A Review of the TCHS Self Study Course
by Todd Luger, L.Ac.
I have been reviewing various databases and search engines for the past few weeks. I have come across a couple of examples of databases and/or software that begin to meet some of the challenges posed by educators and clinicians in ongoing online discussions on this topic in recent months. The first of these databases I have reviewed is found in an offering from the Rocky Mountain Herbal Institute. The databases are contained in RMHIs Traditional Chinese Herbal Sciences (TCHS) - Self-Study Course 2.0.7. This review will cover the Self-Study course, with its TCM databases, plus the Herbal Tutor and Pulse Simulator software. TCHS was created by Roger Wicke, a CHA member and longtime teacher and practitioner of Chinese Herbology. Roger was a student of the renowned CS Cheung, with whom he still collaborates. Prior to studying TCM, Roger graduated from MIT with a Ph.D. in engineering and was involved in medical research. He has been involved with software and computers for several decades. His writings span many health-related topics.
I first became familiar with Rogers work in the mid nineties, when I stumbled upon his course in Chinese Herbology in the OCOM library. I immediately noticed Roger was one of the first in our field to begin to talk about the relationship between system and information science and TCM. He presented his materials to his students as a language of life. A language one had to learn by first setting aside preconceptions acquired through modern education. But rather than substituting the indoctrination of western science with some new age mysticism, Roger offered a rational methodology grounded in the concepts of inductive and synthetic thinking (an approach also taken by European author Manfred Porkert) taken to a new level of sophistication with the addition of insights gleaned from information sciences and systems biology. Roger was also one of the first in the field to write about the importance of centering education around problem solving and cases.
TCHS is a complete self-study course and much more. It is very user friendly compared to most databases because it is programmed in a format similar to many webpages. Anyone who can use the internet can easily master the navigation of TCHS in a short period of time. Because it is merely a series of linked webpage files, it is easily loaded and viewed on any computer with minimal system requirements. TCHS also includes a free version of the Herbal Tutor Lite software. The Herbal Tutor adds much more powerful search, case analysis and educational tools. Below is a list of the TCHS highlights, with editorial commentary.
The self-study course is set up as a series of lesson plans designed to supplement formal training or be used as a study aid, though the various databases included in it may be used in numerous ways. The lesson plans follow the same sequence as Rocky Mountain Herbal Institute's (RMHI) more extensive two-year training program. The CD includes the entire two volume TCHS course materials that are used in the RMHI program. Volume 1: The Language and Patterns of Life and Volume 2: Herbs, Strategies, and Case Studies, materia medica, case examples. Both html and PDF versions are included. This comprehensive residential course covers all the foundations necessary to practice Chinese Herbology: Basic theory, materia medica, syndromes, formulas, treatment of complex cases. It also cover topics of considerable importance, such as diet and environmental toxins. The 2 year RMHI course also includes a lengthy clinical internship. The TCHS self-study course is not meant to replace such formal training or apprenticeship and, by itself, only lays a foundation for deeper study. In order to effectively apply this material, supervised clinical training is essential.
The material covered in the self-study course and companion databases is similar in scope to that covered in the combined contents of a basic theory text (like Fundamentals or Foundations), a materia medica, a formulary, a case study text. But it is Rogers commentary and style of teaching that make this course unique. Presenting each new aspect of this foreign language of life, Roger goes to great lengths to get his point across to an audience that that may have little familiarity with the material. In doing so, he succeeds admirably. In writing this, I am reminded of the new burdens of teaching TCM in the early 21st century. Many teachers have expressed concern that current students have little exposure to eastern philosophy or holistic medicine before entering school. Roger provides a solution to this dilemma in his materials by teaching not only the data, but staying ever focused on understanding this new language. Subhuti Dharmananda took a similar approach in his own course in Chinese Herbology, which I studied prior to acupuncture school and still attribute a great deal of gratitude in laying solid foundations for me.
Speaking of language, everyone is always interested in what terminology is used in any form of clinical or educational materials. It largely conforms to that used in Bensky. One of the goals of the course is to help students prepare for board exams, so the standard reference makes sense in that regard. There are also influence from Dr. Cheung, such as things like wet-heat. For those who are not satisfied with Benskys choices or insist they obscure meaning, never fear. In a solution the late Jim Ramholz would have loved, the herb databases allow you switch between pinyin, latin/english and chinese characters. So there is never any question what the source term was for all the herbs, formulas and even syndromes. No doubt some will still not be satisfied that all the symptom lists are not in Wisemanese, but many of the more unusual terms were translated by Dr. Cheung. While not a current standard, Cheung did have his own standards, which were generally regarded as both accurate and connotatively transparent.
What gives the TCHS course its great power and flexibility are the various databases included in the CD. The TCM Database is an extensive cross-referenced database of symptoms, TCM syndromes, herbs, and classical herbal formulas. It includes the following data in alphabetical and other useful forms. A Symptom-sign cross reference, with symptoms organized by categories such as sensory or sleep or pulse. Clinical syndromes are organized by categories such as 8 principles, evil factors, zang-fu, etc. Herbs are classed optionally by primary function, pharmaceutical, mandarin or common name. Formulas by primary category, common, English or Mandarin name. All of the data in each file can also be displayed in a convenient browser format for quick scanning of comparisons and contrasts between similar information.
There is also a Clinical Case Database. Over 60 real clinical case studies are analyzed by TCM pattern, with recommended herbs, formula, and results. The cases are all fully cross-referenced with the TCM Database, so any herbs, formulas or patterns indicated can be easily accessed for further study. The cases are all drawn from the writings of CS Cheung and are typically complex real life cases, often those where treatment of prior physicians had failed. They provide a wealth of information often not easily found in the English literature of TCM. But the database takes the traditional case study format and catapults it into the 21st century with the power of digital cross-referencing.
Also included in the course are articles on various Special topics: legal, political, and social issues concerning practice of herbal health care, using western herbs, nutrition and diet, health news disinformation. RMHI also provide the latest articles as a free download for all who order Self-Study Course - these include: "Overcoming heavy metal toxicity" and "Introduction to diet and nutrition, checklists and guidelines". These are informative, provocative and cutting edge articles otherwise only available for a fee. Roger Wickes explorations in heavy metal toxicity, music therapy, regulatory issues and more are unparalleled in the field. They are a must read for all serious practitioners who believe TCM theory can transcend it normal boundaries and, if applied with proper rigor, still remain true to the tradition at the same time.
The TCHS course also includes a trial version of RMHIs piece de resistance, the Herbal Tutor software (HT). HT takes the same information in the various TCM databases and organizes it in tables that can be searched and sorted using the power of boolean logic. Many of you understand boolean logic as the ability to search for terms linked such as AND, OR, IS. Medline uses such a system, for example. This means that one can find citations for only those entries containing all the terms listed (AND) or those that contain any of the terms listed (OR) or only those that contain the exact phrase as written (IS - typically denoted with open and close quotation marks). However, in the most general laypersony kind of way, boolean merely means the ability to enter multiple search parameters simultaneously in some organized fashion.
In the HT software, one can open tables of either syndromes, herbs or formulas. Then one can sort and search these tables according to a wide range of parameters. For example, when looking at a formula table, one can either enter data or select from possibilities in fields defined as functions, categories, herbs, syndromes, etc. Then one can search the list for the highest correlation of the entered parameters. The tables can also be sorted alphabetically according to any number of parameters (such as mandarin name, primary category, etc.) This search function gives infinite flexibility to those who know what they are looking for or at least have some idea. Thus, the skilful use of the HT software is much more complicated than merely searching the hyperlinked text of the TCM databases, but it is also infinitely more rewarding for those who master the intricacies. The power of the HT software lends itself particularly well to the real life analysis of complex cases. Thus it is potentially a great tool for the clinical intern and seasoned practitioner. One can rapidly analyze a complex case and then compare and contrast a ranked list of formulas that correlate with the search parameters. This can save tremendous time compared to poring over books and then probably glossing over some critical data anyway.
In addition to the fully searchable tables in the HT software, the progammers have developed the most innovative games to challenge, test and hone ones knowledge and diagnostic skills. While there are several games related to herbs, formulas and syndromes, I found the syndrome games most interesting. One receives a single random clue from the computer and can view a screen of about 25 syndrome choices that include the one sign or symptom listed. From the given symptom, one considers the possibilities from amongst the syndromes and then chooses from a variety of options. One is another random clue - this could be anything. Another is an optimal clue, which usually points strongly in one direction.
However, I usually choose a specific clue from a category such as speech, behavior, respiration, etc. This is allows one to apply the hypotheticodeductive process advocated by Bob Flaws in his masters diagnosis class. This is where the answer to one question should immediately lead one to other questions that can quickly rule in or rule out the diagnosis. For example, if one suspects spleen qi vacuity, there are different questions one needs to ask than if one suspects liver qi depression. This game promotes the skills of efficient questioning, often lacking in even experienced practitioners. It also reveals ruts and weaknesses in ones thinking. When Dan Bensky spoke at CHA last year, he answered the question, Why Study the Shang Han Lun? Because if you dont know whats in the SHL, you will never see the patterns in your patients. This occurred to me as I just peeked at the answer to the syndrome game on my desktop and saw that is was shaoyin stage deficiency cold. I had been staring at the screen and trying to think what zang-fu disorder this might be and it never occurred to me to consider the SHL even though the shaoyin option was listed on the same screen. Even a seasoned practitioner can benefit from such a game.
So who could get some value from this course and software. Well, definitely beginner students. It has all the data from standard sources that novices need in order to begin to learn herbology. It is fully cross-referenced so you always understand what is being discussed and it includes supplementary materials on herbs and related topic not found elsewhere. Advanced students can use the course for prepping for boards, a handy clinical reference, a fresh look at the subject and the analysis of case studies. For experienced practitioners, the convenient cross referenced hyperlinked databases, complex case study analyses and syndrome games all would be invaluable. However, practitioners have the most to gain if they purchase the full version of the HT software. The lite version included with TCHS is more limited in its databases and applications (but it also does not expire, so it yours to use forever). For TCM college graduates who had inadequate herb education or a rote herb education without sufficient case study emphasis, this course is one of several remedial options available. For those who are self-motivated and learned their TCM theory fairly well in Acupuncture school, this self-study course can shore up weaknesses and sharpen one's clinical reasoning skills.
I also found the HT software to be a very useful tool in facilitating the type of case analysis and formulation I teach in my Clinical Herbology class at PCOM. In fact, it was in the course of teaching this class at PCOM that I realized exactly what type of software design would facilitate the formulation method without dumbing down the process. This software does an excellent job of meeting these criteria. However, it does not do everything I wish. I discussed my concerns with the programmers and they addressed most issues. My ideal databases would allow one to search for data by western disease categories. It would also cross-reference the standard formulas with a wider range of chief complaints (as in Sionneau). I would like the option to have pulldown menus toggle to alphabetical lists instead of just having the items grouped by categories. I would have liked a symptom cross-reference table in the herbal tutor program and the ability to search for common herb combinations to modify the formulas. I would like to see the syndromes table hyperlinked to the formulas database and from formulas to modifications and/or combinations. A complete cross-referencing with Wiseman terms would also be ideal as this is the most complete standardized TCM glossary in English.
These issues were all addressed as conscious decisions by the programmers. Their main goal was that the program be educational for students and intuitive for practitioners. Thus, patterns and symptoms were grouped in particular ways to facilitate important theoretical and clinical correlations. Using alphabetical lists would encourage the wrong kind of thinking. On the other hand, a seasoned practitioner may sometimes just want to gain access to data quickly. Western diseases are not placed front and center so the software is useful for both medical practitioners and fully trained lay herbalists. However, seasoned medical practitioners may prefer this type of access. Yet the concern of the progammers for beginner students was again that they would fall into traps with this type of access.
The programmers also decided to not cross-reference as large a number of symptoms with formulas as they could have because their tests suggested diminishing returns with increasing data. Again, the goal in large part being to educate beginner students strongly influenced the programmers decision about this. They wanted students to focus on patterns. While experienced practitioners can make use of minutiae, beginners often fall into the trap of chasing symptoms. As for Wiseman terms, the burden of every textbook author is how to reach the widest audience and still be faithful to the topic. The inclusion of Chinese characters for all syndromes, herbs and formulas does much to alleviate this concern. The programmers also felt that herb combinations were often used in a rote fashion without consideration of herb dynamics and thus ommitted that data as well. While I understand the concerns about students misusing the information, my ideal clinical database would still address most of the issues above. But, in all those areas where the software did not do exactly what I wanted it to, there was a good reason in terms of TCM education. I can thus highly recommend it for teachers as well as students.
To run the course, all one needs is a web browser. To run the HT software reliably, one will need 128 MB free ram and a reasonably fast processor (400 mhz or better). It works best for me on PCs, but the faster the better. It also works in Mac OS 9.x or classic on OSX. It does not work well in OSX native due to problems with the Mac java engine right now. It works fine in classic on Mac OSX, but for some reason, it takes a very long time for the databases to load when first opening the software (about ten minutes). But after that, searches proceed smoothly. It is quite possible I am doing something wrong. It opens quickly in Mac OS9.2 and works great in that environment. Due to the size of the databases, it seems it is vital to have adequate memory and processor speed to fully utilize this program. Most computers made in the past 5 years should be adequate.
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