would take >18 days to "skim" the book once. To absorb its contents would take dozens of readings. Having absorbed them, what would our recall of specific details be 12 or 18 months later? On the other hand, suppose that a CD-ROM, with a proper index/thesaurus, contained the total detail of this work. If one had access to that via a fast computer, one could query any term at any time & locate every bit of detail about that term in minutes. 

The GIGO Law: Note that, in computer jargon, GIGO means "garbage in, garbage out!" Keyboards do not refuse keystrokes. If incorrect, misleading or false data are accepted for publication, the reader is exposed to (and may be misled by) those incorrect data. 

1. New Meta Engines on the Web: One must use a Web Search Engine to do a general Web Search, say to locate the Internet Address for the Homepage of Acupuncture Supply Houses. Many people know some of the standard Web Search Engines, such as AltaVista or Excite. There are advanced versions of these - AltaVista Advanced Search & Excite Power Search. These allow users to impose restrictions on the search; this can return more specific hits. However, there are new, more powerful engines that search multiple basic engines simultaneously. These are called Meta Search Engines. Good examples are: AskJeeves, DogPile, Google, Mamma, ProFusion & SavvySearch. See the Biological Search Options Page and Best Engines on WWW  for the addresses of these & other Web Engines.

The main trouble with Web Surfing, even with a powerful Meta Search Engine, is that one must wade through mounds of hits to find the one Page, or few Pages, of direct interest. Also, most Web Pages have vested commercial interest, & can not be regarded with the same degree of trust as the expert scientific databases.

2. Holistic & General Vet Links on the Web

2a. International TCM, Herbal Medicine & Acupuncture Links Page has Search Options to find HOLISTIC Data as well as CONVENTIONAL Data on Med, Vet Med, Animal Health & Welfare. It also links to IVAD (see 2b). It has extensive Medical, Med & Vet, & Veterinary Links, some of which are:

Medical Links
See also: Medical & Veterinary Links

Veterinary AND Medical Links
See also: Medical Links | Veterinary Links

Veterinary Links
See also: Medical & Veterinary Links

2a.1. Databases for Holistic Med & Vet Med (Conventional & CAVM): This page accesses powerful databases, such as

2a.2. Holistic Med & Vet Med: Links has Links to other CAVM Sites:

Holistic-, Complementary- & Alternative- Medicine Links
See Databases for Holistic Medicine

2a.3. Online Study of AP & TCM (3) is the most important page for those interested in online study of CAM (especially AP, TCM, Herbal Med & laser therapy) in humans & animals. It has volumes of practical material: search options, lectures, acupoint details & charts, manuals, monographs, bibliographies, etc: For example,

Main Study Sites | Articles from Acupuncture.com | Other Study Sites

2b. IVAD (Intnl Vet AP Directory) is maintained by Dr. Robert Basika <robas@magnet.at>. It allows users to locate the National Executive & some members in many countries. Online Registration Forms allow easy updates of details of a Society, or of individual members who want an IVAD Listing. All IVAD Listees must show either IVAS-Certification, or acceptance by their peers in their National Vet AP Soc. This will ensure that each National Vet AP Soc will police its own members.

2c. Veterinary & Medical Links Page has many Links to sites on Agriculture, Vet Med & Science, Universities, Institutes, Organisations & Libraries. It is very extensive. It is structured as follows: A list of Databases, Engines & Options | AP in animals & humans: International Links | Animal & Vet Science - Universities, Colleges & Schools | Biotechnology - Agricultural, Animal & Veterinary | Commercial Sites - Services, Software & Supplies | Diagnostics | Disease Prevention | Email Lists: Vet & Other | Epidemiology | Farm Animal Welfare Links | Forensics | Horses & Equine-related Links | Immunolology | Journals & Periodicals: Vet, Med & Bioscience | Microbiology | Notes for Nutritionists, Advisers & Vets | Organic Agriculture & Farming | Parasitology | Pathology Pharmacy & Pharmacology | Toxicology | Vet & Animal Health Assocs, Groups, Orgs & Socs | Vet & Animal Research Institutes & Centres | Vet Conferences (AGENDAS | REPORTS) | Vet Datasheets | Vet Libraries | Vet Links & other Information Resources | Vet Reference Desk | Vet Textbooks, Manuals, Monographs | Virology |

3. Other Online Databases: [Medline, Acubriefs, VIN, ISI, CAB, DynaMedical, Cornell Consultant]

3a. MEDLINE is the most powerful medical database on the WWW. Until last year, it was also the best online source for free abstracts on AP & TCM. [Since then, Acubriefs, with many more titles than Medline, is online]. MEDLINE is invaluable for clinicians & researchers who want to access Med & Vet abstracts. The next table shows the number of "hits" (titles or abstracts) that contained key words commonly used in CAVM: 

On May 17th, 2004, Medline had indexed >14 million titles. A search for hits relating to TCM indicated that for every 1000 titles, Medline had only 0.723 relating to AP and 1.409 relating to herbalism: 

The total hits for BOTH were only 2.062/1000 titles, but that is an overestimate for TCM, because other forms of herbalism (western, Kampo, Ayurveda, etc) are included. Thus, in comparison to Medline hits on other aspects of medicine, there were relatively few related to TCM. 

For those of us who seek to integrate complementary methods into mainstream Med, the data above make grim reading. They show clearly that publications in complementary methods are a very small part of total medical literature. If we are to make any significant impact on the medical sciences, we must publish much more extensively, & we must have a standard of publication that will reach the journals indexed by Medline.

Nevertheless, Medline is a great source of abstracts on TCM. It is a free service, courtesy of the US Government, via the National Library of Medicine. From 1989-1998, it added >400,000 titles/year. Assuming a mean of 3-5 pages/article, these articles would contain 1.2 to >2.0 million pages of text/year! 

b. Acubriefs Online Bibliography of Acupuncture: This is a great resource; 11000+ titles / abstracts on AP. See 3a, above.

c. Veterinary Information Network (VIN) is a US-based Online Vet service, but with a growing international membership. It costs circa 460 US$/year, but is a powerful resource. It has extensive Speciality Boards, Bulletin Boards on every conceivable aspects of Vet Med (including Complementary Med & AP), access to abstracts of most Vet Journals & a powerful Search Engine to search its entire Site, including its Archived Message Boards.

d. ISI (Inst of Scientific Information) & CAB Abstracts (Commonwealth Agricultural Bureau Intnl) are commercial (expensive) Online Databases. They cover the biological sciences, including Agric & Vet Sciences & are essential resources for researchers. However, Vets can get most abstracts of interest to them free from MEDLINE, or from the Medline Journal Browser. See also DataStar / Dialog [Login: AAAODO; Password: 02****]. This is an excellent but expensive literature abstracts service that simultaneously scans Biosis, CAB, food databases, & Medline.

e. DynamicMedical is an online resource for medical doctors, but Vets may register also. Registered users receive a User ID & Password. Then, they may use the database without restriction. It has intensively edited (distilled) practical information on >2000 human diseases, including presenting signs, differential diagnosis, therapy, prognosis & access to key review articles on the main diseases. This is a must for small-animal practitioners, but all Vets with medical queries can get a wealth of technical information here.

f. Cornell Consultant is a free Online Diagnostic Package for Vets. It is a powerful resource, & an eye-opener to users not familiar with it. It will remove any illusions that casual Vets may have about their diagnostic ability - the ability to recall all the diseases which may present with a given set of clinical signs.

g. Other sources of information on TCM: Some commercial Web pages have very valuable data on TCM for professionals. The data include journal abstracts, full-text articles, clinical notes, etc. Such sites include:

o        Blue Poppy (Bob Flaws),

o        Acupuncture Today (Editor: Peter Crownfield), and Acupuncture.com (Al Stone)

o        RMHI (Roger Wicke),

o        Institute for Traditional Medicine (ITM, by (Subhuti Dharmananda)

o        and MedBoo.

TCMLARS is a powerful resource for TCM literature from China. TCMLARS has two versions, English and Chinese; the Chinese version is much more extensive. Hopefully, the future development of translation technology will allow access to most of the Chinese material. Last year, the TCMLARS subscription fee was:

• 1-3 users: $800/year, unlimited access to English databases

• 4-10 users: $1200/year, unlimited access to English Dbs

• 11-20 users: $1500/year, unlimited access to English Dbs

• 21-250 users: $2000/year, unlimited access to English Dbs

• >250 users: $4000/year, unlimited access to English Dbs

The annual cost of individual access is too high for most individual practitioners to consider. However, a group subscription for >800 members would reduce the individual cost greatly. For example, the cost for a GROUP of 800 people, would only 5$/head/year (4000$/800).

Could the owner of TCMLARS be persuaded to make their data available to professional groups (for example the Chinese Herb Academy). Alternatively, could a popular Website (for example Crane Herbs, Blue Poppy, Acupuncture Today, etc) take a GROUP SUBSCRIPTION and give password-protected access to professionals on a low-cost basis?

4. Web advances in holistic & conventional data: The quality & quantity of online information on AP, TCM & holistic Med has improved greatly. See 2a (which also include Herbal Links & Homeopathic Links), 2b (international Vet AP associations) & 2c. (extensive general Vet links).

5. AP Events WebPages: It is easy for Vets to post & read Web notices of upcoming Vet AP Events. For example, go to the Vet AP Events Page & fill in the details on the Online Form at the bottom of the Page. Alternatively, one may email <IvasOffice@aol.com> for posting on the IVAS Events Calendar. There is a similar facility for human AP on the AP Events Page, and on Acupuncture Today and Acupuncture.com.

6. Software for Cookbook AP: Great advances have occurred in Software for AP & TCM. British Med AP Soc Page reviews the software. Some of it is expensive. My homepage has an Acupoint Cookbook [Top Ten Points for Common Conditions].This database has a Fast Find function for experienced users. A new company, ATRAR, has very good software (graphics, TCM data, client accounts, history files etc), but has no points database to enable users to input a variety of signs & extract the acupoints which match that syndrome. My Top Ten Points database can be used in conjunctin with other AP software. See the Endnotes for further discussion of databases and software in TCM

7. Email Discussion Lists

Specialist email discussion lists, especially those restricted to bona-fide professionals, are very helpful. They offer a fast effective way to stay in contact with peers in the international community. Such lists can be used for networking, group discussions on any topic of interest, discussion of difficult clinical cases, issues relating to TCM politics or terminology, etc. Most lists maintain a searchable archive of past mails, and have a special files area for uploading of files on professional issues. Below are a few lists for professionals in acupuncture and TCM. There are many other lists in that specialty. Use Google to find them on WWW.

a. Acupuncture Jiscmail: This is a UK-based open list for physiotherapists, OMDs, MDs, Osteopaths, DVMs, & other professionals who use AP routinely. To join, email the server <jiscmail@jiscmail.ac.uk> with the message "Join Acupuncture Firstname Lastname" in the Message Field.

b. CHA (Chinese Herb Academy): This is a group of >800 professionals in Chinese Herbal Medicine, moderated by Dr. Todd Luger. Its discussions are in depth and very informative. To join, send a blank email to: <chineseherbacademy-Subscribe@yahoogroups.com>.  

c. Professional Acupuncture List (PA-L) is a useful discussion list, restricted to OMDs, MDs, Osteopaths, DVMs, & other professionals who use AP routinely. See details at About PA-L.

d. Professional Vet Acupuncture List (PVA-L) is a useful discussion list, restricted to qualified Vet acupuncturists. See details at About PVA-L.

e. Traditional_Chinese_Medicine: A large group of acupuncturists and Chinese Herbal Medicine practitioners are members of this list. It is very active and informative, and is moderated by Attilio D’Alberto in UK. To join, send a blank email to: <Traditional_Chinese_Medicine-Subscribe@yahoogroups.com>.  

f. VBMA [Veterinary Botanical Medical Association]: This list, based in USA, comprises veterinarians and other professionals interested in herbalism, western, Ayurvedic, Chinese and Kampo. To join, email your professional details to its moderator, Dr. Susan Wynn DVM <swynndvm@bellsouth.net>.

g. Other E-mail Lists of Vet interest: Email lists for Vets interested in holistic topics are included on the pages relating to AP, Herbal Med & Homeopathy. NetVet [http://netvet.wustl.edu/vetmed.htm & http://netvet.wustl.edu/vmla.htm]. A search of Google for “email discussion lists” or “email discussion groups” and agriculture or veterinary has many other possibilities. 

Lists at Veterinary & Biological Links Pages cover topics as diverse as: | agriculture | alpacas | anaesthesia | animal ethology, behaviour | animal rights | animal-related | aquaculture, fish, marine & shellfish | avian (birds, emus, fowl) | bees, insects, spiders | bioscience | biotechnology | bovine, cattle | canines, dogs | cash crops, gardens, herbs, horticulture & vegetables | cats | complementary Med & Vet Med | deer | ecology & environment | education | epidemiology | equine, horses, donkeys | ferrets | food & food safety | forage | general topics | genetics & genomes | goats | immunology | lab diagnosis, lab safety & lab animals | meat specialists | microbiology | ovine, sheep | pathology | pests & pesticides | swine (pigs, hogs) | toxicology | vegetarianism | Vet nuclear Med | Vet informatics, library & web design | veterinary |

Discussion & Conclusions

There are several thousand WWW Sites for holistic & conventional Vet & biological / pharmaceutical topics. Many are commercial sites, advertising books, equipment, software, or training etc. Others are Homepages for private clinics, which offer diagnostic or therapeutic services. Commercial sites & other homepages that advertise for business may have little to offer the serious researcher or clinician in holistic Med. In contrast to strictly commercial sites, there are several hundred good sites with vast amounts of useful data. The Links Pages, discussed above, are useful, fast ways to access the best of these.

IT & multimedia provide rapid answers to specific technical queries, & solve problems that depend on expert information. Given access to a phone & a modern computer, a practitioner in a rural outpost can cheaply communicate by email with colleagues around the globe. Direct access to medical & TCM databases, whether online or on CD-ROMs, etc, allows instant access to the most up-to-date information. Self-study by distance learning is already powerful educational medium. Modern IT also offers a marvellous opportunity to integrate eastern & western medical knowledge in a way never possible before. Vets who fail to keep up with rapidly changing information will be left behind with the "also rans".

References

1. Felt B (no date) Paradigm's Computers & Oriental Medicine Forum [http://www.paradigm-pubs.com/html/forum.html]

2. Lin JH, Rogers PAM & Yamada H (1998) Integration of ancient & modern medicine towards a sustainable system of animal production & medical care. Proceedings of 24th IVAS (International Veterinary Acupuncture Society) Annual Congress, Taiwan, August 1998. [http://users.med.auth.gr/~karanik/english/articles/integr1.html]

3. Rogers PAM (1998) Information Technology in AP & TCM. Proc 24th IVAS (Intnl Vet Acupuncture Society) Annual Congress, Taiwan [http://users.med.auth.gr/~karanik/english/articles/tai98it.html].

4. Rogers PAM (1999) Acupuncture Links Pages [http://homepage.eircom.net/~progers/vaplinks.htm] & Study Material on Holistic Medicine [http://homepage.eircom.net/~progers/study.htm].

5. Wiseman N & Feng Ye (1998) A Practical Dictionary of Chinese Medicine . Paradigm Publications, Brookline, Mass, USA, 945 pp.

ENDNOTE 1

Development & Integration of TCM Databases: Top quality databases to access TCM literature in international languages are scarce. Access to high quality research data, clinical articles and study material will be important to ensure the future the TCM professions. Fast access depends on thorough indexing, cross-referencing and digital searching. Top search facilities need linkage of several major components in an integrated system of digital databases:

(a) The raw data (abstracts and/or full text with all necessary reference fields and keywords) in digital form;

(b) Heavy professional editing of the raw data to standardise the terminology and remove typos as much as possible BEFORE the data are mounted;

(c) Indexing of all keywords in all search-fields of technical articles.

(d) Thesaurus: Development of an integrated and dynamic (constantly updated) Thesaurus to suggest (and link automatically to) similar terms/concepts/synonyms;

(e) Boolean Search: Development of powerful and flexible engine that can search for complex combinations of words in any or all of the specified search-fields.

TCM DEFINITIONS database: The sooner that we can set up a database of DEFINITIONS of TCM Terms, the better. It is important that students and practitioners understand Chinese medical concepts and terminology. The Publishers and scholars of TCM would have key roles in this work. It should be possible to develop a digital TCM Thesaurus to act as the backbone of a powerful Boolean search engine. It would be a huge task that could involve collaboration between TCM schools, major publishers of TCM textbooks in English (like Foreign Languages Press, Paradigm/Redwing, Blue Poppy, etc), publishers of TCM software (like RHMI, ATRAR, etc), major authors (like Drs. Bensky, Deadman, Fratkin,  Maclean, Macciocia, Wiseman, etc), professional translators and volunteers from TCM email discussion lists (like CHA, Traditional_Chinese_Medicine, etc). The database could have at least the following fields:

1. Chinese GB Characters for each TCM term

2. Chinese Big5 Characters for each TCM term

3. The Pinyin Terms [with and without its accents and/or numbers] for 1 and 2, above.

4. The English translation for 3, above

5. Hyperlinked Synonyms for 1, 2, 3 and 4, above.

Later, when this is done, the Thesaurus [based on masterpieces like the Wiseman & Feng Practical Dictionary of CM, etc] could be developed.

Re (a), above, we need to consider what data to use. We should aim to access at least THREE main types of data:

1. Published, peer-reviewed data from the journals;

2. Data from selected textbooks [if the authors/publishers agree];

3. "Grey Literature" - clinical reports, monographs, academic and commercial WWW sites, etc.

Free data are available in several sources: PubMed Medline, Acubriefs, commercial WWW sites [like Acupuncture Today, Blue Poppy, ITM, RMHI, etc, etc]. Data available for a fee are available from TCMLARS, TradiMed, etc

Unfortunately, the data (although extensive) are spread across very diverse sites. There is no standardisation of terminology, language, spelling, presentation, etc. Also, there is no integrated interface to search all of those sites easily.

Could the Chinese Government, rich philanthropists or Sinophiles be persuaded to finance - even partially - this mammoth project?

Further development of powerful diagnostic and therapeutic software for TCM: Access to powerful TCM/CHM databases would be a quantum leap for practitioners and researchers. Accurate diagnosis (esp Pattern DIfferentiation) is the key to effective selection of herbs or formulas. 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.

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.

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. (see above). 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. SINGLE HERBS 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.: It is most important that TCM practitioners and organizations be seen to have up-to-date information on this topic.

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, and further below).

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.

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 & Feng’s Practical Dictionary 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 diagnosis and treatment. 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.

ENDNOTE 2

In 2003, Dr. Della Lawhon wrote to a CHM list that Boolean operators enable much more specific searching:

“It would be a great advance if we could access our journal literature that way! Because of the technology that Crane uses, one can search for any word that appears in the full text of any file. Imagine if you could only retrieve words from the Subject line! This is the situation we have now with our journal literature in AOM: we can only search for words (relating to a topic) in the Title fields. That's because only NLM is writing abstract and assigning subject terms. I believe strongly that oriental medical theory is critical to our medicine. Therefore, I don't want to see our literature described and accessed only through biomedical terms.

Indexing using OM terminology would give us control of the professional literature in profound ways; wasn't it Confucius who emphasized the primacy of naming? We have not developed to this point, but it is definitely time! Other professions index and abstract the journals articles in their profession; this enables the profession to have control over the literature and practitioners of the field can access it.

I am seeking input from practitioners, OM authors, publishers and teachers on this issue. Please contact me if you would like to share your opinion or learn more about this project. Interested groups have begun to realize the limits of doing research with our literature; specifically the Libraries of Oriental Medicine (LOOM), Tufts Medical School-NIH and the NLM. But I need your input; you will be both the users and the subjects of this electronic product. Essentially, we're talking about either extending Medline or developing our own OM Medline. I'm eager to talk with any and all of you about how you search for literature and the type of access you'd like. I'm looking for senior clinicians & thinkers in our field to plan the best way forward so that the profession is well served.”

ENDNOTE 3

Countering the rumoured ban on Chinese herbal ingredients and formulas: As regards the threat to ban valuable Chinese herbs and formulas in USA and Europe, representatives of the TCM-Herbal Medicine community should stress to the US-FDA and EU Drug Regulation Authorities:

(1)     That most if not all the "documented" adverse effects of CHMs / Chinese supplements were because of OTC (non-professionally prescribed) use, and

(2)     That the adverse effects in most cases involved INTERACTION with other (allopathic) drugs in patients with already compromised liver, kidney or heart function. 

Much remains unclear on herb-drug interactions but there are some data (including WWW data) on that area. For example, one would not use a remedy with a significant amount of digitalis in a subject already taking digitalis- type medication.

We should stress to the Regulation Authorities that even air and water - the most vital essentials for life - can be toxic under certain circumstances. So can salt and sugar!  Therefore, without exception, ALL herbs and medicines are potentially toxic. It is the DOSE and the OTHER ingredients in a remedy that decide whether or not toxicity will arise in HEALTHY subjects.

The risk of adverse reaction is higher, and the toxic dose lower, in unhealthy subjects. Compromised organs in unhealthy patients are unable to metabolise drugs, active compounds in herbal ingredients, or their metabolites, as effectively as healthy organs. Also, some subjects may be intolerant of, or over-reactive to, some of the active agents.  For example, a low percentage of cancer-patients lack the enzymes to metabolise the agents used in cancer chemotherapy. Those unfortunate people have severe side-effects in the days and weeks after administration of the chemo cocktail. [That is an area where acupuncture and correctly prescribed herbal formulas may be of great benefit. Depending on the chemo used, and on the organs targeted by its side-effects, acupuncture and herbs to support or protect liver, kidney, heart & Middle Jiao (spleen-stomach) functions have shown great promise in that area.]

It is as incumbent on herbalists as it is on MDs/allopathic physicians, surgeons and anaesthetists to be aware of possible drug-herb interactions, and of possible interactions between drugs OR herbs on a compromised system, especially if liver, kidney or heart function is weak or compromised before therapy.

The FDA and EU Regulators will ban most of the more dangerous herbs in the Chinese Materia Medica if we try to AVOID the issue of adverse reactions. We must face up to it and carefully document the background health (especially PREVIOUSLY compromised liver, kidney or heart function), and the use of concomitant allopathic and herbal remedies in any patients that suffer adverse reactions while taking (or shortly after stopping) herbal remedies.