Introduction and Findings Computer technology encroaches on every aspect of our lives, and it seems inevitable that sooner or later traditional Chinese medicine should be available on computer - or at least, that teaching and diagnostic aids should be. In fact, a variety of TCM software has been available for some years, and there are currently at least 12 commercial products which purport to put traditional Chinese medicine on your PC. Some of them are simple CD versions of standard textbooks, and some of them are only available in Chinese.
The rest attempt to use computer technology to enhance their content, and are mostly only available by mail order or through the internet. They tend to be the creations of little-known authors or publishers. At an average price of around $200, however, they are not cheap and you want to be pretty sure that you are getting something worthwhile before committing yourself to a purchase. At the time of writing, none of these products have distributors in the UK so the only price available is the dollar price quoted on their literature or website.
I contacted as many suppliers as I could, and ended up with seven products to evaluate. Most of these were reference works containing much of the material which you would find in a standard textbook, but supplemented with illustrations, animations, diagnostic tools, search and indexing facilities to make the information more accessible. Some of them additionally contain appointment books, accounting, patient records and the like, and I have mentioned these features where they are available.
Books about TCM have three potential markets; the general public, who may be interested in books offering a general introduction to a subject; students, who will be more attracted to broad-based texts, and established practitioners who will be interested in specialised and highly detailed books. The market for TCM software should be similar, and I have tried to appraise each package according to the market to which it is directed.
Let me state my qualifications as a reviewer; I have acupuncture training in both 5-element (Leamington) and TCM traditions, but next to no knowledge of herbs or patents. I have, therefore, focused on the acupuncture content of the software packages and made minimal comments on any herbal content.
There are a number of problems which came up again and again in the products which I reviewed:
Content. Most of the authors have written their own content, in which case there are sometimes significant differences from the major recognised textbooks and classical sources. One or two of them seem to have a very amateur flavour and the quality of the acupuncture content is extremely poor. Some of the products reproduce large amounts of material from the better-known textbooks, and I wonder if there may be copyright issues here.
Terminology. It is always contentious as to what English words to use as equivalent to a pinyin term, how to abbreviate the meridian names, and so on. Computer technology is unforgiving, however, and if you use the search facilities to look for a word you are familiar with you may not find it if the authors of the software have chosen to use a different word. Some of the packages under review were not originally written in English and contain some unfamiliar medical-style terminology.
Illustrations. A computer screen will never be the same size as a wall poster, so the illustrations accompanying any software package will of necessity be much simplified; the optimum level of detail is probably comparable to that on one of the medium-sized plastic human figures you can buy from most needle suppliers. However, many of the illustrations in the CD packages were either inaccurate, cluttered or indistinct. Computer technology may be able to improve on this by using multimedia but none of the packages in this review attempted that.
It is necessary to have a structured approach if you are going to attempt to compare different products. I generally compared the acupuncture content of a small selection of the more commonly used points such as Ht 7 shen men, LI 4 he gu, Sp 6 san yin jiao, Ren 17 tan zhong with the corresponding entries in established textbooks such as Fundamentals of Chinese Acupuncture (Ellis, Wiseman & Boss, 1991) and A Manual of Acupuncture (Deadman, Al-Khafaji & Baker, 1998), looking at the anatomical information, symptomatology, and safety warnings given for each point.
In order to test the diagnostic functions, I generally looked to see if each software package would come up with a similar set of points to those in The Practice of Chinese Medicine (Maciocia, 1994) in response to a few common symptoms, using alternative terms for them - migraine (headache), dysmenorrhea (period pain) and acid reflux (heartburn). The results of this test were very disappointing.
On the whole, the results of the reviews were disappointing. At prices typically in the range of $200-$250 (around £130 to £180) these products are more than double the price of even the most expensive textbooks. For this amount of money, they should either contain twice as much information or else be twice as useful, and few of them are. In a few years' time there may be better products, but there has to be an improvement in both quality and price before they will represent good value for money.
In conclusion, I am able to recommend two products:
The 'Best Acupuncture Reference Software Award' goes to Acupartner, a product of the Israeli firm Bamboo Software Ltd; it has excellent content, presentation, and ease of use. At $249, however, it is not a cheap purchase, and a textbook containing comparable information should not cost you more than $50.
The 'Best Software for Students Award' goes to the Virtual Traditional Chinese Medicine Clinic from the University of Technology, Sydney, Australia. This is a teaching - rather than a reference - product, and at a price of $50, no student should be without it.
A couple of other packages represent reasonable value for money, but do not satisfy the quality and ease-of-use criteria needed for a recommendation.
Acubase 2.0 by Trigram Software
Acubase is a program with a lot of content; the 'standard' version includes, in addition to acupuncture points, copious information about Chinese herbs, formulas and patents (including suppliers), patient records and a set of questions for the Californian licensing exam. The 'professional' version (not reviewed) adds an appointment book and accounting functions.
The CD comes with a booklet which gives instructions on how to install it on your computer: the installation process is easy and caused me no problems. No manual is provided, but it is possible to print out the electronic manual which is contained on the CD. This is not such an easy process, and might be beyond some users. The American origins of the product are evident both in the terminology, the content of the examination questions and the extensive product liability disclaimers.
I was quickly able to find my way around the program and feel familiar with it, without needing to refer to the documentation. On-line help is available via the menu or via 'help' button at the top of the screen, and this can be useful sometimes.
The program is structured as a series of databases (points, herbs, etc); all information which is displayed can be added to, changed, or deleted. So if you want to add your own notes about a particular point or herb, this can be added to the information which comes as standard.
Information about acupuncture points is fairly cryptic, so I would regard it as most suited as an aide-memoire for the qualified practitioner than for the student, and this is how the authors describe it. One advantage of keeping the information brief is that everything about an acupuncture point can be seen at once, unlike other software packages which may contain more information but do not display it so concisely.
Almost all of the information given about acupuncture points appears to be reproduced word-for-word from the older English language textbooks - Cheng Xinnong (1987) and O'Connor & Bensky (1981) although these books are not cited as sources. There is no 5-element content, neither are there any warnings about the anatomical dangers of any point, or contraindications e.g. points forbidden in pregnancy.
It is a pity that the program contains no anatomical drawings, although these are promised in a later version. There is considerable evidence of sloppiness - e.g. the point Ren 17 tan zhong is said to be level with the second intercostal space (it should be the fourth), and on the indications for Ki 5 shui quan, both 'dysmenorrhea' and 'dysuria' are spelt wrong. This may not seem important, until you realise that the database search facility will not find this point if you are looking for either of these words! For an expensive product, mistakes of this nature are unforgivable.
Using the search facilities, the list of points suggested for particular symptoms seemed reasonable, based on the TCM symptomatology. It appears that the words 'headache' and 'migraine' are used alternately, so that a list of points generated using the word 'headache' is completely different from a list using the word 'migraine'; again, this considerably restricts the usefulness of these functions.
I would not buy this product, as I do not think its acupuncture or anatomical content is up to scratch. It also contains a very large amount of herb information, which I have not attempted to review; this may be its saving grace.
Acupartner 4.1 by Bamboo Software
Unlike most of the other software packages which are available at the moment, Acupartner has been written to a very high standard, both in terms of acupuncture content and its use of computer technology.
The package was conceived and written in Israel, and the authors are a group of Israeli acupuncture practitioners and teachers. It includes material which would be of interest to both TCM and 5-element practitioners; for example, there is both a complete list of jing (well) points and a list of horary points. The quality of the material in this CD is such that, although concise, it would constitute a respectable basic acupuncture textbook if it were to be produced in book form.
Installation instructions accompanying the disk are very concise but adequate; the software loaded easily onto my computer. The disk includes a 49-page user manual in electronic format which you have to locate and view or print for yourself.
Other than the manual, there is no on-line help but the product has been so carefully designed that this is not a loss. In all of the screens, it is very easy to understand the information which is being presented and to see what options are available for further navigation.
In purely visual terms, the design of the package, the layout of the screens and the choice of background colours is attractive and harmonious. The anatomical illustrations are in pleasant pastel colours and make no attempt to show anatomical structures other than bones, which means that they are not as useful as, say, a good quality wall chart.
Acupuncture points are listed according to meridian and nature (e.g. source point), each with an illustration and notes. The point information is of good quality and solidly based on classical texts, and so omits some practices which appear to be of more recent origin, such as application of moxa on Bl 67 zhi yin to turn a breech baby. There are no warnings about the risks of needling points like St 9 ren ying which are above delicate anatomical structures.
There is a very clever animation effect on the meridian illustrations - each point is illuminated in turn along the course of the meridian, and you can click at any point in order to get full information about it.
A section called 'Disease' allows you to come up with a list of TCM syndromes which may relate to a particular symptom. For example, it is possible go from Neurological -> Headache -> Blood Deficiency. There is a lot of detail at this level, and the list of symptoms and points presented is appropriate. A comprehensive set of search functions enables you to locate information on any symptom, point or organ. It is also possible to add to or change the information presented, although the original data can always be restored.
At the moment, Acupartner is the only product from Bamboo, although there is the suggestion that practice management, herbal, and diagnostic software may be following on. If the standard is the same as that of Acupartner, then they will be very interesting products indeed.
My copy of the Tao Te Ching says 'Better to stop short than to fill to the brim', and although the Archibel CD contains a huge amount of information it seems that it has lost clarity and usability as a consequence of overextending itself.
The disk itself contains three programs: Acuvision, which deals (mostly) with TCM style acupuncture, Acuscalp which is a guide to the (new to me) technique of scalp acupuncture, and finally Triggervision which appears to be an extremely comprehensive textbook on Trigger Point and Myofascial Acupuncture; unfortunately the last of these is not currently available in English.
This review concentrates on the Acuvision component. The authors are Belgian, and, uniquely, the installation program for this component gives a choice of five languages; I chose English. The documentation is impressive - there is a tutorial, in which an image of the Yellow Emperor shows you how to use the program; a 53-page illustrated manual which you can print for yourself, as well as on-line help. It is evident that it was translated into English from some other language, but the quality of the translation is generally good.
The program offers a number of options containing information on TCM syndromes, acupuncture points, herbs and herbal formulas.
In general, each section contains a wealth of information reproduced more or less verbatim from many of the major acupuncture, TCM, and herbal textbooks. The structure of the various lists is sometimes puzzling, and some of the notes, especially the lists of symptoms, are so cryptic as to be meaningless. Navigation around and within the various options is far from intuitive, as information appears in different windows which sometimes overlap each other. A number of program crashes occurred as I was using the product.
The information on acupuncture points is comprehensive, and contains both TCM and 5-element information. Every point has an illustration, although the quality of the illustrations is highly variable and several artists seem to have been used; for example, the illustration for Ren 17 tan zhong puts it level with the fifth rib, although the text correctly states that it is level with the fourth intercostal space. There is no warning against vertical needling of this point.
The 'Open Points' option will be useful for those who are put off from using this technique because of all the charts which have to be used. The '5-element' option will cast a simple Chinese horoscope given a patient's date of birth, complete with weakest element, but this bears no relation to the 'causative factor' beloved of those trained in the Worsley tradition.
The material on herbs and herbal formulas is similarly comprehensive, although almost all of it is reproduced from standard textbooks.
There is a utility which will come up with a list of acupuncture points if you give it a list of symptoms (it does not link to the herb database). The lists which are produced tend to be too long to be prescriptive, but could be regarded as useful suggestions to supplement a traditional diagnosis. The symptoms available are reasonably comprehensive but not exhaustive - 'Acid Reflux' is not available as a symptom at all.
There is so much material in this CD that if it were produced in book form, it would occupy a substantial chunk of my book shelf. In terms of content, it is way ahead of any of the other products reviewed. However, by reproducing material from several major textbooks there is a loss of focus, and it does not contain sufficient structure to enhance this information in the ways which computer technology offers.
The Complete Acupuncture CD-ROM and Traditional Chinese Medicine and Pharmacology by Hopkins Technology, USA In the letter which accompanied the review copy of these disks, the publishers say that their products are intended for the non-professional audience. There is a mixture of material on the disks, drawn from a number of sources - the English translations of a number of Chinese textbooks, additional material by Wei Liu and Xinrong He, who practise and teach acupuncture in the USA, some contemporary video material and a summary of research into the efficacy of acupuncture. The 'TCM' disk includes an introduction to the basic concepts of Chinese medicine and a detailed guide to Chinese pharmacology.
In computing terms, the package is well crafted; it installs easily, does not need an operating manual, is easy to use and navigate, and has adequate 'help' facilities.
There are a few nice features - I quite like the videos on the first disk, which comprise a brief introduction to acupuncture and a demonstration of acupuncture treatment. The second disk includes some good pictures of Chinese herbs.
After that, I am not sure what to make of it. The publishers, Hopkins Technology, produce a range of health-related and complementary medicine material on CD and on their pay-to-view website but are not a force in the textbook market, and the quality of the material seems to be poor.
The level of detail - point and herb formulae, instructions on needle technique - is certainly not appropriate for a casual reader, although the introductory material is not bad.
It appears that the material used to compile these CD's has been drawn from English translations of textbooks which were originally written in China some time ago, although the sources are not identified. It is not wholly relevant to the way in which Chinese medicine has evolved subsequently, and in particular to current attitudes to hygiene and toxicity. An imprecation that 'needles that have been applied to patients with dermatosis and hepatitis must be separated from others' leaves me cold.
The review of research similarly misses the mark. It reproduces the contents of the National Symposia of Acupuncture and Moxibustion and Acupuncture Anaesthesia, Beijing 1979, which is a recognised reference work. However, it is very dated, and there is much more recent research which is not mentioned.
Overall, I would not recommend these CD's either to a member of the public or to a professional. It is a pity, as Hopkins have obviously gone to a lot of trouble to produce them, and if they had chosen contemporary material from which to build them, they could have had a winner. However, perhaps this would have made them more expensive.
The Virtual Traditional Chinese Medicine Clinic by Carole Rogers, University of Technology, Sydney, Australia This package is very different from the information-based products which make up the rest of this review. It is intended as a teaching aid, and it takes the form of a diagnostic game. To quote from the CD sleeve -
'The Virtual TCM Clinic is a game as well as a learning experience. To win the game you need to establish a successful clinic with many satisfied clients. Twelve patients will visit your clinic and it's up to you to diagnose their ailments correctly. Ask questions, read their pulse, inspect their tongue and locate the painful mu and shu points before you make a diagnosis. Make too many diagnostic errors and appointments will be cancelled - forcing you out of business.'
The computer simulates a diagnostic session. You watch a video clip of a patient entering a practice room and sitting down, and you can then select various options to simulate questioning, looking, listening, and palpating your patient; there is a corner of the screen in which you can record your own notes. The answers to the questions are realistic, with patients occasionally avoiding answering questions, describing unusual symptoms as 'normal', and only mentioning major surgery at the end of a long spiel about how good their health has been for most of their life.
During the simulated diagnostic session, you can switch freely from one section to another of the examination and ask questions in any order. There is a reference section in which you can revise syndromes and their associated signs and symptoms. You are given a tongue photo and pulse reading. The target is to identify the most pertinent syndrome (e.g. deficient kidney yin) and you are allowed three tries - if you cannot get it right, you are admonished by an animated Ancient Master. More important, your appointment book begins to show cancellations, and your projected annual income drops, eventually to the point where your receptionist walks out on you. I did not find out what happens if you get all of the diagnoses right!
This is a fun package, and it is presented with flair and humour. Obviously, there is a world of difference between listening to a computer give the answer to a question, and actually interacting with a person who is in pain, but the authors do not pretend that their creation is anything more than a supplement to college-based learning and teaching. They do suggest that it could also form a part of Continuing Professional Education for practitioners but I am very dubious about this.
I can well imagine this being used either by students as a learning aid or by colleges as a teaching aid; colleges might like to use it in the classroom, although they may want to modify it so that the content fits particular parts of their syllabus. Certainly I enjoyed my time with it, and it is strongly recommended for any student of TCM.
Zhangmen 8.0 by Factsoft
Zhangmen is a Dutch package which has a comparatively long history - it is now on version 8, whereas most of its competitors are only in their first or second version. In some respects it is very slick - the integration is good, so that it is possible to get from one section of the program to another quite easily. The characteristic feature of this software package is that it is very compact - it requires very little computer resource and all the descriptions and texts are very concise.
Loading the software onto the computer was no problem. During this process, it asks you to type in a licence number which is supplied as part of the documentation which accompanies the disk. The documentation also includes a 12-page users guide which helps you to get started - this is also available under 'Demo' on the menu once installation is complete.
When you run the program, you are given a choice of options identified only by an initial letter - A (Admin), L (Location), I (Indications), S (Patterns), etc. This seems to be unnecessarily cryptic. For information about a particular acupuncture point, you have to access either via the Location or the Indication route - I could not find a way to display the Location and Indication simultaneously. The search functions are quite fussy; to get information about Ren 1 hui yin, for example, you must type in 'rm1' and anything else will be rejected.
The illustrations are generally simple and reasonably uncluttered; on most illustrations you can switch from a superficial to a dissected anatomical view. Wisely, the authors have not attempted to show detailed bone or muscle structure. There are a good set of ear-point illustrations.
Location information is scanty - LI 4 he gu is described as 'on the thickest point dorsal to the 1st interossal muscle' and if this was not accompanied by an illustration I would be totally lost. The same point, in the 'indications' list, is recommended for starting labour contractions but there is no warning here that it is otherwise contraindicated if the patient is pregnant.
The 'Indications' option will allow you to type either one or two symptoms and then responds with a list of suggested acupuncture points. I was surprised to find GB 20 feng chi missing from the list for migraine, and even more surprised to find that only extraordinary points and earpoints were indicated for dysmenorrhea.
There are a number of textbook-style lists, including one section giving information about acupuncture during pregnancy, but as there are no links to the acupuncture point data the benefits of computerisation are wasted. There is a list of herbal patents which is so brief that it is useless. There is nothing in this package for five-element practitioners, and little in the way of information about traditional functions of the points - Liv 3 tai chong is not, for example, listed as a yuan source point.
At extra cost, you can buy a utility which makes it possible to add or change information in the database. However, if you do this you invalidate all product warranties and support, so this does not look like a good idea.
In summary, this is a nice little package which probably started life as one person's bright idea which has been extended and expanded; however, there is a lack of quality and depth which makes it difficult to recommend. Some of the content is so cryptic as to be unusable.
(The machine used for the reviews was an IBM-compatible PC running Windows 95)
Robert Pedley Robert Pedley practices acupuncture part-time in Slough and works as a computer systems consultant. He first studied acupuncture under J R Worsley in the 1970's and more recently re-qualified from the College of Integrated Chinese Medicine in Reading. He is also Secretary of the Oriental Medicine Research Trust, which initiates and funds high quality research projects.
