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— updated 2019-01-21


Herbalists' BootCamp
Beginner Tutorial #7:   AutoSage-TCM

by Roger W. Wicke, Ph.D.
These BootCamp tutorials will help you get started using the HerbalThink-TCM software, ensure it is installed correctly, demonstrate how to use important features and modules, and teach you basic principles of Chinese herbology that you can begin applying practically. Successful completion of this series is required for all applicants to the RMHInet brainstorming network and to our professional courses.

Copyright ©2016-2019 by RMH-Publications Trust; all rights reserved.

Jump to another tutorial in this sequence:
#1: Introduction, Download #2: Setup and Documentation #3: Self-Study Reference #4: Herbal Tutor #5: Pulse Simulator #6: CaseQuery #7: AutoSage-TCM #8: Completing member/admission requirements

Subtopics on this page…


Tutorial #7:   AutoSage-TCM

Estimated completion time:   6 hours

CaseQuery and AutoSage-TCM together comprise expert-system software for automated pattern recognition of the clinical syndromes constituting traditional Chinese medical (TCM) pathophysiology theory, including quantitative assessment of complex cases characterized by multiple simultaneous syndrome-patterns.

CaseQuery allows users to record detailed case histories of symptom, tongue, and pulse data. Case record files are created in a standardized format that can be read and understood by the AutoSage-TCM analysis software. The user then emails this data file to RMHI, where it is processed by AutoSage-TCM, and then a detailed, cross-referenced report is emailed back to the user.

Both CaseQuery and AutoSage-TCM are described in much greater detail in TCHS Vol.6: User's Guide to AutoSage-TCM. Chapter 7 of that text includes instructions for CaseQuery users and a series of screen shots. It may be helpful but not necessary to read any of that material before completing this tutorial.

For an overview and introduction to AutoSage-TCM:


Questionnaire #7 — copy this form

  • Copy and paste the following into a text document using any simple text editor (Mac OS X: TextEdit;   Windows: WordPad, Notepad). During this tutorial, fill in your answers between the [[[ ]]] marks — please leave these marks intact.
  • Most questions will require simple, short answers. These questions are designed primarily to ensure that you know how to access the appropriate material within each module and to interpret it correctly.
  • Now you are ready to actually begin the tutorial. Follow the instructions in the remainder of this tutorial, and then fill in your answers to the questionnaire when asked to do so.
  • Please email this tutorial questionnaire to your assigned BootCamp tutor (the person who emailed you the original download instructions — Tutorial #1) and wait for a reply/feedback before continuing with the next tutorial.
                             [updated 2018-07-24]

YOUR FULL NAME:  [[[  ]]]

--------------- AutoSage-TCM, a simple case:
A-00: What is the gender and age of the individual in case #C102b_20161123 ?
(Note that this case is DIFFERENT from the case file you created for CaseQuery.)
    [[[  ]]]

A-01: What is the EXACT value of his body-mass index (BMI)? (See the first 
encoded symptom, near the beginning of that entry -- in light gray text.)
    [[[  ]]]

A-02: What does the 2nd encoded symptom say about the quality of fever? 
State your short answer in plain English.
    [[[  ]]]

A-03: What is his pulse strength at position L1? (Remember to interpret the 
'shorthand' notation correctly, i.e.: mild Moderate SEVERE EXTREME!!.)
    [[[  ]]]
    Hint:   See the link  'All pulse parameters summarized, by position'  
    for a display of the pulse qualities in the same format as in the 
    CaseQuery  'PULS'  tab.

A-04: What is unusual about the pulse at position L2? (Why are there two 
sets of data lines specified here instead of the more typical single line?)
    [[[  ]]]
    Hint:   You may wish to refer back to the  'PULS'  tab within 
    the CaseQuery program to review the instructions for encoding pulse 

A-05: One of the tongue tissue colors is specified to be 
'TONGaTISCOLOR_1_red_d1s'. Find the link to the corresponding color sample. 
In what way does this color differ from normal — hue, saturation, and/or 
    [[[  ]]]
    Hint:   You may wish to refer back to the 'TONG' tab within the 
    CaseQuery program to examine the color table for tongue-tissue colors. 
    Also, you may wish to review "The HSL color-space model explained"
    in the Supplements to tutorial #6.

A-06: What portion of the tongue is specified to be the preceding color? 
(Which sectors/rows?)
    [[[  ]]]
    Hint:   Click on 'TongueMap' to see a map of the selected sectors,
    much easier that attempting to interpret the encoded text.

A-07: Referring to the section "Syndrome-pattern analysis summaries: 
ByProductOf_MAGN_RANK_PROB__overThresholdOnly", list the top-scoring 
dominant (1st-tier) syndrome followed by its importance score, 'product 
    [[[  ]]]

A-08: Examine the reasoning behind the conclusion for the top-scoring 
dominant syndrome.
   How many of its active symptom variables have scores for RANK_raw 
≥ 1.0? (List them here by copying and pasting.)  [[[  ]]]
   What is this syndrome's probability score and why is it relatively 
high? (Hint: examine the competitor syndromes.)  [[[  ]]]

A-09: Likewise, list the only other dominant syndrome followed by its 
importance score, 'product of MAGN*RANK*PROB'.
    [[[  ]]]

A-10: Likewise, list the three 2nd-tier syndromes followed by their 
respective importance scores, ***in order of importance***.
    [[[  ]]]

A-11: Referring to the section "Detailed analysis of all syndromes, 
by functional group", find the syndrome 'ORGU_5_DeficiencyOfHeartYin' 
and examine its detailed analysis.
   What is its importance score (MAGN*RANK*PROB)?  [[[  ]]]
   Why is its score so low in spite of a number of its symptom variables 
being significant? (Hint: examine the competitor syndromes and their 
effect on the probability, PROB.)  [[[  ]]]

--------------- AutoSage-TCM, a complex case:
B-01: What is the complexity score for case #C901_20161123 ?   Note that 
this is a DIFFERENT case ('example of a complex case') from the one for 
A-series questions.
    [[[  ]]]

B-02: What do the instructions (see 'Complexity metrics') say about complex 
cases and designing clinical strategies for helping them?
    [[[  ]]]

B-03: What are the three dominant (1st-tier) syndromes in this case, 
listed ***in order of importance***?
    [[[  ]]]

=============================== END ===========================================

Autosage-TCM, a simple case

In the first part of this tutorial, you will be reading the AutoSage-TCM analysis report for case #C102b_20161123   (link opens in a new window).
Note:   this case is different from the case you completed for CaseQuery, in the preceding tutorial and is a fictional composite of a number of real cases.
After reading the instructions,  How to use this report , contained within that report, answer the questions in the questionnaire.

Refer to the report's table of contents to find specific sections. In the  Summary of original case record  section, you will find the complete set of encoded symptom data, listed in a standard order identical to its sequencing within the CaseQuery tabs. To start with, go to that section now, read  Encoding of symptom-sign data explained . Remember to jump back to the table of contents when you need to find a different data section.


—>>  Questionnaire — AutoSage-TCM, a simple case

Please answer all questions in section A of the questionnaire.


Followup — what actually happened in case C102b ("a simple case")

Over a period of several years, the author, Wicke, had provided consulting services to former students and RMHI graduates in three very similar cases occurring during epidemics of hemorrhagic fever, each in various tropical countries. In each case, the practitioner sought advice after hospital physicians had declared all the administered antibiotics a failure and the patient likely to die within days. In each case, standard Chinese herbal formulas for Ying- and Xue-stage syndrome-patterns were then given, with only slight modifications, and fevers of over 105 deg.F. diminished to under 100 deg.F. — 40.5 to 38. deg.C. — within 3 to 12 hours; other symptoms also resolved (including one case of imminent kidney failure associated with dengue fever), and the patient was released from the hospital. All three cases recovered fully within another week.

When a single TCM syndrome-pattern clearly dominates, uncomplicated by secondary syndromes of a quite different nature, the herbal textbooks point to a standard class of Chinese herbal formulas for such cases. Such cases are said to be "simple", because the assessment is clear. However, "simple" implies nothing about the relative severity of such cases, which can range from the benign to the life-threatening. (Ying- and Xue-stage patterns, by their nature, are inherently dangerous conditions, except in the very mildest of cases.)


Autosage-TCM, a complex case

The first case you worked with in this tutorial was relatively simple. The dominant patterns of that case were all clustered around the main theme of "DampHeat". Graduates of RMHI's Level-1 course will be able to easily recognize the dominant pattern, because the symptoms are very close to its textbook definition. The first test of any expert system is to double-check that it can achieve accurate identification of simple test cases. If your client has a clearly dominant syndrome pattern that closely matches the textbook, you will not need to use AutoSage-TCM, except perhaps to demonstrate to a skeptical client that you know what you are doing.

In contrast, an increasing number of people are now experiencing very complicated symptom pictures that do not clearly match any textbook pattern. These are typically people who may have received conflicting medical diagnoses from a series of doctors who have prescribed multiple pharmaceutical drugs and therapies. Designing expert systems to analyze such cases has been exceedingly challenging and the vast majority of TCM expert systems have succeeded in identifying only the single dominant pattern, which falls far short of what is really necessary in such cases. AutoSage-TCM is a revolutionary system for providing accurate, quantitative estimates of the magnitude, rank, and probability of each of the multiple dominant syndromes that may coexist in a complex case.

Refer to the AutoSage-TCM analysis report for case #C901_20161123   (link opens in a new window).


—>>  Questionnaire — AutoSage-TCM, a complex case

Please answer all questions in section B of the questionnaire.


Followup — what actually happened in case C901 ("a complex case")

[This section is optional reading — contains advanced material.]

This case was extremely challenging. Though the individual was only moderately debilitated and though the multiple TCM syndrome patterns present were mild, these patterns were persistent and seemingly resistant to various changes in diet, personal habits, and multiple herbal strategies. For many years, it had been suspected that parasitosis (in this case, the syndrome JueYin Parasitic Evil) was at least a partial factor. However, the classical formula Wu Mei Wan, when tried on multiple occasions, had no beneficial effect, though few negative effects were noted either. (Wu Mei Wan is considered a general-purpose antiparasitic formula appropriate for the syndrome-pattern of JueYin Parasitic Evil.) Because of that, and the simultaneous presence of multiple other syndromes, the practitioner chose to focus more on the other patterns, including TaiYin Evil, DampHeat of Urinary Bladder, Sinking of Spleen Qi, yet with little progress. Frequent urination with insomnia and highly disturbing dreams persisted.

After completing the first thorough AutoSage-TCM analysis, it was clear that JueYin Parasitic Evil was indeed the dominant pattern. The analysis report motivated the practitioner to further ponder and to research the parasitosis angle. From a careful analysis of the symptoms, which included bouts of watery diarrhea, and comparison with symptom-sign pictures for infestation by distinct parasitic pathogens, it became evident that some form of protozoal infection was likely, for watery diarrhea is a common symptom of infection by Entamoeba histolytica and Giardia spp. The protozoa are single-celled organisms, in contrast to most other parasites which are multicellular worm-type organisms. In researching the antiparasitic properties of the ingredients of Wu Mei Wan, it was determined that while this formula has broad-spectrum antiparasitic activity against many types of macroscopic worm parasites (helminths), it is not that effective against protozoa. In searching for herbs that have strong anti-protozoal properties, it became evident that many of these herbs constitute a distinct class from the anti-worm (anti-helminthic) herbs. After a thorough Internet search and a perusal of the scientific literature, several herbs were chosen that seemed to possess strong anti-protozoal activity: neem leaf (Azadirachta indica) and kutaja (Holarrhena antidysenterica), which are two herbs used in Ayurvedic medicine. Both the preceding herbs are very bitter and thermally "cold" in a TCM sense, so to preserve the general design of Wu Mei Wan, with its extremes of very sour, hot-spicy, and cold-bitter, additional hot-spicy herbs were chosen that also have significant anti-protozoal action: chili peppers (Capsicum annuum) and Szechuan pepper (Zanthoxylum bungeanum). Ginger, black pepper, turmeric, and apple cider vinegar were added as assistant herbs to warm the Interior and circulate Qi and Blood.

Upon taking a dose of the preceding anti-protozoal formula, which preserved the overall sour/spicy-hot/bitter-cold design of Wu Mei Wan, but substituting more effective anti-protozoal herbs, the client experienced almost immediate effect. Within 30 minutes of taking the first dose, pronounced intestinal borborygmus was heard followed by a sensation of relief in the abdomen. That following night the client experienced relatively undisturbed sleep with reduced urgency/frequency of urination after many years of insomnia and frequent waking to urinate. The following day, the watery diarrhea had stopped and stools were well-formed and normal. (From these facts, it was speculated that the syndrome pattern of DampHeat in the Urinary Bladder was directly related to the JueYin Parasitic Evil and that perhaps the same protozoal parasites were responsible for many of the symptoms including urinary urgency and frequency.)

Over the next two years, the preceding formula was modified slightly and alternated with tonic-supplementing formulas to restore the Qi and Yin and to protect them from the harshness of the antiprotozoal formula. Bouts of disturbed dreams and night urinary frequency periodically recurred, though with significantly lessening severity with persistence in using this herbal strategy. It is widely acknowledged that chronic protozoal infections can be notoriously difficult to treat, regardless of the method used, whether by conventional, herbal, or naturopathic medicine. My own experience is that herbs can be quite effective with this condition, but a one-size-fits-all approach is often a hit-or-miss proposition. Cleverness, persistence, and self-reflection are required, because the strategy must often change from week to week depending upon the exact symptom pattern manifestions at the time. In this case, consideration of the specific antimicrobial actions required was also a key factor in arriving at a successful herbal strategy.

Additional points relevant to this case:

  • As with many chronic conditions, the TCM syndrome-patterns must be considered in choosing herbs to avoid side-effects and improve chances of success. Based on personal reports of numerous clients over the years, the preceding approach can often be more effective in the long run than the one-size-fits-all standard of treatment with pharmaceuticals.
  • Not all cases of medically diagnosed parasite infection will manifest as the TCM syndrome-pattern "JueYin Parasitic Evil"; there are many other possibilities (e.g.: most commonly, disharmonies affecting the Spleen, Liver, and Intestines), and the herbal formulas and strategies for each should be ideally optimized to match both the TCM syndrome-pattern(s) present and the identity of the parasitic pathogen, if known or suspected.
  • Medically, parasitic pathogens are known as great imposters, inducing symptoms that can mimic those of many other diseases; therefore, if exposure to parasitic organisms is suspected in the patient history, and clinical progress is resistant to standard strategies, it may be prudent to consider the possibility of parasitosis and other more exotic factors.
  • In the author's experience, medical/lab tests for parasites such as stool cultures are notoriously prone to under-diagnosis, and some reports suggest that rates of 70% false negative results may be common. In other words, parasitic pathogens may be factors in patient symptoms even though routine lab tests for such pathogens reveal nothing abnormal. As in pre-modern times, choosing herbal strategy based purely on symptoms and signs may eventually lead to successful solutions, as in the preceding case.

Summary of what you learned in this tutorial

The AutoSage-TCM expert system can analyze a CaseQuery report file to produce a detailed analysis of the syndrome-patterns, allowing you to determine the dominant patterns and to examine the exact reasoning behind those conclusions. As a teaching tool, it accomplishes the equivalent of many hours of private tutoring and hand-grading by human instructors, allowing human instructors to focus their efforts on explaining higher-level meta-patterns and clinical experience.

Please submit your completed questionnaire for this tutorial, wait to receive feedback from your assigned tutor, then go to  Tutorial #8:   Completing member/admission requirements