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— updated 2017-01-28

Herbalist Review, Issue 2016 #1: Mentorship-internship, expert-system software, interactive games to replace outmoded and ineffective university education
The future role of AutoSage-TCM in RMHI's clinical Chinese herbology curriculum

by Roger W. Wicke, Ph.D.

This article is a slightly revised version of a notice previously sent to all RMHI graduates, students, and associates regarding planned changes in RMHI's curriculum over the next few years.

Subtopics on this page…

Copyright ©2016 by RMH-Publications Trust; all rights reserved.


Expert systems in TCM pattern diagnosis

Expert systems for performing TCM pattern assessment have been attemped by numerous research groups around the world for several decades. At RMHI, we have been quietly and steadily working on our own version since 1992. And quietly, because unless one has something tangible to publicly demonstrate, most of these attempts have yielded disappointing results that are mostly reported in highly specialized research journals, in incomprehensible science-speak jargon to make the outcome seem more impressive, and then forgotten. Steadily, because this effort has required multiple layers and levels of features that had to be implemented before the entire system could hope to succeed: computerized syndrome, herb, and formula reference databases, database structures, inference engine logic, and a format that non-technical users could understand and interact with. (I possibly would have never begun this project if I had realized how complex it would become and how much work required, but in retrospect, I have a much more thorough understanding of traditional Chinese medicine than before I started.)

Though there is a very crude expert system underlying TCM Herbal Tutor, our interactive game software for learning TCM syndrome-patterns, we never even used the word "expert system" to describe it, because as an analysis tool, this expert system would have been as disappointing as all its predecessors reported in the research literature. However, as an educational aid for the very limited task of generating random questions to help students gain skills in TCM pattern identification, it has been a solid success and has been a key element of RMHI's curriculum for over 15 years. TCM Herbal Tutor, however, has revealed through 15 years of student statistics, that only a small percentage of the population, about 10% has the cognitive skills required for learning TCM pattern reocgnition. This is the embarrassing secret behind the current status of the TCM profession, at least within the USA, for the past few decades. Many schools have effectively given up even trying to ensure that their graduates have this absolutely crucial skill, instead providing impressive-sounding substitutes: extensive course-work in an increasing array of western biomedical topics, study of medical Chinese and translation of the classical literature, rote memorization of hundreds of herbs and formulas and TCM theory. To illustrate how futile all this is, suppose I told you about an aspiring plumber who spent several years memorizing the parts catalogs of the major plumbing supply companies, could translate the catalogs written in other languages, and could recite in detail the history of plumbing all the way back to ancient Babylon, yet had not bothered to apprentice with anyone who actually knew how to use the specialized tools needed for removing and installing various kinds of pipes and the circumstances where each might be appropriate? Is this insane or not? I rest my case.

When electronic calculators were first introduced to the general consumer market in the early 1970's, many white-collar professionals like accountants expressed fears that their jobs would be at risk, as computers progressively took over an increasing array of repetitive and boring tasks. That has not yet happened, even after 50 years. There is no doubt that calculators have changed the face of every field that involves mathematical calculations and even jobs that formerly did not depend on such calculations. As computing became faster and cheaper, the range of applications for its services has expanded at a faster rate than the computing technology itself has improved. While there are no guarantees for the future, science-fiction promises of truly intelligent computers that can replace human judgment have been vastly over-hyped, and in areas that developers have been over-eager to replace human judgment entirely, disaster has often been the consequence.

From the years that I first studied traditional Chinese medicine ("TCM") in the mid 1980's, I recognized that it held some profound secrets that were only hinted at by a few of my early teachers. Dr. C.S. Cheung, one of my first teachers, long-time mentor and colleague, perhaps came the closest to pinpointing the essence of Chinese herbology as the art of identifying complex patterns from the clinical data of symptoms and signs. Chinese herbs themselves are not really that special; useful and potent herbs can be found in every continent. It is the sophisticated system of pattern-recognition logic that makes Chinese herbology unique among all the world's herbal/medical traditions; no other system even comes close to its level of detail. However, as Dr. Cheung pointed out, very few students of Chinese herbology have ever really mastered it; even the ancient master herbalists of their day commented on this. For more information on this problem, read:

  • http://www.rmhiherbal.org/aa/f-ahr2-educ.html
    Modest proposals for improving traditional Chinese herbology education
    See especially subsections:
        The experiences of self-study of Yue Mei Zhong
        The five levels of attainment as a TCM herbalist

Over the past 25 years, I have thought about this problem and discussed it at length with colleagues; numerous articles on our website have been a spinoff of this effort. I now believe that I can explain in mathematical detail why this has been the case and have proposed a very specific set of solutions to dramatically improve common understanding of its core principles. We have already implemented one solution that has been in use since 2000 - the TCM Herbal Tutor software. The second major breakthrough in this process is the recently completed AutoSage-TCM expert system software and the textbook and user's guide that accompanies it.

Twentieth-century mathematicians and cybernetics pioneers like Alan Turing, Norbert Wiener, Claude Shannon, and Bertrand Russell all recognized that any type of information (e.g.: mathematical equations, human language, visual images, sound recordings) could be reduced by encoding to a sequence of numbers. When computer technology became widely available, the internal number format most convenient for use was the binary system of 0's and 1's, reflecting the underlying physics of transistor logic in which a circuit state could be easily and quickly flipped from "on" to "off". Such state transitions could in turn trigger changes in the transistor circuits connected to it, thus allowing not only the storage of information as numbers but complex logical and mathematical operations on this information.

Within the previous year, we have been putting the finishing touches on expert-system software that we have christened "AutoSage-TCM". It represents 25 years of work, beginning with an early, aborted attempt in the early 1990's, after I recognized that Chinese medicine was far more sophisticated than I had ever suspected. Over a decade would pass as I thought about the problem, discussing it with close colleagues in TCM, computer science, signals processing, and mathematics. That was probably just as well, because the current algorithm implemented by AutoSage-TCM would have required over 100 hours of CPU time only 20 years ago on a typical desktop computer of that era. Hopelessly slow. Now it requires only a few minutes of CPU time to process a single typical clinical case report.

In the textbook and user's guide to AutoSage-TCM, I include detailed explanations of the logic underlying pattern recognition in traditional Chinese medicine. This entire textbook volume will be included in the Free option of future versions of HerbalThink-TCM. There are several reasons for this, but the top reason is that I feel it is important to get this information out to a large number of people.

How will this affect previous and future RMHI graduates?

  • Enhanced public recognition of your skills:
    Regardless of whether you ever take advantage of AutoSage-TCM or not (perhaps you generally dislike computers), the increased public awareness of what accurate TCM pattern assessment should be will only enhance your credibility with the public. For many years, many people would assume that state licensing of acupuncturists, national certification by the NCCAOM, and other certifications promoted by the acupuncture profession are guarantees of minimum competence standards. That is simply not true. For many years the following webpage has been posted on our website:
        http://www.rmhiherbal.org/aa/c-healthqa.html
        How to choose a Chinese (TCM) Herbalist — How to recognize quality TCM herbal health care


    On that page I outline the basic steps that any TCM herbalist should be performing before even considering recommending an herbal formula or any other advice: symptom history, tongue inspection, pulse palpation, etc. It is astounding to me how many practitioners claiming to be trained in TCM who do not do any of these. Years ago a friend of mine needed a referral in another state; not knowing anyone, I referred to my NCCAOM directory and found 6 names. Before making an appointment, I advised him to verify that these individuals followed the basic guidelines outlined on that webpage. He reported back to me that all 6 practitioners offered to provide him with an herbal formula for his quite serious medical condition, without even taking a symptom history, without inspecting his tongue, and without any pulse palpation. It was that year I tossed my NCCAOM directory into my woodstove. In recent years, I've heard from an increasing number of people who have had similar experiences.

    From the very beginnning, RMHI has had straightforward but uncompromising standards for graduation. I will stand behind all of our graduates. Though we have never been accredited, a member of any confederation of schools or professional organizations, many people are now recognizing that RMHI has more exacting standards than almost any other school in the world. (I also refuse to accept any students who cannot or will not do the required work and preparation. Too many of our colleges and universities have become diploma mills whose standards have drastically diminished to ridiculous levels. We have far fewer students that during the 1990's, but my recent efforts have been focused on completing the expert system. Now, I intend to turn back my focus toward attracting qualified students; I know they are out there, I just need to find them.) To my knowledge, no other school offers potential applicants a self-administered aptitude test that measures the one skill that is absolutely essential to make TCM work - the ability to recognize and evaluate complex patterns within random groups of symptoms. Due to the decline in the public education system, as well as likely mass poisoning from multiple toxic chemicals (causing brain damage), I estimate that only about 10% of the current generation of young people are capable of passing our admissions test.

    So the bottom line is that if you are an RMHI graduate, you can expect that increased public awareness of what accurate TCM pattern assessment should be will only enhance your own credibility and reputation, even if you have a disdain for computer technology and graduated before we ever introduced the HerbalThink-TCM reference software, interactive games, and the AutoSage-TCM expert system.
     
  • Available of software tools to help you educate the public and to expand your practice
    When I first started my practice in the university town of Boulder, Colorado (it was my childhood home), I was apprehensive. Boulder was a New-Age mecca with every type of holistic practitioner under the sun, and the thought of all this competition was depressing. Fortunately, teaching classes and writing have always been my strong points, so I took advice from some close friends and did not waste any money on advertising. I started offering classes in basic TCM pattern recognition, Eight-Principle-Patterns type stuff, and showed people how even this very crude system could help them make major refinements in the way they chose herbs and foods for themselves on a day-to-day basis. A local community college became interested, other herbalists expressed interest in joining me, and my practice expanded to nearly full time within 2-3 years. At that time, there were very few good textbooks in Chinese herbology, so the general public had to be educated from the ground up.

    All of you now have the advantage that your own credentials are effectively displayed on RMHI's website. Curious website visitors, potential students, and potential clients of your own can visit our website, check out our requirements, and download the Free version of HerbalThink-TCM. They can examine in detail exactly what you had to learn, and most will quickly realize that what we offer is several cuts above the vast majority of TCM schools.

    When AutoSage-TCM becomes publicly available (estimated release date is 2016 September), I plan to make it available at a significant discount to RMHI graduates and to any TCM herbalist who can pass the equivalent of our Level-1 exam. This will allow you to resell the report to your own clients along with your consultation services, education, and advice. You can examine a sample AutoSage-TCM report here:
        http://www.rmhiherbal.org/herbalthink/autosage.html
        Essentials of Expert-Systems Pattern Recognition for Traditional Chinese Medicine: User's Guide to AutoSage-TCM
        [see 'Sample Report' link about half-way down page]


    Also, if you teach classes to the general public, you are encouraged to refer students to our website to download the Free version of HerbalThink-TCM. The beginning level interactive games are accessible within the free version, and you can assign students to complete these as a way to learn your lecture material. A lot of people will benefit by some initial help navigating the software controls, so be prepared to help students with installation, setup, and showing them a few sample games to get them started.
     
  • Any RMHI graduate is welcome to join the rmhinetwork email discussion list at no charge:
    At this time, I plan to continue offering this as a free service to all RMHI graduates as long as I am able. You can use this list to discuss cases, software issues, how to use it as an educational aid in your own classes, etc. I also provide a lot of updated material on diet, environmental health, health politics, and other stuff that I was ignorant of during my early days of teaching, so some of you early graduates of RMHI will find this material useful. Especially my information on heavy metal toxicity, of which in the early 1990's I knew very little.
     
  • AutoSage-TCM will gradually take a greater role in grading case reports in Level 2 (Supervised Internship):
    These reports will allow students to effectively grade their own pattern evaluations, then submit to me a summary of how close they think they came to the report's answer, detailing any mistakes that they made. An important part of gaining experience is to be able to evaluate and correct one's own knowledge and skills, learning from mistakes.

    Initially, this process will have to be closely monitored to ensure that AutoSage-TCM is really accurate, but in early tests, it has seemed to surpass the level of precision and accuracy that most humans can provide. And it can do a much more thorough breakdown of the logic and reasoning that I could ever hope to do. The best analogy I can make to this is that of mathematical calculation - I can multiply or divide two 20-digit numbers, but it is tedious and boring to do so. I can easily estimate the result, but the computer will always be quicker and more accurate.

    What AutoSage-TCM will NOT do is to tell the user what to do with the pattern assessment. One will still have to have a high level of understanding of TCM theory to know how to plot a reasonable clinical strategy, track down environmental health and diet factors in the client's situation, etc., and that is where I will continue to offer my expertise.
     
  • Change in our admissions policy to be college-degree-neutral:
    15 years of statistics of RMHI student performance have made it crystal clear that the number #1 factor in predicting clinical ability is the ability to recognize and evaluate complex patterns within random subsets of symptoms. We have proven repeatedly that all the following are irrelevant:
    • knowledge of and ability to read traditional Chinese literature in the orginal Chinese language
    • ability to memorize long lists of data
    • academic background in anatomy and physiology
    • college-level degrees
    That will fly in the face of the current beliefs of many TCM college administrators and practitioners, but we have the solid numbers to prove it. RMHI graduates who have completed the one-year-long Level-1 program consistently demonstrate ability to analyze complex cases with multple syndrome-patterns at the very beginning of their internship period. This is a skill than many certified and licensed TCM practitioners NEVER learn, yet it is absolutely essential for understanding the frequently complex patterns that are seen in industrialized nations that have experienced multiple forms of toxic pollution, an increasingly industrialized and unhealthy food supply, and iatrogenic medical systems.

    Beginning in 2016, RMHI will no longer require academic background in anatomy and physiology. Passing our admissions aptitude test is far more important than any other single factor. In fact, completion of college-level courses of any type is irrelevant. (In this we are merely following the lead of major corporations like Google, who have stated as much with respect to applications for employment at their companies.) We have found that students who study anatomy and physiology on their own often develop a much healthier relationship to this knowledge than students who have completed formal college courses. They are less likely to treat the information learned as dogma and seem better at recognizing when and how to use it to solve practical problems. Instead, anatomy and physiology will be integrated into the Level-1 curriculum at RMHI: students who have not yet studied this subject will be required to submit a short paper each month on a subject of their own interest and choice, preferably related to a health problem of interest or question that has arisen in the course of their TCM studies. These articles will be posted for others in the RMHI discussion network to read.
     

The economics of TCM health care - ancient China vs. now

I have never been one to assume that the status-quo methods for doing anything are either correct or desirable. Ever since my childhood I always had some awareness of the Matrix of Illusion that was continually being spun around me. Religion, politics, the medical-industrial complex, corruption in the legal profession, the self-contained ivory-tower delusions of academia were ideas I grew up with; my grandfather was one of the very early conspiracy theorists. Now that the Internet is waking people up on a mass scale, I am relieved that I can now discuss many of these subjects without inducing states of cognitive dissonance in my listeners and readers.

Let's consider some of the economic, political, and social reasons why traditional Chinese medicine has for many centuries been transmitted by the terribly inefficient means of rote memorization, which modern educational psychology studies have repeatedly shown results in generally poor levels of comprehension and cognitive ability. The information may be retained like religious dogma in the minds of its students, but very few come to understand and utilize this knowledge at a high level of competence. But so what? If you, the emperor of China, require that only a tiny percentage of herbalist-physicians ever fully understand what they have memorized, then a system of education by rote memorization may serve your purposes quite nicely. After all, if there is a limited supply of rare and valuable herbs like Ginseng and Cordyceps, why train large numbers of people to understand and appreciate their use? Better to keep the highest knowledge of Chinese medicine restricted to only a select elite, who can pass the rigorous medical exams required of all physicians allowed to treat the royal family and the nobility. Rote memorization has long been used in Asia as a tool of social control, to train a population of compliant subjects who do not question authority and can no longer even think to question it.

Fast forward to our modern era of medical technology and pharmaceutical corporations: while the methods of medicine have changed radically, the underlying motivations have not really changed that much. It is still highly profitable for the controllers of society to keep people ignorant of how their monetary and legal systems are manipulated for the profit of a few, how their foods and medicines are contaminated with poisons that guarantee huge profits for the medical-industrial complex, and how their religions are manipulated to keep the population in fear of hell-fire if they get out of line and to fear people of alien cultures and religions. So the question is how does this affect the education of so-called "alternative" forms of health care, which, if effective, might prove to become a threat to the system? Simple, the formula has not altered much for thousands of years: Offer practitioners of those methods social and economic status by licensing them, regulating their schools to "improve" quality, and offering reimbursement through insurance and government health plans like Medicare and Medicaid if they toe the line and do not become too independent. After accepting these economic and intellectual constraints, it will be easy to infiltrate the bureaucracies that control these schools to dumb down their curricula, expunge anything of real value, and gradually substitute modern medical notions. This has happened in all the so-called alternative health professions over the past 100 years: acupuncture, naturopathy, chiropractic, osteopathy, massage therapy. Each time some new upstart makes major breakthroughs, its profession is offered the promise of more status and greater economic benefits in exchange for regulation and licensing. I repeatedly hear old-timers in each of these professions bemoan how their professions have deteriorated and younger practitioners seem content to be merely second-rate varieties of medical practitioner.

A possible solution to this cycle of control and corruption has been already revealed by the Internet. Millions of people worldwide have learned to circumvent the former hierarchies of control and share information directly with other ordinary people seeking answers.

That is the key to how Chinese herbology has to evolve if it intends to remain relevant. Practitioners must reach out to the public, of which a rapidly growing percentage is demanding significant involvement in their health care; they wish to know the how, why, and wherefore, and to be involved in all decision-making. AutoSage-TCM will finally make available to all a detailed means for verifying the pattern-assessment skills of their practitioners and whether they are adhering to correct protocols of traditional Chinese herbology. I fully expect that RMHI graduates will come out looking good when the dust settles.

Interesting reading

For anyone who is seriously considering studying traditional Chinese medicine, I highly recommend the following 13-page essay by Heiner Fruehauf:

  • [a1] Fruehauf, Heiner; "Chinese Medicine In Crisis: Science, Politics, And The Making Of 'TCM'"; 1999.   Originally published in The Journal of Chinese Medicine, 1999 October.
    Due to its importance, multiple copies of this article seem to continually appear, disappear, and reappear on the Internet. Rather than include a link here that is likely to go bad, the reader should do a Google search for:
        Heiner Fruehauf, Chinese Medicine In Crisis: Science, Politics, And The Making Of TCM
    Following is a currently (2016-10-15) available link:
          http://chineseclassics.org/j/images/tcmcrisis.pdf

Though I attained a Ph.D. in Biomedical Engineering and worked in medical research prior to studying Chinese medicine, I generally agree with Fruehauf's observation that naive scientific-materialistic attempts to modernize traditional Chinese medicine have been a disaster in almost all respects. I would only add the following observation: The Chinese Communist bureaucrats who destroyed traditional Chinese medicine and substituted it with the stripped-down and zombified version they designated as "TCM" abused the true scientific method by applying the methods of cybernetics and information theory to a subject they neither respected nor understood. Like a set of carpenter's tools, cybernetics is merely a set of tools, which can be used constructively to build useful and wonderful things; these same tools can also be used to commit murder. As thousands of alternative investigative journalists have revealed over the past few decades, scientist and academics have shown a penchant for corruption, fraud, and a willingness to distort the truth just as readily as politicians and corporate executives when vast amounts of money and power are at stake.

While I am in agreement and sympathy with Fruehauf's assessment of the situation, I would merely point out that without integrity, any set of intellectual, philosophical, and spiritual paradigms may be abused to produce a result that destroys life, promote lies and deceptions, and results in a general disintegration of human culture.