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REVIEW ARTICLE
Year : 2023 | Volume
: 9
| Issue : 1 | Page : 21-28
Development of intelligent acupuncture applications and related technologies
Yun-Fan Bao1, Zhi-Han Zhang2, Hui-Ying Yu3, Xiang-Ning Huo1, Yang Lu1, Tian-Cheng Xu1
1 Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
2 Institute of Life Science and Chemical Engineering, Jiangsu Second Normal University, Nanjing, China
3 Institute of Pharmacy Macau, Macau University of Science and Technology, Macau, China
Correspondence Address:
Dr. Tian-Cheng Xu
Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023
China
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2311-8571.364416
The study focuses on developing mobile applications based on intelligent acupuncture, classified into education and intelligent diagnosis and treatment. The mobile application function is divided into two directions: assisting acupoint positioning and perfecting acupoint knowledge system. The study does a relative review on Android and IOS, showing that the number of Android users is rather more prevailing than IOS. It suggests that intelligent acupuncture mobile applications should comply with the trend of acupuncture globalization in the future, developing multilingual versions. Further, the content should be characterized by the experience of different famous doctors to avoid homogenization. Technically, intelligent applications should continue to develop three-dimensional and augmented reality technology, to optimize the accuracy of acupoint positioning.
Keywords: Acupuncture, intelligent diagnosis and treatment, mobile application
Acupuncture has been formally recognized by 103 member states of the WHO and adopted into the medical insurance system by eight countries and regions until 2019.[1] Acupuncture therapy has its unique advantages and caters to the market due to its efficiency. However, the imbalanced distribution of urban and rural medical resources and quality acupuncture practitioners' unevenness leads to insufficient acupuncture medical services to meet social demand. Researchers have developed a series of mobile applications for education and intelligent diagnosis and treatment by combining acupuncture and artificial intelligence. These intelligent applications are committed to solve the development dilemma of an unbalanced distribution of medical resources, difficult personnel training, and low scientific research level of traditional Chinese medicine (TCM).
Analysis of Target Population and Main DirectionsTarget population and its characteristics
Intelligent acupuncture applications are mainly divided into two categories: education and intelligent diagnosis and treatment such as those APPs listed in [Table 1]. Hospitals and universities mostly develop acupuncture education applications to help students majoring in acupuncture and young doctors' study basic knowledge. There are many digital acupuncture applications in the APP market, using three-dimensional (3D) and augmented reality (AR) technology to build human body models, which clearly show the acupoint positioning and help users study the theories of acupuncture. For example, Visual Acupuncture 3D® can realize the precise positioning of acupoints, visually demonstrating the acupuncture process and providing effective training for students. Visual Acupuncture 3D® has many students users, and the AppGodLike® platform shows that its installation amount has reached 106,182 times. Jiu Daifu® received 2088 ratings on the APP Store, and Android APP Market had a total of 6.81 million installations. It is a well-developed education application with clear pages and rich operation videos. A Manual of Acupuncture®[2] has English, French, and German versions and provides rich curriculum resources for practitioners, reaching a score of 5.0 in the APP Store. The Zhongji Meridian Acupoints® features a 3D human anatomy for learning acupuncture, installed 110,000 times on the Android platform. Wang[3] developed an acupuncture education application, which applies computer signals for the construction of the human model, improving the simulation of the human body to help students practice. The acupuncture education system designed by Guo[4] established an acupuncture database and used intelligent algorithms to help students practice acupuncture. ShenProfessional®[5] helps novices easily learn acupuncture and provides professional doctors with a rich acupuncture knowledge base. In the medical education application market, Western medicine education application occupies an advantage. Anatomical education application such as 3D body® has been downloaded 22.21 million times on the Android platform, and the downloads can reach 6069[6] times in a single day. In addition, the user range of anatomy education applications such as the 2021 Human Anatomy Atlas More Details®[7] covers most regions of the world, occupying first place in the download list of paid medical applications. On the contrary, the user coverage of acupuncture education applications such as Jiu Daifu® is limited to China and neighboring countries, rarely downloaded globally. Furthermore, the total downloads of acupuncture education applications are less than those of anatomical education applications. Besides, many mature anatomical applications are developing new functions related to meridians and acupoints, further squeezing the market of acupuncture education applications.
The standardization of TCM diagnosis and the development of information technology provide technical support for the development of intelligent acupuncture diagnosis and treatment applications.[8] Intelligent diagnosis and treatment application is mainly developed for scientific researchers and medical personnel in universities. On the one hand, it assists diagnosis and treatment and improves treatment efficiency; on the other hand, it is used for data collection and analysis to complete scientific research tasks. Gu[9] designed an ear acupoint therapy APP to control and stimulate acupoints through APP for auricular therapy. Lee[10] created an acupuncture therapy APP for pregnant women, sending messages to arrange the treatment time and therapy. Bao et al.[11] designed an application that can analyze pathogenesis and treatment schemes for patients and instruct acupuncture operation. The acupuncture remote diagnosis and treatment system developed by Ai et al.[12] is used remotely to upload medical data from subordinate doctors to experts for reference to realize the sharing of medical resources. The intelligent acupuncture system developed by Li and Wu[13] is used to collect patient information and establish a database of historical cases, which can provide different acupuncture prescriptions for patients. AcuGraph®[14] analyzed the skin resistance to form data images that reflect the patient's health condition and provide acupuncture therapy. AcuPartner®[15] offers multiple language versions and gives acupuncturists treatment ideas and a large amount of acupuncture knowledge. Acuvine®,[16] Acusimple®,[17] and Unified Practice®[18] are designed specifically for acupuncturists, helping acupuncturists arranging work, checking medical records, consulting with colleagues, and improving the efficiency of diagnosis and treatment. As China gradually enters an aging society, acupuncture intelligent diagnosis and treatment applications will be important in health management. The Palm Acupuncture®[19] provides a large amount of acupuncture healthcare information for people in need. It can help users lose weight and provides acupuncture prescriptions. Dai et al.[20] developed an APP for disease prevention and healthcare based on acupuncture therapy. However, most Chinese people tend to use herbs to heal their bodies, and acupuncture is not a mainstream in the future. There is still room for the development in the application of acupuncture in health management in the future.
Application direction
Locate the anatomical position of acupoints
The correct positioning of acupoints is the basis of acupuncture treatment and an important guarantee for safety and effectiveness of the treatment. The common methods include acupoint-located method by anatomical landmark (a method to determine the location of acupoints based on various body surface marks of the human anatomy), finger-cun measurement (a method that acupoints are taken according to the measurements specified by the patient's own fingers), and proportional bone measurement[27] (a consistent determination of the length and width of each part of the body based on the bone joints on the body surface and the examination of the location of acupoints). However, these positioning methods require long-term clinical experience accumulation, solid foundation in the human anatomy, and rich spatial conformation capabilities, which makes acupoint positioning a big problem for beginners. Traditional teaching methods cannot show the deep spatial structure of acupoints,[28] which is not conducive to learners understanding the location of acupoints.
Acupuncture applications mostly use 3D virtual simulation technology to realize the accurate positioning of acupoints such as those APPs listed in [Figure 1]. Hong et al.[29] designed an acupoint detection system to calculate the 3D coordinates of acupoints and project them onto the human body to facilitate teaching practice which is listed in [Table 2] with other Anatomical medical APPs. Yan et al.[30] developed the Acu3D platform to build a 3D model of the human body meridian, showing details such as the structure of the meridian and acupoints from dynamic and static aspects. Luo et al.[31],[32] applied virtual reality (VR) technology to the teaching process of wrist-ankle acupuncture and established a medical virtual education system. Hu et al.[33] found the Unity3D platform and applied VR technology to visualize the acupoint stimulation process to meet teaching and the public's medical requirement. Lan et al.[34] used AR and 3D technology to locate acupoints and provides acupuncture prescriptions. Patients can use the acupuncture prescriptions provided by the system to achieve self-healing at home. Cao and Shi[35] used VR technology to construct a virtual external environment, a virtual human body, and acupoints. Students can practice acupuncture on a virtual human body in a virtual environment. However, there are still problems in the accuracy of acupoints positioning using a 3D simulation system. In the future, it is necessary to carry out more experiments to compare the data of artificial acupoint positioning. In addition, most acupoint positioning systems are limited to acupoints from the 12 meridians, and acupoints such as extraordinary points (a kind of experiential effect points that do not belong to the 14 meridians but have fixed positions), Ashi point (a kind of acupoint that appears in the local and peripheral pain points of lesions as acupoints), and Dong's extraordinary points (the general name of acupuncture points created by Taiwan acupuncturist Dong Jingchang) are not included.
The integration of intelligent applications and traditional teaching methods improves the teaching efficiency of acupuncture studies. For example, Yang et al.[36] established a virtual simulation system and proposed a learning model of “human–computer interaction.” The anatomy education application 3D body® provides a 3D digital model of the human body through virtual imaging technology, including more than 5000 human structures,[37] which can clearly show the internal structure of organs and the spatial location of meridians and acupoints on the phone. In addition, the application can be used offline and bilingual. As an education application, it can electronic the manually drawn images and apply them to multimedia teaching, which alleviates the shortage of human specimens. Dai et al.[38] conducted experiments with 120 students majoring in acupuncture. The control group adopted the traditional teaching model, and the 3D body® assisted the experimental group. The scores of the experimental group in acupoint positioning were much higher than those of the control group. Qin et al.[39] conducted experiments on 98 students of nervous system anatomy. The control group adopted the traditional teaching mode, and the experimental group used the 3D body® to teach. The experimental group's practical and theoretical performance was better than the control group. He and Qin[40] conducted experiments on 90 clinical medicine students from China. The general group used textbooks to study, and the experimental group used DXY®. The experimental group scored better than the general group in the final test. Hu[41] conducted experiments with 40 neurosurgery nurses in China. The control group used ordinary textbooks to study, and the experimental group used 3D body® combined with textbooks to study. The experimental group scored higher than the control group in assessment. In the study of acupuncture, students need to master basic anatomical knowledge and understand it in a traditional way. However, most anatomy education applications focus on Western medicine so that students cannot understand the human body from the perspective of Chinese medicine after using it. There are some acupuncture education applications in the application market, but they are far from 3D body® in terms of professionalism, popularity, and design. Therefore, the development of acupuncture education applications needs to be improved. In terms of user experience, developers should consider Western medicine education applications as the standard and add TCM as a distinguishing feature. In addition, considering the danger of operating acupuncture, the acupuncturist needs to master modern medical knowledge such as anatomy and receive professional training to ensure efficiency and safety. The current education application of acupuncture can only assist education and cannot replace offline courses. Novices cannot learn acupuncture only depend on education applications without practical classes delivered face to face. Therefore, most users of acupuncture education applications are students who have taken courses. In the future, acupuncture education applications should open the market of nonprofessional acupuncture lovers.
Improvement of acupoint-related knowledge system
In reality, the prerequisites for practicing acupuncture are mastering acupoints' characteristics, functions, and meridian circulation. Acupuncture applications should contain basic acupuncture theory such as those APPs listed in [Figure 2] and [Table 3]. Yu founded the “Chinese Acupuncture Multimedia Database Retrieval System,” which systematically records the name, location, functions, and sources of acupoints so that users can learn acupuncture in detail. In addition, it brings convenience to researchers who devote themselves to ancient medical books. In recent years, acupuncture prescription databases for specific diseases have gradually developed. Zhang[43] established a database of antique medical books on acupuncture prescriptions for the treatment of stroke. These databases digitize traditional medical books and promote the development of acupuncture modernization.
Analysis of application characteristics of different platform
IOS
Applications based on the IOS platform use many 3D models and real pictures of the human body to provide users with a more intuitive introduction to acupoints, improving users' learning efficiency such as those APPs listed in [Table 4]. The applications provide a variety of pictures, videos, and notes to introduce acupoints and their acupuncture methods in detail, making the inserting process safer. Most applications provide versions in different languages, which suit users in various regions. These applications provide an accurate searching engine. When users encounter problems during the learning process, they can search the acupoint information they want directly and accurately. The application provides functions such as drawing pictures and taking notes to help users explore the actual position of the acupoints and improve the learning efficiency. Acupuncture applications based on the IOS system contain many illustrations with few text parts, while the illustration and text proportions are imbalanced. The proportion can be adjusted to facilitate users' understanding.
Table 4: Acupuncture mobile application of iPhone operating system platformAndroid
Developing of a series of modern information technologies such as digital information technology, intelligent mobile network, the Internet, the Internet of Things, and big data makes it convenient to improve and solve information shortages in the health management field. With the popularity of smartphones and the development of mobile Internet technology, the number of health management APPs on the Android platform is growing rapidly, such as those intelligent diagnosis and treatment APPs listed in [Table 5].[52] In page design, Android system applications focus on information searching and knowledge learning. The application interface of the Android system is combined with graphics and text, which caters to the public esthetics. However, the function of the application interface is complex, and the content is homogeneous, so the application developer needs to add characteristic content.
Comparative analysis of application characteristics
IOS is a mobile operating system developed by Apple, which has smooth operation and high security.[55] Most of the acupuncture-related applications developed based on the IOS platform are mainly in English. Today, the application of artificial intelligence technology in American acupuncture research is earlier than in China, so the American acupuncture application has higher professional requirements for users. Android is a free and open-source operating system based on the Linux kernel. Its services, such as smart home service systems, pay more attention to practical use.
The Android operating system accounted for more than 81% of the market share, while the IOS operating system only accounts for 16%[56] among the global mobile phone operating systems market in 2019. Nearly 80% of the world's people use the Android operating system, promoting the popularization and user experience of applications developed based on the Android platform. Da Jia Chinese medicine® has exceeded 6 million downloads, and the meridian acupoint diagram® has approached 9 million users. Applications based on the Android platform are more convenient, making them more popular with mobile phone users. The development of these applications helps nonprofessional users to enjoy health management at home.
Analysis of future development trends
The intelligent acupuncture mobile applications facilitate education, assist doctors in diagnosis, and alleviate the uneven distribution of medical resources to a certain extent. However, the current research and development of “acupuncture + artificial intelligence” application equipment still have the following problems: (1) The functions are scattered, and the composite functions of education and intelligent diagnosis cannot be realized in one application. (2) The technical level is low, the intelligent diagnosis and treatment equipment mostly stays in data mining and detection, and there is no in-depth medical data mining.[57] The work is still in the preliminary preparation and laboratory stage and cannot replace doctors for independent diagnosis. (3) Failed to reflect the characteristics of traditional acupuncture therapy. “Acupuncture + artificial intelligence” applications can do basic operations such as acupoint selection and needle insertion. In contrast, the processes of acupuncture characteristic therapies such as skin acupuncture, bloodletting, and sunken cord are not included. The experience of famous doctors also needs to be incorporated into intelligent acupuncture applications in the future. (4) Compared with Western medicine intelligent applications, the development of intelligent acupuncture applications lacks in-depth study of a single disease.
To meet the potential user needs, developers should integrate multiple functions in one acupuncture intelligent mobile application which can combine advantages from those APPs listed in [Figure 1] to [Figure 2] as well as [Table 1] to [Table 5]. Those functions include data mining, intelligent diagnosis, digital therapies, etc. They may reflect the unique therapeutic effect of acupuncture. We need to put forward higher requirements for applying intelligent acupuncture diagnosis and treatment on the existing basis, which requires us to formulate corresponding solutions according to the raised problems. Thus,we can design a completely new acupuncture application such as the UI design in [Figure 3].
In response to the above problems, the following are the solutions: (1) Cultivate interdisciplinary talents. Universities of TCM should set up computer science majors in school and cultivate students with medical and applications development skills, promoting the integrated development of acupuncture and computer. (2) Collect patients' medical data and further expand the database to protect privacy to expand the scope of the application.[58] (3) Learn from advanced medical applications to improve the practicability and humanized design of acupuncture applications.
ConclusionAcupuncture has been widely used in more than 180 countries[59] and regions worldwide, showing huge international influence. To cater to the global market, the future development of acupuncture applications should investigate user habits worldwide and develop multilingual versions. In terms of users, with the aging of Chinese society and the popularity of smartphones, acupuncture application developers should include the elderly into the target user group and design mobile applications with more convenient operation and more visible page fonts. In terms of application content, the mobile application of acupuncture should avoid homogenization and deeply excavate the experience of ancient acupuncture books and famous doctors. The acupuncture application developer should meet the multilevel medical needs of the public so that acupuncture can be more widely spread and applied.
Financial support and sponsorship
1. 2022 Jiangsu Science and Technology Plan Special Fund (Key Research and Development Plan Social Development) Project (BE2022712); 2. 2021 Jiangsu Special Research Project of TCM Science and Technology Development Plan (ZT202120); 3. Research Project of Nanjing University of Traditional Chinese Medicine (XT202001).
Conflicts of interest
There are no conflicts of interest.
References
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