Applying Process Modelling Concepts to Modelling Acupuncture Channels

Jin Sa and Quan Zhu Faculty of Computing, Engineering and Mathematical Sciences University of the West of England jin.sa@uwe.ac.uk 1. Introduction
Acupuncture as an alternative medical treatment is beginning to be widely accepted in the west. Such a growth of acceptance has triggered a demand for an understanding of how it works. In this paper, we propose an idea for modelling the principles behind the working of acupuncture. The proposed work has two aims. One is to provide a suitable model that can be used to benefit the understanding and the further development of acupuncture. The other aim is 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 process modelling 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 requires the study of channels (or meridians), acupuncture points, body's energy. In general the treatment 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 one another by invisible pathways called channels. The channels are pathways in which energy is circulated throughout the body. In Chinese Medicine, the energy flowing in the channels are called Qi. The flow of the Qi regulates normal functioning of the body, and diagnostically reflects illness. There are 72 channels connecting all the tissues and organs. The most important ones are the 12 primary channels. Each of the 12 primary channels is associated with an organ; for example, there is a lung channel, a large intestine channel, a Spleen channel and a stomach channel. These channels are connected to each other so that Qi can flow from one channel to another 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 lung channel at 3am, moving to the large intestine channel at 5am, and eventually completes its cycle 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 and healthy, but if Qi becomes blocked, stagnated or impaired, it can result in ill health with symptoms such as sore throat and headache. An imbalance in a persons body can result from many 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 the skin. To restore the balance, the acupuncturist stimulates the acupuncture points to manipulate the level of Qi in the channels, which in turn affects the state of the organs. The practice of acupuncture 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

important to understand the relationship between the acupuncture points and the associated organ via its channel. More details on acupuncture can be found from numerous established acupuncture organisations [2,3,4,5].

3. Existing Acupuncture Software and Their Limitations

Many commercial software products have been developed for educational purpose to aid the understanding of acupuncture. Some of the most popular products include Zhangmen [6], AcuPartner [7], Qpuncture [8], Acu-Soft [9] and Acupuncture Interactive Book [10]. Almost all of these products are based on the same principle of clicking over an acupuncture point to reveal its name, anatomical location, and conditions for which it may be used. A few of them also have facilities to illustrate the needling techniques. The essential difference between them is in the presentations. While some present basic textual information, others present sophisticated 3D images. Zhangmen [6] provides two-way correlations between treatment points 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 of acupuncture points may be presented. However, there is no conceptual framework to indicate the 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 the symptoms, lets consider two specific channels. Among many places, the Lung channel passes through the throat and the shoulder. Similarly among many places, the Stomach channel passes through the throat and the stomach. If the Qi is not flowing well in the Lung channel, the patient may get sore throat or pain in the shoulder. So a point along the Lung channel may be used for treating sore throat or pain in the shoulder or other symptoms. If a patient is suffering from sore throat, it may be the case that the Qi is not flowing well in the Lung 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, but other 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 information about the relationship between the acupuncture points and their treatments, but none explains how 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 a simple 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 some limitations in the understanding and further development of acupuncture. It is difficult to understand why treating a particular point can cure symptoms elsewhere. The effectiveness of treatment depends on the level of Qi in the channels. There is some work in producing hardware sensors to detect the level of Qi via the acupuncture points [11,12]. The lack of quantitative definition in the software model means that it is not possible to link it to such a hardware device to provide diagnostic and treatment tools.

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

4. A Comparison with an Organisational Process

Consider a simplified example of students going through different years in a University. In each year there are a number of modules that each student must pass. If a student fails to pass a 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. However there may be factors causing big changes to the general flow of students from one year to the next, for example, high failure rate, and a large group of direct entrance. Consequently we may 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 the acupuncture channel system. Features Core flow Amount of flow Unbalanced flow Qi in channels From one channel to another Level of Qi Stagnated, blocked and impaired in various channels Causes of imbalance Too cold, depression, wrong diet etc Consequences (or symptoms) Insufficient labs, not enough Headache, sore throat, etc. student to justify option modules, etc. Actions to correct imbalance Revisit module contents, Stimulate at the acupuncture field board, replacing the points tutor, etc Table 1 Comparison between student flow and Qi flow In the next section we propose an idea of modelling the dynamic flows in acupuncture based on the concepts used in modelling organisational processes. Student example From one year to another Number of students Too many students in one year and very few in another High failure rate, etc.

5. Modelling the Dynamic Flow of Qi as Workflow

There are many approaches for modelling workflows in organisational processes. The main concepts in modelling workflow include: process, role, attributes, activity, interaction, and sequences of activities. Given that we have drawn similarities between the flow of Qi and workflow in an organisational process, in this section, we present an idea on structuring a model 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 the channel (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 software for acupuncture. In our proposed model, a Qiflow role also maintains the different stages within the channel and the level of Qi within each stage. Activities for a Qiflow role includes moving Qi from one stage to the next, blocking, reducing, and increasing the level of Qi at a particular stage. Disturbor : A disturbor role may take input such as emotional status, types of diets etc. A disturbor maps these inputs to information denoting their effects (based on Chinese medicine

theory), which in turn is passed to the corresponding Qiflow role to change the level of Qi in the channel. Acupoint: An Acupoint role includes all the acupuncture points along that channel. The logic within such a role allows users to specify the level of Qi to be increased or reduced. The Acupoint role interacts with the Qiflow role to pass on the corrective instructions. The flow of Qi in the Qiflow role will be changed accordingly. This model illustrates the relationship between external factors, such as cold, to a particular symptom, such as sore throat, through the flow of Qi in the related channel. It also shows the relationship between manipulating a particular acupuncture point and the changes in the symptoms 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 as workflow in organisational processes. The aims of our work in this area are to produce better educational software for acupuncture and to facilitate further development in acupuncture treatment. We believe that the dynamic model presented in this paper, if linked with some graphical user interface, can provide a much more intuitive understanding of the acupuncture theory than the existing software because the relationship between the acupuncture points and the symptoms can be illustrated by the flow of Qi in the corresponding channel. The quantitative dynamic model can also be used for simulation purposes to analyse the effect on the flow of Qi when different imbalance factors have been encountered, and similarly when different corrective actions have been put in place. In addition, the ability to describe Qi quantitatively has the potential of linking the model to some hardware sensory devices, which can 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 be experimenting 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 detachment pattern can be applied to modelling organisational processes. Organisational processes are often 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 external changes and the possible responses to these changes in addition to the basic core business logic. 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 above separates these three aspects. The basic core business logic is usually fairly stable. If new external factors start to have impact on the core business, it is only necessary to replace the external factor role. Similarly if the organisation decides to have an alternative way to correct the problems in the core business, it is only necessary to replace the corrective role. Future work in this area may lead to process patterns as defined in [14,15]. Such a pattern may be applied to many organisational processes where we require a regular flow of objects, for example, a billing department requires a regular flow of bills through its process; a university requires a steady flow of students.

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 in Medicine 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.
rd [11] X. W. Sun, and Q. M. Zhu, Development of computer based acupuncture systems, 3 ICBEM, pp. 95-96, Ljubljana, Slovenia, 2000.

[12] Chen KG. Electrical properties of meridians. IEEE Engineering in Medicine and Biology 1996 May/June; 58-63. [13] I. Beeson, S.Green, J. Sa, and A. Sully, Linking business processes and information systems 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 at work, Wiley, ISBN 0-471-29551-5, Wiley, 2000.