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Applying Process Modelling Concepts to Modelling Acupuncture

Channels

Jin Sa and Quan ZhuFaculty of Computing, Engineering and Mathematical Sciences

University of the West of Englandjin.sa@uwe.ac.uk

1. Introduction

Acupuncture as an alternative medical treatment is beginning to be widely accepted in thewest. Such a growth of acceptance has triggered a demand for an understanding of how itworks. In this paper, we propose an idea for modelling the principles behind the working ofacupuncture. The proposed work has two aims. One is to provide a suitable model that can beused to benefit the understanding and the further development of acupuncture. The other aimis to use the acupuncture channel system as an application domain for process modelling. This

unusual application domain should provide us an opportunity to study the existing processmodelling techniques from a different perspective.

2. Introduction to Acupuncture and the Channel Theory

Acupuncture is a clinical subject [1] addressing the prevention and treatment of disease,following body's energy principle originated from traditional Chinese medicine. It requiresthe study of channels (or meridians), acupuncture points, body's energy. In general thetreatment can be applied to many conditions including infectious diseases, internal diseases,neuro-psychopathy problems, diseases of eyes, ears and throat, allergies, general pain relief,addictions and some purely-psychological disorders.

In acupuncture anatomy, the internal organs of the body are all interconnected with oneanother by invisible pathways called channels. The channels are pathways in which energy iscirculated throughout the body. In Chinese Medicine, the energy flowing in the channels arecalled Qi. The flow of the Qi regulates normal functioning of the body, and diagnosticallyreflects illness.

There are 72 channels connecting all the tissues and organs. The most important ones are the12 primary channels. Each of the 12 primary channels is associated with an organ; forexample, there is a lung channel, a large intestine channel, a Spleen channel and a stomachchannel. These channels are connected to each other so that Qi can flow from one channel toanother in a fixed cyclic way. This cycle is known as the Horary cycle, in which it takes 2

hours for the Qi to make its way through one channel. The flow of the Qi begins with the lungchannel at 3am, moving to the large intestine channel at 5am, and eventually completes itscycle with the liver channel after 24 hours, and it starts a new cycle again.

In Chinese medicine, when Qi flows freely through the channels, the body is balanced andhealthy, but if Qi becomes blocked, stagnated or impaired, it can result in ill health withsymptoms such as sore throat and headache. An imbalance in a persons body can result frommany different factors such as inappropriate emotional feeling, cold, heat, or wrong diet.Along each channel, there are acupuncture points. These points are closer to the surface of theskin. To restore the balance, the acupuncturist stimulates the acupuncture points to manipulatethe level of Qi in the channels, which in turn affects the state of the organs. The practice ofacupuncture rests upon the relationship that exists between a specific acupuncture point and a

particular organ. Treating a channel affects the organ to which it is connected. Therefore it is

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important to understand the relationship between the acupuncture points and the associatedorgan via its channel.

More details on acupuncture can be found from numerous established acupunctureorganisations [2,3,4,5].

3. Existing Acupuncture Software and Their Limitations

Many commercial software products have been developed for educational purpose to aid theunderstanding of acupuncture. Some of the most popular products include Zhangmen [6],AcuPartner [7], Qpuncture [8], Acu-Soft [9] and Acupuncture Interactive Book [10]. Almostall of these products are based on the same principle of clicking over an acupuncture point toreveal its name, anatomical location, and conditions for which it may be used. A few of themalso have facilities to illustrate the needling techniques. The essential difference betweenthem is in the presentations. While some present basic textual information, others presentsophisticated 3D images. Zhangmen [6] provides two-way correlations between treatmentpoints and disease/symptoms. For example, given a particular acupuncture point, the software

may indicate several uses; and vice-versa, given a particular symptom, a number ofacupuncture points may be presented. However, there is no conceptual framework to indicatethe most suitable mapping between a particular point and a particular symptom.

To understand the reasons behind this many to many relationship between the points and thesymptoms, lets consider two specific channels. Among many places, the Lung channelpasses through the throat and the shoulder. Similarly among many places, the Stomachchannel passes through the throat and the stomach. If the Qi is not flowing well in the Lungchannel, the patient may get sore throat or pain in the shoulder. So a point along the Lungchannel may be used for treating sore throat or pain in the shoulder or other symptoms. If apatient is suffering from sore throat, it may be the case that the Qi is not flowing well in theLung channel, or it may be the case that the Qi is not flowing well in the Stomach channel.

Therefore to cure sore throat, sometimes it is better to use points long the Lung channel, butother times it may be better to use points along the Stomach channel or other related channels.

Although many of the existing software for acupuncture provide a vast among of informationabout the relationship between the acupuncture points and their treatments, but none explainshow they are related by modelling the flow of Qi in the channels. One product, AcuPartner[7], has an animation of acupuncture points hopping along the channels. However this is asimple graphical display, it has no information about the level and the flow of Qi.

The lack of information about the level and the flow of Qi in the channels have somelimitations in the understanding and further development of acupuncture.

It is difficult to understand why treating a particular point can cure symptomselsewhere.

The effectiveness of treatment depends on the level of Qi in the channels. There issome work in producing hardware sensors to detect the level of Qi via theacupuncture points [11,12]. The lack of quantitative definition in the software modelmeans that it is not possible to link it to such a hardware device to provide diagnosticand treatment tools.

In this paper, we propose an idea on modelling the dynamic aspect of the theory behindacupuncture by explicitly modelling the level and the flow of Qi in the channels.

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4. A Comparison with an Organisational Process

Consider a simplified example of students going through different years in a University. Ineach year there are a number of modules that each student must pass. If a student fails to passa module, the student is not allowed to progress into the following year. In an ideal situation,the number of students going through different years should be about the same. Howeverthere may be factors causing big changes to the general flow of students from one year to thenext, for example, high failure rate, and a large group of direct entrance. Consequently wemay have problems such as insufficient number of tutors or labs for a particular module.Within the university, we normally have some measures to regulate the flow of the students,for example, field board (exam board) adjustment and change of teaching staff etc.

The following table draws similarities between this organisational process and theacupuncture channel system.

Features Student example Qi in channels

Core flow From one year to another From one channel to another

Amount of flow Number of students Level of QiUnbalanced flow Too many students in one

year and very few in anotherStagnated, blocked andimpaired in various channels

Causes of imbalance High failure rate, etc. Too cold, depression, wrongdiet etc

Consequences (or symptoms) Insufficient labs, not enoughstudent to justify optionmodules, etc.

Headache, sore throat, etc.

Actions to correct imbalance Revisit module contents,field board, replacing thetutor, etc

Stimulate at the acupuncturepoints

Table 1 Comparison between student flow and Qi flow

In the next section we propose an idea of modelling the dynamic flows in acupuncture basedon the concepts used in modelling organisational processes.

5. Modelling the Dynamic Flow of Qi as Workflow

There are many approaches for modelling workflows in organisational processes. The mainconcepts in modelling workflow include: process, role, attributes, activity, interaction, andsequences of activities. Given that we have drawn similarities between the flow of Qi andworkflow in an organisational process, in this section, we present an idea on structuring amodel of the flow of Qi in terms of the concepts used for modelling workflow.

Each channel is modelled as a process containing three roles, one for the flow of Qi in thechannel (Qiflow), one for the possible factors that may cause changes in the flow (disturbor),and another for the set of actions that can be done to correct the level of flow (acupoint).

Qiflow: A Qiflow role keeps information about all the acupuncture points along the channel,and their mappings to symptoms. This information is very much similar to existing softwarefor acupuncture. In our proposed model, a Qiflow role also maintains the different stageswithin the channel and the level of Qi within each stage. Activities for a Qiflowrole includesmoving Qi from one stage to the next, blocking, reducing, and increasing the level of Qi at aparticular stage.

Disturbor: A disturbor role may take input such as emotional status, types of diets etc. Adisturbormaps these inputs to information denoting their effects (based on Chinese medicine

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theory), which in turn is passed to the corresponding Qiflowrole to change the level of Qi inthe channel.

Acupoint: An Acupointrole includes all the acupuncture points along that channel. The logicwithin such a role allows users to specify the level of Qi to be increased or reduced. TheAcupointrole interacts with the Qiflowrole to pass on the corrective instructions. The flow of

Qi in the Qiflowrole will be changed accordingly.

This model illustrates the relationship between external factors, such as cold, to a particularsymptom, such as sore throat, through the flow of Qi in the related channel. It also shows therelationship between manipulating a particular acupuncture point and the changes in thesymptoms through the flow of Qi in the related channel.

6. Reflections, Conclusion and Future Work

6.1. Application to Acupuncture

This paper has illustrated that the dynamic flow of Qi in channels can be modelled asworkflow in organisational processes. The aims of our work in this area are to produce bettereducational software for acupuncture and to facilitate further development in acupuncturetreatment. We believe that the dynamic model presented in this paper, if linked with somegraphical user interface, can provide a much more intuitive understanding of the acupuncturetheory than the existing software because the relationship between the acupuncture points andthe symptoms can be illustrated by the flow of Qi in the corresponding channel. Thequantitative dynamic model can also be used for simulation purposes to analyse the effect onthe flow of Qi when different imbalance factors have been encountered, and similarly whendifferent corrective actions have been put in place. In addition, the ability to describe Qiquantitatively has the potential of linking the model to some hardware sensory devices, whichcan be developed into diagnostic and treatment tools. Of course modelling Qi as workflow is

only one possible way of capturing the dynamic aspect of the channels. We will beexperimenting with different models.

6.2. Lessons Learnt for Modelling Organisational Processes

The detachment of the external factors (disturbor) and the corrective activities (acupoint)from the basic core activities (Qiflow) in a model makes it easier to evolve. This detachmentpattern can be applied to modelling organisational processes. Organisational processes areoften evolvable due to external impact [13]. In order to address this demand for changes,models of organisational processes tend to include information about the possible externalchanges and the possible responses to these changes in addition to the basic core businesslogic. The results are that the model is very complicated to understand; and it is subject to

change because not all external factors can be anticipated. The detached pattern aboveseparates these three aspects. The basic core business logic is usually fairly stable. If newexternal factors start to have impact on the core business, it is only necessary to replace theexternal factor role. Similarly if the organisation decides to have an alternative way to correctthe problems in the core business, it is only necessary to replace the corrective role. Futurework in this area may lead to process patterns as defined in [14,15]. Such a pattern may beapplied to many organisational processes where we require a regular flow of objects, forexample, a billing department requires a regular flow of bills through its process; a universityrequires a steady flow of students.

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6.2. Deriving Executable Process Models from Process Patterns

In [15], a number of process patterns have been defined using an extended UML notation.The pattern described in this paper can be defined using the notation described in [15].Possible future work includes investigation of deriving executable process models by refining

or specialising process patterns and evolving executable process models.

7. References

[1] J. J. Tsuei, The Science of acupuncture theory and practice, IEEE Engineering inMedicine and Biology, May/June, pp. 52-57, 1996.

[2] Bristish Medical Acupuncture Society, www.medical-acupuncture.co.uk

[3] Internal Healers, www.internationalhealers.com/acupuncture/circuits.asp

[4] Acupuntcture, Holistic-online.com, www.holistic-online.com/Acupuncture/acp.htm

[5] TCM Basics.com, A healthcare research project of Wyith, tcmbasics.com/channels.htm

[6] Zhangmen Acupuncture Software WebSite http://www.factsoft.nl

[7] AcuPartner 2000 http://www.acupartner.com

[8] Qpuncture http://www.Qpuncture.com

[9] Acu-Soft, Software for Practice http://www.seirin.de/uk/software/as_ueber.htm

[10] Acupuncture Interactive Book, KAREsoft.

[11] X. W. Sun, and Q. M. Zhu, Development of computer based acupuncture systems, 3rd

ICBEM, pp. 95-96, Ljubljana, Slovenia, 2000.

[12] Chen KG. Electrical properties of meridians. IEEE Engineering in Medicine and Biology1996 May/June; 58-63.

[13] I. Beeson, S.Green, J. Sa, and A. Sully, Linking business processes and informationsystems provision in a dynamic environment, Journal of Information Systems Frontiers 4:3,317-329, 2002.

[14] S. W. Amber, Process pattern building large-scale systems using object technology,Cambridge University Press, ISBN 0-521-645668-9, July 1998.

[15] Hans-Erik Eriksson, and M. Penker, Business modelling with UML: business patterns atwork, Wiley, ISBN 0-471-29551-5, Wiley, 2000.