SUMMARY
1. There is no standard way of choosing AP prescriptions but ancient Chinese laws give useful guidelines. There is considerable variation between textbooks as to the functions of specific AP points and as to the "best points" to use in specific problems.
2. Beginners can build their own databases by storing every listed function of each specific point on computer. The more textbooks and clinical articles stored in this way, the better the database. The database can be "tidied up" at intervals by sorting on condition and author, eliminating any duplicate entries and amalgamating complementary data. However, storing data in this way is a very tedious process. It took the author 10 years to check point codes, cross-reference the functions and store the data from 55 textbooks and other articles on human AP on a Hewlett-Packard 1000 - Series F Mini-computer with 20 MB hard disc. The database contains points for > 1100 clinical conditions.
3. From the raw data, it is possible to construct a Database Summary. This is a complete listing of each point coded under each specific condition. Before output, the points are sorted according to a weighted citation index, so that the most frequently recommended points are listed first and the least frequently come out last. Each point has its citation score attached, enabling the user to see at a glance the "value" of the point. The author codes - key to the source material - are also listed.
4. The Database Summary is used as the basic source of the prescription. When, say, points for "shoulder arthritis" or "male impotence" are needed, the relevant condition codes are entered into the computer. The Database Summary is searched to locate the condition and all points and scores and author codes for the condition are output to the screen or the printer.
5. With modern computer graphics it is possible to store the body charts in digital form and to use graphic display to output the location of the points (or selected points from the list) to the screen or to a plotter.
6. Beginners, research workers and experienced acupuncturists who wish to have access to a comprehensive database (but who do not have the time or patience to construct their own) may be interested in commercial AP databases. (The Rogers database is not available commercially).
7. Computer-based filing is far more efficient than paper- or card- index systems. However, to be able to beat power-failures or hardware/ software faults, it is advisable to keep at least one "hard copy" (paper printout) and one software "backup" of the database summary.
8. The list of points output are all the points ever listed for the condition in the database. In general, the first 4-6 points on the list will be suitable for routine use. However, for best results, the user should be familiar with the basic concepts of AP, especially as they relate to choice of points for therapy. S/he should be able to adapt the prescription to the specific needs of the patient, selecting possibly a few points further down the list because these may be highly relevant to that particular patient.
9. Research workers involved in controlled trials of AP effects can ensure that no point in the database list is used as a placebo point.
10. Students and beginners may also use the graphics and the database as an aid to their study of meridians, point locations and functions. Self- assessment tests are also possible.
11. Clinicians could use the computer to store case records, treatments given etc.
12. Clinicians and research workers could use computers with touch- or light- sensitive screens, combined with "revolving models" of their patients to log the location of any AHSHI points or trigger points in relation to the location of pain, pathology or diseased organs. Such data would save time in subsequent visits and would be a very useful research tool in reflexology and AHSHI/Trigger Point therapy.
INTRODUCTION
Mastery of AP requires years of study and practice. It involves concepts and relationships which are foreign to western thought and training. As a consequence, most western professionals in the medical, physiotherapy, dental, psychiatric and veterinary field are unwilling to devote the time, energy and expense necessary to this study. Those who study AP usually rely on relatively short courses which concentrate only on the basics. Later, through reading (self-study), practice and discussion with colleagues, they develop their expertise. Most have their favourite personal methods of choosing AP prescriptions. In this choice they are guided by (a) their previous experience and training and (b) indications given in a few AP textbooks.
There is no standard method of choosing an AP prescription for any specific condition or syndrome but there are about 14 "laws" (most of which are based on traditional concepts) which assist the practitioner in the final choice of points for specific patients.
The problems with individual textbooks are great. Up to now, there is no internationally-accepted nomenclature for the AP points. Some books list points and indications which are not listed in other books. Point names, codes and usage vary between textbooks. The serious student of AP will also find many mistakes in the coding of points in some books.
One solution to the dilemma is for the practitioner to set up a cross- reference system listing all uses of individual AP points from the texts and articles at his/her disposal. Many practitioners have done this, using a card-index or loose-leaf system. Some of these systems have been published commercially (Shenberger 1980). The relevant card or page for a specific symptom or syndrome is consulted when required and the most frequently recommended points are determined by a visual examination or manual frequency-ranking of each point filed for the specific condition. However, these manual systems are relatively inflexible and require much time to operate. Each time a new reference is added, the point rankings may change and may require re-calculation.
Modern microcomputers can store, sort, process, retrieve and display vast amounts of data. They have replaced manual filing systems in industry, science, general practice and research areas. In the next decade computers seem set to become even more powerful, cheaper and more versatile. For instance, voice input systems may well replace the typewriter keyboard. Voice output systems are already available for many microcomputers but the VDU, printer and graphics plotter will probably remain standard features. Most modern micro- computers have high-quality screen graphic display as a standard feature already.
This paper will discuss some of the applications of microcomputers in the study and practice of AP. It will concentrate primarily on the construction and retrieval of AP prescriptions but a few applications in the study of AP and in AP research will be outlined.
A. SETTING UP DATABASES OF AP POINTS
Two main types of database are possible: 1. Comment files and 2. Files relating only to the points used for specific conditions.
1. The comment files can retain data on the uses of the points (methods of stimulation; intervals between sessions; differential diagnosis; complementary methods of therapy etc). They can also be used to store data which is not yet amenable to coding for the point files (e.g.) data on Earpoints, Scalp Zone points etc which may not be catered for in the type 2 files.
2. The point files contain the list of points recommended by each reference text for each specific condition.
Before either Comment or Point files can be set up, the user must plan carefully the coding system to be used to identify the condition, the reference and the point codes.
Condition codes: A six digit number can be used to identify specific con- ditions. For ease of use and purposes of later amalgamation, it is probably most suitable to code the conditions on the basis of the body region primarily involved, rather than on a random basis. For instance condition code 040708 could represent stenosing tenosynovitis of the radial styloid at the wrist in a coding system which uses the following convention, in which the first two digits specify the main body region involved:
Emergencies and first aid 0lXXXX
Head, its functions and organs 02XXXX
Neck 03XXXX
Thoracic Limb 04XXXX
Thorax and back 05XXXX
Abdomen 06XXXX
Pelvic limb 07XXXX
Skin 08XXXX
Fevers, infectious diseases,miscellaneous 09XXXX
The second two digits can specify the subregion involved.
For instance:
Thoracic limb, general conditions 040lXX
Shoulder, scapular area 0402XX
Axilla 0403XX
Arm 0404XX
Elbow 0405XX
Forearm 0406XX
Wrist 0407XX
Hand 0408XX
Finger 0409XX
The last two digits can specify the specific condition or symptom.
For instance:
Elbow area (general points) 040501
Elbow: AP analgesia for surgery of 040502
Elbow: pain, arthritis etc 040503
.
Elbow spasm, contracture 040505
.
Elbow: Paralysis 040508
Etc
The condition codes and their specifications can be set up on a file named CCODES.
Reference Codes: The database will probably rely mainly on material from textbooks, journals, study manuals etc. These can be stored on a file called RCODES. Each reference can also be assigned an "authority rating" in the range 0.1 to 1.0. For instance, textbooks published by the Academy of Traditional Medicine, Beijing can be given the maximum rating (1.0) where- as a poorly written, anecdotal article in a dubious journal could be given a low rating (0.1 or 0.2). These authority ratings can be used in the cal- culation of "weighted point scores" at a later stage. If authority ratings are used, it is important for the beginner to take expert advice on what value to assign to each reference. Not all books from Far East are of top quality. Not all books from western sources are of poor quality.
Point codes: The western convention for point nomenclature uses an alpha code for the meridian and a numeric code for the point. Thus point Hoku (Large Intestine 4) is usually called CO 4, LI 4, GI 4, DI 4 depending on the text and language etc (Colon; Large Intestine; Gros Intestin; Dikke Darm etc). This confusion in alphanumeric point coding causes serious pro- blems. One must ascertain which system is being used by each reference. One must then recode this to the system being used by oneself. For instance, data from a French text relating to (say) acute gastritis might read: 36E, 12CV; 6MC, where E= Estomac; CV= Vaisseau de Conception; MC= Maitre du Coeur. This must be transformed to ST36; CV12; PC 6 if the user's convention is ST= Stomach; CV= Vessel of Conception; PC= Heart Constrictor- Pericardium.
It is essential that the user adopt one convention and retain that one. However, since alphanumeric data requires more storage space in the computer and since it is easier to sort and manipulate numeric data, the user must also adopt a numeric code for each point. Thus, the typical point code file would have the following details: user's alphanumeric code; user's numeric code; point name; point location. This file can be called PCODES.
Setting up the Point Files: Having set up the files for the condition codes (CCODES), reference codes (RCODES) and point codes (PCODES), the user can develop an input program to take raw data from the keyboard, transform it to numeric point code and store it under the appropriate condition and reference codes. The input program can be fully interactive, requiring no memorised knowledge of the condition or reference codes. It can also contain screen prompts; error traps to prevent accidental entry of wrong point codes etc. At the end of the entry session, a record of the entries can be printed for editing. Any mistake in the point code file or the comment file can be corrected immediately. The corrected entries can then be passed for merging with the relevant database files.
B. PROCESSING THE DATABASE POINT FILES
As the database (raw data) is being expanded, conditions and references are usually added in sporadic input sessions. Before processing, the database must be sorted by condition code and author code. The sorted database can then be read by another program to eliminate duplicate entries and amalgam- ate points that may have been entered in two or more input sessions for the same condition and author. This tidied-up database is then substituted for the original.
Three main types of processing are possible:
1. Auto-processing;
2. Processing for specific conditions;
3. Combining a number of conditions to obtain a summary of the points for specific regions, organs etc.
1. Auto-processing: A program can be developed to read the first condition code and author code. The "authority ranking" (rating value) is assigned to each point for that author. The next author is then read and point scores are added to the previous values. When a new condition is met, the program sorts the points for the previous condition according to descending values of the point scores. The sorted list of (numeric) points is transferred back to the user's alphanumeric point codes. This frequency-ranked list is then sent to the printer and to a summary file (DATSUM), together with the point scores and author codes. The next condition is processed in the same way (having zeroed the registers). When the last condition is processed, the program ends. Thus, a complete listing of all the points (with their scores and references) for each condition in the database is generated on the printer and on the summary file. This file (DATSUM) is the one which will normally be used for quick reference. If the database is expanded frequently, updates of DATSUM will be needed every 3-12 months, depending on the intensity of the input.
2. Processing for specific conditions: This uses a similar program to the auto-processing program, except that the condition code(s) required are specified by the user. It may be of value when rather rare conditions are being examined, if the user believes that additional relevant data may have been added to the database since the last auto-processing (generation of the last DATSUM file).
3. Processing for a combination of conditions: This option is probably of most interest to the research worker or to the user who finds that the data for a specific condition in file DATSUM is scanty. For instance, one may want to summarise all the points listed under Elbow conditions. For this purpose a program must be written to (a) search the database for all points coded under 0405XX. These data are stored on a temporary file (HOLDER) and all conditions on it are given a dummy code 040500 (=elbow). File HOLDER is then sorted by author, so that all points listed for elbow conditions by each author are in sequence. The sorted HOLDER file is then put through the auto-processing program ((1) above). Alternatively, (b) the user may specify which conditions are to be amalgamated - for instance elbow pain, elbow tremor, elbow spasm etc. The relevant codes are entered, the conditions located and recoded 040500 (=elbow), the data passed to the HOLDER file and processed as in (a) above.
C. CHOOSING APPROPRIATE PRESCRIPTIONS
If one's sole source of reference is a single textbook, the choice of points for specific conditions may appear to be simple - the therapeutic index included in most good textbooks usually lists 4-10 points. If the user is unsure of the best ones, s/he may alternate prescriptions between sessions, so that all points in the therapeutic index are used at some stage in that patient. This is inferior Cookbook AP, akin to broad spectrum antibiotic cover or blunderbuss therapy.
The user with access to a computer database faces much greater difficulty. For instance, under the heading "Sequel to CVA, polio etc (hemiplegia, paralysis)" an early version of a database summary based on 28 references listed 217 points which might be relevant: The top 6 points were LI11; GB34; ST36; LI 4; TH 5; LI15. Their scores were .89, .74, .68, .66, .65 and .64 respectively. At the end of the list, the last 6 were BL41; GB41; LV 4; LV 6; BL14; Z 31 (scores .03 to .02 respectively). One might assume that the top 6 would be the most appropriate but this need not be so. For instance, if the main symptoms referred to the lower limb, LI11, LI 4, TH 5 and LI15 would not be very relevant. If the main symptoms were facial paralysis + aphasia, those 6 points would be of little value. However, if the user searched under the headings "upper limb paralysis", "lower limb paralysis", "facial paralysis" and "aphasia", much more information would be forthcoming. The following table lists the top points for each of those conditions;
| -(1)- -(2)- -(3)- -(4)- -(5)- -(6)- | |
| Upper limb paralysis | LI11 TH 5 LI15 LI 4 SI 9 LI10 |
| Lower limb paralysis | LI11 TH 5 LI15 LI 4 SI 9 LI10 |
| Facial paralysis | ST 6 ST 4 LI 4 ST 7 TH17 ST 2 |
| Aphasia, mutism | CV23 GV15 HT 5 LI 4 GB 2 TH17 |
It is important to search under the MAIN SYMPTOM or the MAIN REGION/ORGAN involved. Even this may not be specific enough. For instance, if the facial or lower limb paralysis involved specific nerves or joints, these should be searched also. The following table illustrates this (only the Top 6 points for each condition are shown) :
Facial paralysis, hemiplegia
Optic branch LI 4 LI20 ST 7 ST 4 ST 6 TH17
Maxillary branch ST 4 ST 6 CV24 ST 7 ST 3 GV26
Mandibular branch ST 6 CV24 LI 4 ST 4 ST 7 ST 3
Lower limb paralysis, hemiplegia
Saphenous nerve BL38 ST36 GB31 BL60 GB30 ST44
Tibial nerve (upper) SP 5 SP 6 KI 3 BL62 SP 9 SP11
Thigh paralysis LV 8 BL23 BL25 ST36 ST33 BL38
Obturator nerve SP 6 KI 6 LV 8 - - -
Femoral nerve ST36 GB34 ST30 SP10 GB30 GB39
Knee paralysis L 16 BL40 GB34 ST33 LV 8 SP 7
Leg and calf paralysis BL57 ST36 SP 6 GB34 BL58 BL40
Tibial nerve (lower) ST36 LV 2 LV 3 BL62 GB35 BL37
Fibular nerve ST36 GB35 BL38 BL60 BL62 GB30
Ankle paralysis ST41 BL60 SP 6 KI 3 BL57 GB37
Foot paralysis BL60 KI 3 SP 6 GB39 BL61 ST41
Foot extroversion SP 6 KI 3 NL10 NL11 NL13 NL15
Foot introversion BL60 GB39 NL11 - - -
One drawback of the frequency-ranking system of constructing prescriptions is that powerful AP points such as the "New points" and "Strange points" are not listed in many (especially older) textbooks. They are described only very recently (in the past 10-15 years). The classical (meridian) points have been documented for millennia. Therefore computer databases will usually rank these new powerful points in a lower position than the meridian points. Users must be aware of this. For instance, points like Lanwei (L 13); Tanlangtien (L 23); Szufeng (A 1); Tingchuan (NX 4) are very effective in appendicitis, cholecystitis, heatstroke and asthma respective- ly. The naive user of a computer database may ignore such points because of their lower frequency score. This could reduce the therapeutic success which would be obtained.
For really thorough work, the user should compare and contrast the list of points recommended for the main area/organ, the main symptoms, related symptoms, the related nerves etc. This presupposes that the user has a professional training in medicine or the paramedical sciences, including veterinary medicine.
It is my opinion that the best use of AP would be in the hands of persons professionally qualified in these areas. However, because of the complexity of AP, it is not enough to be a doctor with access to a computer. A basic training in the principles of AP is essential for the best results. When it comes to AP therapy, I would prefer to be treated by a well trained acupuncturist (who need not be a doctor) than by a well trained doctor whose theory of AP is weak !
The most common AP prescription is that which combines AHSHI (trigger) points, local points and one or two distant points on the meridian through the affected area or organ. There are, however, at least 14 Laws of choosing points. These Laws are covered in standard textbooks of AP (for instance, The Essentials of Chinese AP, Peking, 1980). These laws are fundamental to any serious study of AP. They include alternation of points between sessions. Overuse of individual points is to be avoided - there is increased risk of infection, nerve damage and loss of effect from overused points.