Every physician knows that one of the fundamental elements of a therapeutic strategy is to predict the possible evolution of a clinical situation. Thus therapy can be adapted much more efficiently. Though, it is practically impossible, and imprudent, to assert with certainty the degree of the evolution of a case. There can be only probability.

Indeed, the factors of uncertainty or errors are numerous and hard to determine. Still, some data can be established to allow an evaluation approach that I’ll call "Probability of Prognosis".

This will never be a certainty, only an approach. The problem is to reduce as much as possible the range of uncertainty.

SYMBOLISM

It’s evident that for the same clinical case, a 15 years old subject will respond much better than a 75 years old one, as the immune system of the younger is much stronger. Without forgetting that the very young and the very old have the same fragility.

It is generally known that a woman has a different clinical response than a man. If it’s not only for the adrenergic neuro-vegetative dominance in women, it’s also for hormonal differences.

Traditional acupuncture had already anticipated this approach. Chapter 1 of the Nei King is explicit when its says: "Woman is 7 and Man is 8". Starting from the age of 7 for a woman and 8 for a man, the text presents evolutional periods determined by cycles of age such as: 1 time 7 years, 2 times 7 years, 3 times 7 years, 4 times 7 years, etc, until 7 times 7 years when a woman "cannot procreate.." etc. Similarly for a man, from 1 time 8 years, 2 times 8 years, 3 times 8 years etc, until 8 times 8 years...

One can of course wonder by which criteria the values of 7 years for women and 8 years for men were established. For those familiar with the symbolic mechanisms of Taoism, the answer is quite simple:

Heaven-Yang Total-Man fertilizes Earth-Yin Total-Woman, who "creates the 10,000 beings".

Thus Man corresponds to "Anterior Heaven" with its 8 Pure Energies, or "Tsing" or "Koua" or Trigrams. Thus man "is 8". Woman, on the other hand, obeys fertilization; therefore she "transforms". As I have shown in other works, notably in the Acupuncture Course (1973), this transformation is nothing but a regular permutation of 7 steps, that goes on regularly according to the rules, laws and algorithms of acupuncture.

I conclude: if the fertilizing man is "8", then the "transforming" woman is "7". It can be said that the "Pure Energy" that she receives from Heaven-man is transformed into "Pure Light", visible as a flame symbolizing Life. The woman is the "7 flames" of the Biblical Menorah... I could develop this symbolism, found in the Nei King, the Lei King, and Tao masters as Chuang-Tzu, Lie-Tzu or Ming-Tzu, but it would be outside the scope of this article.

DYNAMICS

What is interesting in the traditional data is the repartition of evolutivity by age and sex. The major referential of the acupuncture dynamics is "the Law of the 5 Movements" (Pentasymetry or Pentacoordination - see Energetics course ESAF) that comprises two fundamental synchronic cycles, one circular, the other inductive, pentasymetric. These two cycles are interactive: i.e. the fundamental dynamics is made up of two consecutive cycles of 5 movements, totaling 10.

But the main fact, often forgotten by many "traditional" acupuncturists, is the notion of Time, which never stops, implying a continuous movement. The consequence is very important: the dynamics of the Law of the 5 Movements cannot be circular; it has to be Spiral.

VARIATION AND ALTERNATION

All the elements and information that constitute our environment can vary. That’s what I have called the "variability" of the three fundamental concepts of our explorable universe (Energy, Structure, Evolution). To avoid complicating this paper, it suffices to know that this variability has been shown to obey the so-called "Spiral of Fibonacci" which follows a very simple, quite childish, algebraic law: 1, 1, 2, 3, 5, 8, 13, 21, 34, 55 etc. (Note that this spiral is a fundamental element of Genetics...).

One has to take into account the traditional argument called "the Law of Alternation", which means, according to the texts, "a time for Yin, a time for Yang"... Which leads to an oscillation, or pulsation, of the Fibonacci spiral in the dynamics of the Law of the 5 Movements. That means 10 movements "Yang" from 1 to 55, and 10 movements "Yin" from 55 to 1 etc.

Now one problem is present: how to enter in this dynamics.

IDENTIFICATION

Every group or functional system is identified to a trigram. For instance: 010 Shaoyin groups "Kidney" and "Heart", 011 Jueyin groups "Liver" and "Pericardium" etc. From this data, a course of action can be proposed.

A subject comes to consult for digestive troubles. The anamnesis and the examination reveal a second major symptom: crises of cholecystite. Note that in medical practice it is very rare, even impossible, to find a real monosymptomatic clinical case. There is always a secondary symptom. As the traditional texts constantly repeat, "one should not take the leave for the root".

Since every trigram identifies a system, we thus have two trigrams to identify that clinical case: Yangming 101 for digestive problems, and Shaoyang 100 for cholecystite. Consequently we can build a hexagram, which will certainly obey the only 64 possible hexagramatic combinations. The Anterior Heaven has 8 trigrams, all in interaction. Therefore the possibilities are only 8x8 = 64 combinations.

To simplify the subject, I translated every trigram into a binary code: 101 for Yangming and 100 for Shaoyang. Only two combinations are possible: either 101 100 or 100 101.

The 64 hexagrams follow a logical and predictable order (see Movement of Energies and Acupuncture Course - ESAF). This order simply follows the natural sequence of numbers. If one "enters" the system by any hexagram, and follows the logical dynamics of the Law of the 5 Movements, one can describe a trajectory going through 10 steps. The 10th hexagram will be the logical target of this movement. This hexagram will have to be interpreted as the probability of clinical evolution, in function of the two trigrams of its constitution.

VARIABILITY

Variability will be determined by two factors: the Spiral of Fibonacci and what I call "the inflexion". The Spiral of Fibonacci starts each movement from value 1, then 2, then 3, then 5, etc. Therefore, from the hexagram of entry the movement skips the following one, then again the next one, then the 2 next ones, then the 3 next ones, etc, until the last one located at 55 hexagramatic distances from the one before last. One thus has a regular spiral variation.

For the "inflexion" the value of woman is 7 and of man is 8. Consequently, in each analysis of the Spiral of Fibonacci, the constants 7 and 8 are added respectively for a woman and for a man. It’s the way one materializes the mathematical "difference"of the movement.

The inflexion follows also the variations of age such as: "at one time 7 the woman has her teeth, her hair grows" etc. Then at two times 7, then at three times 7, then at four times 7 etc, until seven times 7. Similar variations of one time 8 until eight times 8 are for a man...

So, to activate this variable, it’s enough to follow the traditional data and create a "Life Scale" of 7 times 7 for a woman, and 8 times 8 for a man.

A critical point on which I hesitated for a while was the age to start the movement.The solution came by itself: if the dynamics of the movement obeys the Law of the 5 Movements, the start point have to be age 5, followed by all multiples of 5. Whatever, I have continued the movement past age 49 (seven times 7) and 64 (eight times 8), estimating that past this age a women is perfectly operational, and a man is still valid... But one has to take into account the decrease of physiological functions with age and, somehow arbitrarily, I have inverted the gap starting at 60 for a woman (60,64,67...) and at 76 for a man.

RISK FACTOR

All the variation factors are now integrated. We have a list of 10 consecutive predictable hexagrams, each formed out of two trigrams, totaling 20 trigrams. Each of them corresponds to a functional group recognized by traditional data. One needs only to determine the most frequent group (trigram) in the sequence, in order to find the functional group most at risk.

INTERPRETATION AND RESULTS

At the beginning, I considered this "Prognosis management" no more than a kind of a logical game, without much clinical relevance.

Then, surprisingly, practice showed that this management was reliable and valid, provided no mistake is done in the equation of entry. A wrong question brings always a wrong logical answer.

Therefore, the first obstacle is to establish the hexagramatic equation of the patient. This is the principle problem. The experience of my students shows that, at the beginning, it is normal to hesitate and make mistakes. Progressively with practice, questions and answers become more precise and efficient.

My long time practice of this technique showed me that one has to take into account the TWO last hexagrams, and to analyze the 4 trigrams composing them. They are the functional groups corresponding to the actual situation of the patient. The Risk Factor being an additional data.

I have developed this approach notably in two systems: one of "Energy", and one of "Structure" types. Using both systems for the same case, one can confront the two different aspects. I must say that my first program Gestion seems reliable and efficient.

In order to conform with the general approach of the "Ecole Superieure Acupuncture France (ESAF)", the same program Gestion has been transcribed into binary code. This variation is much more modern and clear, including all the functional groups in correspondence to those binary codes.

It is always possible to calculate manually. However that modality causes many mistakes, which very often are not perceived. I have created the program "Gesfib55" to be used on any type of computer (except for Macintosh), under Windows, Qbasic or directly from diskette by Gwbasic.

Here I give an example of clinical analysis: a 20 year old woman, a 60 years old woman and a 20 years old man, presenting the same case of gastritis with cholecystitis (see Appendix). The comparison of the three responses, below, illustrates their physio-pathologic differences. I have added also a direct binary example for the same case, which allows the reader to choose the mode of expression suitable to him.

Note that these techniques are part of the 2nd year course, or the end of the 1st year, in different schools that I direct.

Note: The "Gesfib55" diskette is available by correspondence either directly to my address or to the direction of ESAF:

The French text is easily translatable by a computer specialist.