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— updated 2008-12-12

Herbalist Review, Issue 2008 #1: The history behind HerbalThink-TCM software — why it was developed

(The HerbalThink-TCM family of software applications includes the Traditional Chinese Herbal Sciences Self-Study Reference, TCM Herbal Tutor, and TCM Pulse Simulator)

HerbalThink-TCM is interactive learning software developed at RMHI to provide a challenging, thorough, and fun alternative for learning the principles and methods of traditional Chinese herbal sciences.

Subtopics on this page…

Copyright ©2008 by RMH-Publications Trust; all rights reserved.







Introduction

Many of our students and software users have asked us about the history of the HerbalThink-TCM software (formerly known as the Traditional Chinese Herbal Sciences CD-ROM). In this article, each of the primary developers, Curt Kruse, M.S., and Roger Wicke, Ph.D., explains why and how the software was developed.


What originally motivated you to develop the HerbalThink-TCM software?

Roger: Before we developed HerbalThink-TCM, the most urgent motivation was the difficulty of teaching students the principles of clinical pattern recognition. Among the better teachers of TCM throughout the world, this is recognized as a serious obstacle to improving quality of practice in the profession. It's one thing to have students memorize the 100 to 140 or so basic patterns of illness (like Deficiency of Kidney Qi, Qi-stage Extreme Heat, Exterior-Deficiency-Cold, etc.) and regurgitate the definitions on written exams -- that's easy -- and quite another to be able to use these definitions to accurately assess real people. Real people generally do not fit neatly into 140 slots defined by the traditional textbooks. Instead, they commonly present with mild patterns, hints of patterns, and/or combinations of multiple patterns simultaneously. This reality drives both new students and even experienced practitioners to distraction and endless debates, even to the point that many so-called TCM herbalist-acupuncturists revert to a simplistic biomedical style of choosing herbs: This formula for hypertension, that formula for migraines, that formula for influenza. They might have saved themselves a lot of effort by never having learned TCM in the first place, since one could just as well look these up in popular "quickie" reference books that classify Chinese herbs and formulas according to western biomedical criteria.

Because of the difficulty in learning pattern recognition skills, even many graduates of four-year TCM colleges never learn these skills. Sure, they may have a degree or a certificate of completion to show for their pains, and may even have passed state licensing or certification exams. I remember the California acupuncture licensing exam as being peppered with deviously obscure references to TCM theory, but I know plenty of practitioners who passed that exam and yet later gave up on the practice of TCM herbology because they did not understand the basics of pattern recognition.

The main problem with multiple choice exams, by far the most popular type of exam because of their ease in grading, is that they are great at preparing students to compete on TV game shows (What's My Chinese Herb?) but very poor at testing the complex decision-making skills essential to a clinical herbal practice.

HerbalThink was designed to present users with problems that mirror the often ambiguous nature of clinical data that one might obtain from real patients.


But surely there are lots of ways to teach pattern recognition skills without resorting to computers?

Roger: Of course, and one of the obvious methods is to assign homework problems that reflect the types of real situations one might encounter clinically. Very few TCM college courses do this, for a number of reasons. Such homework takes a lot of time to develop and grade. Accrediting boards usually do not allow credit to given for homework time, because this has to be estimated, and accrediting boards love "objective" standards that can be unambiguously measured. Thus, much better to simply time the number of hours students' derrières are seated in class and award credit hours based on derrière-to-chair contact time. Another problem is that students also complain a lot about the homework. Because the more realistic you make the problems, the more difficult they become, the greater the frustration they induce.

I had developed a series of homework problems comprising about 25 cases pulled from documented clinical cases, both in the U.S. and in China. I presented these problems in a graduated manner -- the easier ones first, to introduce basic definitions and principles, followed by gradually increasing complexity to prepare them for the real world. My own college courses were like that. I remember having no multiple-choice exams in college and graduate school; both the homework and the exams were in the form of problem solving or essay questions. I believe there was a general disdain of the multiple-choice question format among the faculty. The bottom line was that the problem-solving format was a great way to learn; it worked. I'm grateful for the education I received in college.

However, with each passing year, fewer American students are willing to perform this kind of labor. Tolerance for struggle has almost disappeared, yet systematic research of learning methods has proven repeatedly that if learning something is too easy, it's quickly forgotten. There's an optimal level of difficulty and timing in presentation that gratifies the student with a sense of achievement, and yet the quality of struggle embeds the knowledge in long-term memory.

The students who successfully completed my courses during the 1990's frequently commented that they were well served by this mental struggle. They were consistently pleased with their level of knowledge and ability when contrasting their own experiences with graduates of more conventional TCM schools. But I did have my share of anxiety-inducing experiences. Some students, who seemed more concerned about purchasing professional credentials, complained endlessly about the homework and my grading. One year, this happened to me once too often, and I decided I'd rather have fewer students than deal with this nonsense. Our admissions procedure was tightened to eliminate students I call the paper-chasers — purchasers of gold-embossed certificates. Now over 50% of our students are from other countries, which has helped to compensate for the decline in the number of American students willing to do the work.

These experiences did lead me to question whether a curriculum based on problem-solving homework and final exams could possibly replaced with something even more effective yet less stressful for both me and the students.


And that something better would be computer-aided learning?

Roger: Yes. In 1997, my long-time associate Curt Kruse decided to sit in on my Chinese herbology courses. Curt has an interesting background. He graduated from the Colorado School of Mines with a Master's degree in geophysics and a specialization in expert systems and artificial intelligence. He's worked for several major oil companies. Curt originally completed my Chinese herbology courses for personal health reasons in 1988 when I was practicing in Boulder, Colorado. In 1997, while I was teaching the course, he developed a few software routines to help drill himself on the material I was presenting in class. When he demonstrated the software to me, I instantly saw the value of it and encouraged him to develop a user-friendly version for our students.

Curt: One of the biggest potential advantages of computer-aided learning is the possibility of instantaneous feedback. With computer-aided learning, the student can answer a question and then get instantaneous feedback about whether the answer is right or wrong. One practical difficulty that I've noticed in traditional classes is that homework assignments are generally returned to students with a delay of at least several days, and by this time, the students have forgotten what the questions were and why they chose the answers that they did. In order to benefit from this feedback, the student must review their original homework trying to remember their reasoning for each answer. They should also review any answers that they were unsure of but made a lucky guess. It would be easier if the feedback were instantaneous, but without computers this is not practically possible. Because of this the learning process can take a long time, and sometimes this delay prevents students from learning from their mistakes. With instantaneous feedback the student can cover the material as fast as they are capable of, and they can learn from their mistakes as fast as they make them.

Another benefit of computer-aided learning is that computers are good at handling complexity. Since TCM pattern recognition is a complex skill, this provides a significant advantage. The usual way of teaching pattern recognition has more to do with practical limitations, than it does with the students' ability to learn. For example, a student usually starts out memorizing the symptoms that make up a syndrome definition. Later they learn the more realistic process of recognizing the syndrome from the symptoms. The first step is not actually how the information is used and is only a practical step necessary to keep the second step from being too difficult. With the HerbalThink software, these two steps can be combined, and the student is actually learning both steps at the same time with less effort. The student learns the syndrome definitions at the same time that they are learning how to recognize the syndromes. This is only possible with the use of a computer.

Students can go at their own pace, making it easier to fit the course into people's busy schedules. The HerbalThink software allows the student to study whenever they like. This means that students who need extra time can take it without slowing down the class. It also means that students who already have some knowledge of TCM can complete the course faster. Because the HerbalThink software keeps track of what information the student already knows and what information they need to study more, it can make the best use of students' time. This also allows each student more freedom to jump around in the material. The computer will keep track of which things need to be filled in later. Instead of arranging our lives to fit the course, the computer allows more flexibility in arranging the course to fit our lives.


What about the problem of "exam trauma"? Do you attempt to address this?

Curt: One problem that I observed in the classes but initially did not know how to solve was the problem of exam-taking trauma. Students everywhere know how stressful exams can be. Since Roger's classes were difficult, exams were stressful. There is also the problem with the finality of exams. Will you pass or will you fail? What if you know the material but have a bad day? Most of us have simply learned to accept exam trauma as a difficulty to be endured. When we wrote the software, it was originally a study tool and not a testing tool; the scores were merely a bookkeeping device to determine topics and data on which the user needed more practice. We eventually realized, however, that the studying and the grading could be combined. An unexpected benefit of this is that there is no exam trauma. The student plays the games until they reach the required score. If the student has not reached the required score, it only means that they need to play a while longer until they reach it (if they are capable — no amount of time can compensate for a basic lack of ability). There are no final consequences for having a bad day. They simply keep working until they pass, and no mistake is serious that it cannot be overcome with a little extra work. After all, better to have students make lots of mistakes on computers and learn from them before "practicing" on real people.


Curt, what criteria and design goals did you have when you first developed HerbalThink? How do you overcome the problem of students cramming for exams and then forgetting most of what they learn (short-term vs. long-term memory)? How do you promote understanding of subject material vs. simple rote memorization?

Curt: I was helping with the TCM classes when Roger began teaching in Montana. I had taken his course many years earlier, but the course had improved significantly, and I felt that a refresher course would be useful, so I took the class along with the other students. I've never been good at memorization, so I began writing software tools to help me in the class. As I was writing the software I became interested in how people learn. Because I was a student at the same time, I was able to be my own test subject. My goal was to create software that would speed up my own learning and to help me pass Roger's course. Since the course focused heavily on clinical case studies, the software was designed to help me analyze cases and to learn the required skills.

Because I'm not good at memorization, I first created simple matching games that require the user to pair up one type of data with another — for example, matching an herb name with its primary function category. This turned out to be an effective way to memorize lots of data. Through experimentation with timing, I found that information could be embedded firmly in long-term memory by keeping track of the user's performance on each data item and then presenting it again whenever it begins to fade from memory. Initially, new data needs to be presented several times until it stays in short-term memory. Later, after the information is at risk of fading away, it must be presented again to secure it in long-term memory.

The difficulty of the games also has to be managed. To maximize the rate of learning and maintain interest, the program needs to track performance and present information that's neither too easy nor too difficult. Too much information too fast is overwhelming and frustrating, too much repetition of information that one knows well is boring and risks losing one's attention, so I designed the games to continually adjust the level of difficulty to the needs of each user.

Though the matching games are ideal for learning simple relationships between types of information, such as the function categories of herbs, or their thermal properties, I quickly realized that clinical analysis skills involve complex pattern recognition skills that simple matching games and flash-card type learning do not address. I created various types of identification games that mimic the pattern recognition activities of real clinical situations, for which we are required to make judgments based on incomplete or ambiguous information. One such identification game allows the user to ask for clues about a hypothetical client's symptoms and signs; at each stage the user must decide whether enough information has been provided to conclude which pattern is being described, and if not, what questions should be asked to help differentiate among possible or likely patterns. Guessing the patterns without enough data is a serious, though common mistake among practitioners that the software trains users to avoid. On the other hand, asking for excessive amounts of redundant information indicates that the user does not know the pattern definitions well.

The matching games and identification games that I created provide the basic building blocks for a series of games that teach much of the knowledge necessary to successfully analyze complex clinical cases. The matching games are good for memorizing basic information and classifications. The identification games are good for integrating this information into a pattern-recognition framework that closely simulates the way we retrieve this information in real life. As an example, when thinking about a clinical problem, one does not ask oneself to retrieve all the data about a specific herb; instead, one asks questions like "What set of herbs would most effectively tonify Qi, strengthen Spleen, resolve Dampness of Middle and Lower Burner, and are not too hot or spicy, because the client/patient also has some mild Stomach Yin Deficiency?"

For analyzing case studies and asking questions like the preceding one, I developed a database of syndromes, herbs, and formulas that would allow me to flexibly search, sort, and display the data. I used this database to analyze all my case studies for Roger's class, and it ultimately saved me huge amounts of time as well as ensuring thoroughness. Any time I need to analyze a clinical case study, I still use the HerbalThink database to explore possibilities and to determine TCM syndromes, herbs, and formulas.


How many herbs do you require students to learn? What about students who want to learn the system of Chinese herbology but apply it to western or local herbs?

Roger: We require learning only the 90 most commonly used herbs in the materia medica, but those herbs are learned quite thoroughly. These 90 herbs constitute almost 90% of the ingredients in classical formulas, so memorizing a lot more than this results in diminishing returns for a lot more work. We'd rather see students learn a small set of herbs really well than learn 400 herbs and then forget most of them anyway, which is what happens in curricula that emphasize rote memorization without profound understanding. Instead, we emphasize theory and clinical pattern recognition skills much more then memorizing materia medica. Besides, the software databases allow users to quickly reference materia medica information, and if they understand basic principles and terminology, they can apply the information correctly after looking it up.

Another issue is that people are increasingly questioning the quality and integrity of Chinese herbs grown and processed in China. While we feel that it is possible to be selective and still get good quality, the incredible pollution levels in certain regions of China and the recent scandals over intentional melamine contamination of Chinese-manufactured food ingredients like milk protein certainly will not help the image of the Chinese herbal industry.

We have an increasing number of students who want to learn the Chinese herbal system, because it really is the most sophisticated herbal system in the world, but who want to shift away from Chinese herbs and toward more locally grown herbs. Here is the advice I give these people: learn the basic 90 herbs of the materia medica well, as these herbs are thoroughly described in historical literature, are in common use, and their pharmacological properties have been extensively studied. Learn how to use them, understand the principles of Chinese herbology, and then you will be able to apply these principles to other herbs and even foods. After all, some of these 90 commonly used herbs grow naturally in many parts of the world (mint, kudzu, licorice) and others are in common use worldwide (cinnamon, ginger, orange peel, cardamom, ginseng, ephedra). I don't know too many people who would be willing to throw out ginger and cinnamon from their kitchens, just because they are not locally grown. But people do need to scrutinize quality, not only of Chinese herbs, but of the foods they buy at the grocery store. Globalization has created some incredible opportunities for corporate scams, and it is not just Chinese products that are affected.


So how did students initially respond to using the software?

Roger: In 1997, having been a TCM herbal practitioner for over 12 years and an instructor of TCM herbology since 1988, I thought I knew all the basics and didn't use the software myself. After Curt developed a user-friendly version for students, we both agreed that we needed to thoroughly test the software ourselves by going through the identical procedure we would later require of students. It took me about 40 hours of time working with the software to complete the course requirements. (Based on subsequent student feedback, we now estimate that a typical student will require 600+ hours to complete what we call our Level-1 curriculum.) Afterward I experienced an epiphany: my own clinical skills had sharpened noticeably, and I recognized that in my 12 years of practice, several of those years filled with almost a full-time, 40-hour week of clients, that I still hadn't exhausted the range of possibilities described in the traditional Chinese clinical literature.

Because of my own initial reluctance to allow a computer to expose my own weaknesses, I realized that there would be resistance among students and other TCM practitioners. During the first few years, use of the software in our courses was entirely optional as we continued to improve it and work out the bugs. The statistics of student performance, though, revealed stark differences. Those students who used the software consistently passed our written exams, and I noticed that the clinical skills of these students were noticeably superior. The exact opposite was true of students who didn't use it, proving to my own satisfaction that we would eventually need to require it of all our students.

Among a large number of herbalists, there is significant resistance to using computers for any reason. However, with the increasing amount of useful health information on the Internet, this is gradually changing, and resistance is diminishing. The idea that a computer could possibly teach certain skills better than a human teacher still rankles among some.

Today, we have users who are quite enthusiastic about the software. They commonly report that the games are fun to play, even addictive — though in a good way. We are discovering that if we can just manage to persuade someone to start using it, the software sells itself. The difficulty is in getting people to take that first step and try it out. The other difficulty is to get students to drop the old idea that they need to know the material perfectly before "taking the exam". In fact, the software is designed so that one can plunge right in and play the games without even reading the textbook, though we don't recommend that. The feedback from the games will eventually teach the user textbook theory and definitions in intimate detail.


Roger, could you comment more about your own resistance to using the software?

Roger: I think it's only natural for professionals who've been working in a field for over a decade to get a little cocky about how much they know, and to assume that they need learn no new tricks. Now I see that it's healthy to be shaken up a bit. In retrospect, I was getting into a rut with teaching and with my practice and needed a change. Having a background in biomedical engineering and a lot of my own professional experience with computer software design, I decided to go whole hog and devote the foreseeable future to co-developing TCM herbology software products with Curt. My initial resistance to using the software had an element of fear in it, a fear of my role being taken over by a computer. But now I see it as a collaboration between humans and silicon, an evolution. The software performs certain teaching functions repeatably and reliably, thousands of times, which I could not possibly hope to do as a human teacher without personally tutoring each student for hundreds of hours. The closest analogy I can make is that of a student apprentice studying full time with a master herbalist seeing dozens of clients each day. The computer focuses on the well-defined paradigms of Chinese herbology, that can be mathematically structured and programmed, then presented to students in literally billions of potential combinations. Now, I can focus on those aspects of Chinese herbology that are truly beyond the computer's abilities, like evaluating seemingly contradictory symptom-sign clues, where the pulse data might contradict the tongue appearance, or performing the detective work necessary to ferret out environmental, occupational, and dietary factors underlying a client's health problems. Curt, the computer software, and I are now a team that works together with students to help them learn and to solve real clinical problems.

Because of my own initial resistance, I can empathize with TCM instructors who disdain computer-aided learning software. To many people, the idea that a computer might perform certain tasks better, more accurately, and more reliably than humans is unsettling. But the upside is that the computer-human team can be so much more powerful than either alone. The Internet revolution has demonstrated that potential, though, like any technology, it can be abused.


How does learning pattern recognition by computer differ from learning it the old-fashioned way by studying clinical cases?

Curt: The usual way of learning pattern recognition skills without a computer is by experience. The way that this is best done in a class is by analyzing lots of case studies. In courses where case studies are not used, this skill is simply left for the student to figure out on their own after they graduate. With the use of a computer, it is possible to make an easier transition from textbook knowledge to case studies and pattern recognition skills.

There is a progression of skills required for learning TCM pattern recognition. First, one must memorize the list of symptoms that define each syndrome. Next, one must be able to identify the syndrome that corresponds to its definition — the complete list of symptoms and signs. Next, one must learn to recognize possible syndromes from partial symptom-sign information, which is considerably more difficult. In the case of an incomplete match of symptoms and signs, one must determine whether these symptoms and signs are adequate to determine a unique pattern match or whether more information is required and what questions should be asked to differentiate the remaining possibilities. Finally, it is necessary to be able to recognize multiple syndromes that might be present at the same time and to judge relative magnitudes.

These skills are difficult to learn, and real cases can sometimes be quite complex. It takes a lot of preparation time to develop a progression of case studies from simple to complex so that the students do not get overwhelmed. Ideally, you would find case studies that illustrated basic concepts first and then progressed gradually to more complex case studies. By using computer simulations it's possible to randomly generate a virtually unlimited number of simple case problems, before presenting the complex issues often arising from real case studies. When using HerbalThink's Syndrome Identification game, users begin by recognizing the syndromes from complete symptom information, which is like flash-card learning. When they are comfortable with this, they can progress to using partial information. When they are using partial information they must learn to judge how much information is necessary to determine a unique syndrome. They also can practice asking general questions that most quickly help differentiate the correct syndrome. When the student has mastered these skills using simplified computer cases, he or she will be ready to move on to more complex real cases.


A lot of people are worried about computers taking over our lives and about the phenomenon of young people spending too much time playing video games. How do you address the skeptics that claim that computer-aided learning does not prepare students as well as traditional internships and learning by experience?

Curt: I also worry about computers taking over our lives. I often feel as if I'm more resistant to computers taking over my life than the average person, even though I'm a software programmer. I do not want computers to handle my personal life. However, I find computers to be an extremely valuable tool for dealing with information. When it comes to storing, analyzing, and learning information, I think computers are wonderful. I've been involved with using computers to automate other human tasks that people generally thought were inappropriate for computers. Instead of making these processes more rigid, I've found that it frees the people from the mundane tasks so that they can spend more time working on truly interesting and profound aspects of their subject. This is also true for herbalism. By creating software that helps with learning basic textbook knowledge about TCM herbology, it allows herbalists to spend more time with herbs and real cases, and less time memorizing and looking up information. I've always felt that the computerized learning of herbs should never replace hands-on learning. However there is a significant portion of TCM that is not hands-on, even in schools that do not use computers. There is a significant amount of book learning and rote memorization that can be replaced with more efficient computer instruction.

Chinese pulse taking is a subject that many people would probably believe is inappropriate to be taught by a computer. Pulse taking is widely believed to be extremely difficult to learn often taking many years of intense study just to be able to do it at all. The main problem with teaching pulses seems to be that it is difficult to explain to another person what a pulse feels like. Unless two people can feel the same pulse and then discuss it, it is very difficult to communicate this information. Roger had already made some advances by coming up with a more systematic method of describing pulses. He had made drawings and descriptions that seemed to be quite good for a book. However, I noticed that even with these pictures and descriptions there was a great deal of confusion about what the terms meant. I learned that even experts would disagree on terminology and had difficulty describing what they feel in a pulse. Students would struggle to understand the pulse terminology, and quite a bit of time was spent in the seminars just trying to clarify how to describe pulses using pictures and words. I realized that software video animations could be a big improvement over pictures and words for describing pulses. As we worked to create the TCM Pulse Simulator software, some of my own misconceptions about pulses were cleared up because the Pulse Simulator provided a better way to communicate this information. Some of our students have used the Pulse Simulator before coming to the seminars. It was amazing to see some of them comfortable with taking pulses and able to get reasonable pulse readings similar to Roger's readings after only a week of hands-on training. If these students could have seen how difficult it had been for previous students without the aid of the Pulse Simulator, they would have been shocked. I felt that the Pulse Simulator was successful in getting the terminology issues out of the way so that the seminars could focus on more advanced information.

Our computer-aided learning software is not intended to replace clinical classes or internships. It is intended to get the student to that level quicker so they can spend more time on real life learning and less time memorizing information and definitions. It replaces the many hours of tedious and often ineffective rote memorization and drastically reduces learning time. You don't want to start an internship unclear about basic definitions. When a student goes to a clinical class or internship and has to ask questions that could be answered by a book, they haven't made the best use of their time. The main purpose of HerbalThink is to make the period of learning abstract information faster, more efficient, and even entertaining, so students can begin hands-on clinical work sooner.


Many software users have become wearyingly familiar with the parade of operating system upgrades and software upgrades, like a treadmill that one can never get off. How have you dealt with this problem over the years?

Roger: When we started this software development in 1997, the Java programming language had just become popular for creating specialized interactive content for Internet web pages. It had a number of features that we liked, including increased levels of built-in security and cross-platform capability — a single program could be developed to run on both PC Windows and Macintosh computers with a simple add-on layer that would make it fully operational on either computer. Java was developed by Sun Microsystems as open-source software, and after the Internet bubble popped in 2000, Java continued under intensive development by Sun and also by Apple, who began including it on all Macintosh computers. It turned out to be a great choice for us, not only because Java had lots of nice features, but because it has become a very well-supported language. Java is now one of the world's most popular consumer software products. Many companies are now developing desktop applications in Java, including the open-source replacement for Microsoft Office called OpenOffice. So Java shows all the signs of being around for a long time into the future.

It turns out that the original version we developed in the year 2000 has needed very little tweaking, and some of the minor glitches in performance have been solved, not so much by us, but by improvements in the Java run-time versions created by Sun and Apple over the years. Amazingly, our original version was targeted for the old Macintosh OS 9 system, which is now obsolete, yet that version still works well on the latest operating systems, including Vista for the PC and OSX 10.5 for the Mac. With a few minor tweakings, it now runs up to speed on the latest Intel Macs. That has allowed us to focus more of our efforts on developing content. (If the Linux operating system ever increases its market share, with only minor effort, we could potentially produce a Linux-compatible version, but so far we have not had much request for it. If any readers of this article would like a Linux version, I'd like to encourage them to contact us.)

The most serious glitch we experienced was with the latest Mac Intel processors. Our software worked on it, but scrolling in the data tables was very slow, and we were not happy with it. That is the main reason we stated on our website that the software was supported on only PowerPC Macs and PC Windows. In reality, several of our students have been steadily using it on Intel Macs, with advice from me as to how to work around the glitches. The latest versions of Java produced by Apple seem to have entirely solved this problem for us, and we now state that we support both the old PowerPC Macs and the newer Intel Macs.


How does RMHI's program interface with the network of accredited TCM schools, the NCCAOM, and state licensing of acupuncture?

Roger: We interface only minimally. In my opinion, the American educational establishment has failed and is irredeemably broken. John Taylor Gatto, a public school teacher who twice won the New York Teacher of the Year award, has stated that the educational system is so broken that the only viable solution is to let it collapse and work on alternatives. That's our philosophy — to isolate ourselves from a system that has become self-destructive and to provide an alternative.

Over the 20 years I've taught Chinese herbology, RMHI has steadily increased its standards and improved its curriculum. The introduction of our interactive learning software has made major improvements in graduate's clinical skills and performance. The improvements are measurable and dramatic. However, to achieve this, we have admitted fewer American students and more foreign students to the point that foreign students are now the majority in our distance-learning program.

During this same period, U.S. educational performance, by almost every objective standard, has declined substantially. I know lots of college professors who whisper in horror about this phenomenon in private, but it's becoming increasingly difficult to talk openly about it. There have been cases of professors being fired or sued by students for bucking the trend toward dumbing down and giving passing marks for incompetency. The average U.S. four-year college graduate achieves a level of knowledge that is achieved by high-school graduates in France and Switzerland. American education has become a laughingstock among other developed nations. We spend more per student that any other country worldwide, yet each year we have less to show for it. (The U.S. also spends more per capita on health care than any other nation, and its health care system is similarly broken, for similar reasons — too much money, too much corruption, and a recognition by bureaucrats that parasitizing off this broken system is to their private advantage.) College degree programs and professional education of all types have attempted to paper over this decline by decreasing homework requirements, gradually simplifying questions on standardized exams, and awarding advanced degrees for diminishing levels of achievement. The TCM profession in the U.S. is following this trend, now by the introduction of "Doctorate" degrees. If present trends continue, in a hundred years we'll be awarding Ph.D. degrees to people who can recite the alphabet and the multiplication tables. It angers me to see this kind of charade. It's pathetic. I refuse to have anything to do with it. When such degree programs are established on a base of administrative bureaucracies and regulatory schemes, increasing amounts of money are thrown at the problem as the profession continues to deteriorate.

Instead, our approach is to circumvent and ignore all these dysfunctional bureaucracies. We are an entirely private organization with little administrative overhead. Our time and money almost exclusively go toward developing content for our software and our curriculum. Lateral networks like the Internet are replacing hierarchical bureaucracies anyway — this is a sea change in human civilization that is as inevitable as it is unrecognized, especially by people inside the establishment. But the reality is that more and more people are searching the Internet for health and medical advice and relying on electronic, worldwide networks for advice on diet, herbs, medical advice, and practitioner referrals. They are overcoming the old tyranny of mediocrity by simply ignoring it. (In the past few years, I've seen clients who know more about their illnesses than any of their doctors, because they take full advantage of the Internet.) Hierarchical bureaucracies no longer serve as the information gateways and arbiters of truth they once were. Their power is waning, sometimes to the point of irrelevancy, yet also inevitably, they desperately attempt to salvage their dwindling power through legislation, regulation, licensing, accreditation, control of the universities and schools, etc., to postpone relentless decline. I call it the "Twilight of the Bureaucrats", a tragicomic opera in acts that are ongoing, with greater bombast than even Wagner could summon.

In spite of our refusal to spend time and resources on bureaucracy, we've had students use their work at RMHI toward university graduate degrees and CEU credit for health professionals, and several foreign physicians have taken our courses under sponsorship by their governments; our focus on quality to the exclusion of paper-pushing and political pandering seems to be working for us. We've developed a niche for ourselves and attract highly dedicated students from around the world. To potential students who seem more concerned with acquiring paper credentials, we point out there are far easier (though much more expensive) ways to get these credentials and are glad to refer them elsewhere.

Herbalists do not require a license to practice anywhere in the U.S. and many other nations of the world. We advise potential students that their ultimate goal should be to acquire the best education they can in order to be effective clinically and to document the quality and extent of their training to the public. Moreover, in today's economic environment, they should attempt to get their education at as low a cost as possible. That's one of the advantages of our software — for very minimal administrative and grading time on our part, a student can gain hundreds of hours of experience on their own time by playing interactive computer games that simulate realistic clinical situations and problems.


How does the HerbalThink software cut the costs of education?

Roger: As far as software products go, HerbalThink-TCM may seem expensive. Our current version represents almost 15 years of development and expansion in our curriculum, and we are continuously adding new material and refining it. But if you compare it to the cost of four years of tuition at any TCM college, it provides a way for a self-motivated student to gain equivalent knowledge and skills that are not even taught at conventional colleges, yet at a bargain-basement price. We've had quite a few students enroll in our program after graduating from four-year schools, because they recognize that they've not learned enough to prepare them for difficulties of clinical practice. After completing the curriculum requirements of the HerbalThink-TCM software, students are ready to begin clinical internships, either through RMHI or opportunities elsewhere. We encourage students to intern with experienced TCM herbalists, many of whom are found outside the world of accredited schools. Often, experienced independent herbalists may be willing to take on interns at low or even no cost in exchange for students' help in filling and dispensing herbal formulas, especially when they see how competently these students have learned basic TCM theory and materia medica.

As the economy worsens and student loans become more difficult to finance, we believe students will increasingly question the wisdom of going $80,000 or more into debt for a conventional classroom education that is substandard. The tradeoff is that students in our program cannot expect to simply buy their credentials without demonstrating competence, as has been the trend in American higher education. The software allows us to demand objectively measurable performance from students.

By offering a professional-level education at drastically lower tuition rates, thanks mostly to the efficiency of the software, we hope to level the playing field in the TCM herbology profession worldwide. Bright students who otherwise would not have been able to afford the tuition or who do not have connections with the wealthy class or bankers, can now learn a subject that throughout history has been accessible to poor people. We think that herbal medicine should remain a tool of the people, and not an elitist profession based on financial ability to purchase credentials, as some in the U.S. would like it to be.


What are your plans for the future?

Roger: For the past four years or so, we have focused almost all our efforts on a future major upgrade that will include a greatly expanded materia medica with color photos of the herbs, pharmacology and phytochemistry data, expanded toxicology information, antimicrobial properties, as well as expanded explanations of the traditional functions. While our original software is more than adequate for basic instruction, I've always wanted an herbal database that would allow me to access pharmacological properties, all known chemical constituents, and to view their molecular structures. We already have this feature included in our current in-house beta-test version, and we hope to release it sometime next year. It should be a handy research tool. All this new information has taken us several years to compile, and the total price will be higher, though existing users will be able to upgrade at a significant discount.

To help people more easily get started using the software, I'll also be producing a series of audio-visual tutorials to demonstrate how to use the HerbalThink-TCM software for specific tasks. These will be posted for free download on our website, and I'll be notifying subscribers to the RMHI Herbalist Review newsletter as these become available.

Also to be included in our next upgrade is a major new textbook and database on the effects of music and sound, with discussion of both the scientific research in the past 50 years and of how traditional Chinese pattern assessment might provide additional insight into how to apply this information clinically. I've had a life-long interest in music, and finishing this project has consumed over two years of my life, but I've never enjoyed working on any project so much. Thirty years ago I completed a graduate thesis and published several articles in scientific journals on the human auditory perception of music and sound, and it has been fascinating to revisit this subject now from the perspective of a TCM clinical herbalist. A lot of our students and website visitors ask me when the music textbook and database will be added to the software package, and I tell them we make no promises as to release date, but we are working on it almost full time lately. For the past 6 years, an article I wrote on the effects of music and sound on health has consistently been the single most popular page on our website, which initially puzzled me. RMHI is a Chinese herbology school, and I don't advertise this article on our front page. It's buried deep within our website. I think that many people instinctively recognize the power of music, which is why this article resonates with so many.

Planned for a later release is a major upgrade of Herbal Tutor and Pulse Simulator, with the new content of the Self-Study Reference added to their databases.