D. STUDYING AP FROM COMPUTER FILES
In many areas of study, the computer has already proved to be a very useful aid. By interaction with the VDU (monitor screen), the user can play with the system. It is a pleasant, painless learning process. Three main options are possible:
1. Studying the course of the meridians and the locations of the main AP points;
2. Studying the main functions of specific AP points and
3. Self assessment tests.
1. Studying meridians and points: With modern computer graphics it is possible to digitise maps, pictures or other types of drawings. It is possible to digitise pictures of the body (man, dog, horse, ox etc) with surface and deep anatomy shown in full colour. The course of the meridians and the location of each AP point could be digitised on separate files. These files could be used for study-purposes by calling up the body outline to the screen and searching the files for (say) ST meridian or specific points. These would be displayed on the screen. Alternatively, when choosing points for a particular patient, the program could display the location of the top 6 points in one colour and the next 6 in a different colour and so on. The database summary for any specific condition, the spatial relationships of the points to the affected part/function or organ could be seen readily. This would be a most powerful visual aid to study. This technique will show that the most important points for specific parts or organs are clustered on or near the affected areas with other points distant from the area.
For instance, the database summary (DATSUM) for stomach and duodenum may show the top 6 points to be: ST36; CV12; PC 6; BL21; ST25; CV 6. Of these only CV12 is directly over the stomach and BL21 (Bladder Shu Point for Stomach) is below spine of T 12 in the innervation area of the stomach. However other points over the stomach area or in the flanks or back (in stomach innervation areas) will also be shown: CV14-09; KI17-22; ST19-24; SP16; BL17-22 and 46-50. In addition, the "New" and "Strange" points in these areas will also be shown. It will also be obvious that many distant points, especially on the PC, TH, ST, SP and LV meridians will be shown also. These meridians are closely related to stomach function in traditional Chinese concepts.
2. Studying the main functions of points: Having established a database summary (DATSUM), this can be used to generate ones own "textbook" of point functions, which can be stored on a new file (PTFUNC). The user may opt to store the top 6 points for each condition, together with the condition code. By sorting this file on point Code, all the uses of each point are stored together. For instance, suppose the top 6 points for the following conditions were:
Condition code 1 2 3 4 5 6 010101 GV26 KI 1 A 1 LU11 HT 9 PC 9 . . 010108 GV26 ST36 GV20 A 1 LU11 LI 4 . . 090804 ST36 GB39 BL57 ST32 GB34 SP 6 The read program would then transform this to file PTFUNC as: Point Status Condition GV26 (1) 010101 GV26 (1) 010108 KI 1 (2) 010101 A 1 (3) 010101 A 1 (4) 010108 LU11 (4) 010101 LU11 (5) 010108 HT 9 (5) 010101 PC 9 (6) 010101 ST36 (1) 090804 ST36 (2) 010108 GV20 (3) 010108 LI 4 (6) 010108 GB39 (2) 090804 BL57 (3) 090804 ST32 (4) 090804 GB34 (5) 090804 SP 6 (6) 090804
The file would then be sorted on point code, status and condition code. The sorted file would then be read against the condition code file (CCODES) to substitute the description of the condition for the condition code. The final version of PTFUNC would be a most comprehensive summary of all the main functions (status 1 to 6) of each point. Searching this file as a study exercise would give a very complete view of the function of any point of interest.
Note: the "New" points and "Strange" points would get poor representation in this exercise for the reasons earlier. To study prime functions of these new points from the database summary, the meridian points would have to be eliminated first and the remaining points processed as on the last page.
3. Self-Assessment tests: The user could write a suite of questions based on the database, point functions, point locations etc or on AP examination papers. The correct answers to these questions could be stored. Self- assessment could be based on intermittent exercises in which a random 50 questions would be chosen. The answers would be compared with the correct answers. The users score would be stored and dated for future reference.
There is considerable scope for commercial software development in this area, as in the other areas discussed in this paper.
E. COMPUTER APPLICATIONS IN AP RESEARCH AND CLINICAL WORK
There are three main applications in AP research:
1. In the selection of "active" and "placebo" points in clinical AP trials;
2. In the logging of AHSHI points (trigger points) in clinical disorders (myofascial pain syndromes; internal disorders etc);
3. Case records.
1. "Active" and "Placebo" points in clinical AP trials: Controlled trials of AP effects are largely confined to western countries. In the East, the clinical efficiency of AP is taken for granted, (having been used for millennia). Controlled human trials using "placebo AP groups" would be unethical to many Eastern researchers.
A typical double-blind Western clinical trial is based on at least 2 groups of patients; a control group and at least one treatment group. The Control group is usually needled in "placebo AP points" which are selected as being "non-active" in relation to the clinical problem. The Treatment group is needled at points which are recommended as being "active" for the clinical problem. The patient and assessing professional is unaware of whether or not the points being used are "placebo" or "active". At the end of the trial, the clinical results are assessed and compared. If the "active" group have significantly better results than the "placebo" group, the conclusion is that AP at the "active" (correct) points caused this effect. If there is no significant difference between groups the conclusion is usually that AP was no better than placebo needling.
The design and conclusions from many such trials are frequently invalid for the following reasons: "Placebo" effects in medical trials usually occur in 20-40% of patients. In many AP trials 50-70% of "placebo AP" patients improved objectively or subjectively because the points used as "placebo" points were active but the researchers did not know this ! Many AP trials have been conducted by workers whose detailed knowledge of AP was negligible or minimal. These workers usually chose points from a "standard AP textbook" or were guided by a "qualified acupuncturist". As discussed earlier, few if any textbooks (even the best ones) are exhaustive in their coverage of all the effects of specific points or in their listing of all points which may be "active" for any specific condition. Furthermore, many qualified acupuncturists have blind spots and personal preferences in point selection and may not be aware of data in textbooks, journals etc which they have not studied. Many qualified, Eastern trained acupuncturists know little of the conclusions of western style "scientific" AP, i.e. that the points are NOT as specific as the Traditional School would suggest and that the effects of ap are mediated primarily via the neuro-endocrine and autonomic nervous systems.
Thus, in the selection of "placebo AP points", one should avoid using any points close to the affected area; on nerve segments related to the affected area; New, Strange, Hand or other points listed in recent texts as effective in the clinical condition. For instance, point Lanwei (L 13) on the lateral aspect of the leg, has powerful effects in acute abdominal conditions, including appendicitis. This point (as with all the newly described points) is not mentioned in many textbooks. Inadvertent inclusion of active points in the "placebo group" will cause a higher than normal "placebo" effect. Because of the high clinical success in the "placebo" group, the "real AP group" stands little chance of showing significantly better results.
Other reasons for invalid results include: incorrect needling technique (it is important to obtain DeQi: paraesthesia, heaviness, numbness, sensation radiating towards the affected part etc); incorrect depth of needling; insufficient time; too few sessions etc. However, the choice of valid "active" and "placebo" points is absolutely critical in the design of a valid experiment.
Workers who are interested to conduct clinical AP research would get very valuable data from a comprehensive database. For best results, they should also have studied the basic concepts of AP and the western conclusions on AP mechanisms. Despite such preparation, there are some who argue that it is very difficult to design a fully valid trial of AP using "placebo AP" controls.
2. Logging of AHSHI and other tender points in clinical disorders: Trigger Point and AHSHI therapy have been discussed elsewhere. As a result of the research of Travell, Moss, Fox, Melzack, Carole Rogers, Khoe, Chung, Pontinen, Macdonald, Kothbauer and many others, trigger point/AHSHI therapy is widely accepted in Western medicine. Although most authors have attempted to document the exact locations of the trigger/AHSHI points in their studies, there is a need for a systematic documentation for every part of the body, including the internal organs. The microcomputer, with a touch- or light-sensitive screen, offers a unique application in this field. With modern optical techniques, it should be possible to digitise a human-shaped doll (such as that used in the study of AP) so that it could be "viewed" from any angle on the monitor screen. When the problem areas of the patient (myofascial syndromes; other pain syndromes; internal organ disease etc) have been located, they could be transmitted to the computer via the touch- or light-sensitive screen (having "rotated" the model, if necessary). The precise location of the AHSHI/ trigger points could be logged in the same way when they are detected by careful palpation. If this study were to be conducted in a number of clinics simultaneously, a very precise, comprehensive database of AHSHI/trigger points could be built in the same way as outlined in Section A of this paper. This database could be summarised for each body region, muscle, organ etc as a software package for clinicians. It would be an invaluable guide to clinical diagnosis and to the location of the diagnostic/therapeutic points in those conditions in which AHSHI/trigger points arise. A similar package could be constructed for veterinarians, especially those interested in horses, dogs and cattle.
The logging of the location of AHSHI points would also be of use to the general AP practitioner. It would save time in subsequent visits and offers a useful prognostic aid - disappearance of the AHSHI points indicates that the condition is improving.
3. Case Records: Microcomputers are being used to log case histories, treatments given, progress etc in medicine and veterinary medicine. The software packages could be adapted relatively easily to cater for the additional data involved in AP diagnosis and therapy. Rapid retrieval of the case record and previous treatment is helpful to general practitioners and hospital staff alike. It also applies to dentists, physiotherapists and other health-care professionals who may use AP as part of their therapeutic methods.
CONCLUSIONS
The microcomputer, with graphic display and sensitive screen input has many applications in AP, whether at the level of the student, the clinician or the research worker.
Software packages, developed by the user or purchased commercially, will bring vast information storage and retrieval power to the user. Acupuncture is set to enter the twenty-first century, with a place of honour in western medicine, due to the pervading influence of the ubiquitous micro. People who would otherwise not have studied AP will do so now.
REFERENCES
Anon (1980) Essentials of Chinese AP (College of Trad. Med.) Foreign
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O'Connor, J. and Bensky D. (1983) AP - A Comprehensive Text. Shanghai
College. Trad. Med. (Eastland Press, Chicago), 750pp.
Shenberger, R.M. (1980) AP therapy prescription index. Shenco, 205
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