基于认知心理逻辑的“观其脉证，知犯何逆，随证治之”研究

【作者】 周琳琳；

【导师】 贾春华；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2012， 博士

【摘要】 自20世纪60年代以来,认知科学已逐渐成为当今的前沿科学,并成为一股强大的学术潮流,直接影响着当前众多学科的研究方向,它是包括了心理学、语言学、逻辑学、神经科学、人类学、哲学、计算机科学等的综合学科。“观其脉证,知犯何逆,随证治之”这句话出于汉代医圣张仲景所著的经典《伤寒论》中,可以说是中医辨证论治的浓缩。本论文在认知科学的研究背景下,试对“观其脉证,知犯何逆,随证治之”思维过程分别进行心理学、逻辑学方面的初步探索。本论文由四部分构成：第一部分为基于认知心理语言逻辑的“观其脉证,知犯何逆,随证治之”研究方案。在回顾了认知心理学问题解决研究现状、动态认知逻辑研究发展现状、中医辨证论治思维研究进展的基础上,提出了“基于心理、逻辑等研究方法的‘观其脉证,知犯何逆,随证治之’的研究构想”。“观其脉证,知犯何逆,随证治之”的思维过程可以从认知心理学的问题解决理论来分析之,可以从动态认知逻辑中公开宣告、信念变化来刻画之。因为从认知心理学的角度来看,诊治一个或几个病证就是解决一个或几个问题,中医学“辨证论治”即是一系列有目的指向的认知操作的问题解决过程。“观其脉证,知犯何逆”是确定问题和表征问题；“随证治之”是计划解决方案和执行计划；病人服药后效果如何,应该如何调整处方是问题解决中的评估计划、评估解决方案。从认知逻辑学的角度来看,在辨证论治这个有目的指向性的认知操作的动态过程中,中医师的信念会随着治疗前后临床信息的变化而不断变化和完善。因此我们就可以认知心理学问题解决的立场去研究辨证论治过程,并以动态认知逻辑来刻画它。第二部分为“观其脉证”——中医证候研究进展、趋势与设想。它要解决的是“证候是什么”及“应该如何研究”的问题。该部分勾勒出当今有关证候研究的重点热点问题,如证候的概念、证候的规范化、证候的客观化、证候研究的多学科介入等,基于此提出证候研究的趋势与设想,即建立规范的证候体系和证候诊断标准,寻找证候本质,既是证候研究的初衷也是证候研究的落脚点。但证候研究遇到的困难和存在问题是显而易见的,方法学的落后、思维的僵化是证候研究中最为突出的两大瓶颈,从逻辑学、语言学角度探求中医学所蕴涵的内在逻辑、分析中医语言,从根本上理解中医语言和逻辑,从而使中医理论研究和证候研究在多学科介入的情况下,既不迷失自我又能革新思维理念。第三部分为“知犯何逆”——认知心理学阐释与概念隐喻分析。从认知心理学对“观其脉证,知犯何逆,随证治之”进行阐释,认为“知犯何逆”属问题表征,它解决“是什么与为什么的问题”,即医生将病人表现出的症状体征赋予相应的临床意义,而所赋予的意义是隐喻的。然后以鼓胀病为例,将历代名家医案中有关鼓胀病的医案作为研究语料,归纳总结出鼓胀病的病因病机类型,并从概念隐喻角度进行了较为详细的语言分析,认为中医病因病机概念的形成大多是“类比”即“隐喻”的结果,中医病因病机概念隐喻的功能主要在于“解释”临床病症的发生发展变化规律。第四部分为“随证治之”——基于公开宣告的中医治疗信念变化的动态逻辑刻画。从公开宣告的动态认知逻辑立场对《金匮要略》“随证治之”的公开宣告逻辑刻画,认为应用公开宣告的动态认知逻辑的方法可以对“随证治之”思维的形式结构进行刻画。更多还原

【Abstract】 Since the1960s, Cognitive Science has gradually become today’s cutting-edge science. It is a strong academic trend and has a direct impact on many disciplines such as Psychology, Linguistics, Logic, Neuroscience, Anthropology, Philosophy, Computer Science, and so on. The sentence of "Observe symptoms to know how it committed against, and then follow the legislation to treat syndromes" has come from "Treatise On Cold" written by Zhang zhongjing in Han Dynasty. It can be said the concentrated of "Syndrome Differentiation and Treatment" in Chinese Medicine. The paper will has an initial exploration of "Observe symptoms to know how it committed against, and then follow the legislation to treat syndromes" from Psychology, Logic in the background of cognitive science.This thesis consists of four parts. The first part is a research program of "Observe symptoms to know how it committed against, and then follow the legislation to treat syndromes" based on Cognitive Psychology and Logic. After reviewing the research progress of Problem-solving Theory in Cognitive Psychology, the development progress of Dynamic Epistemic Logic and "Syndrome Differentiation and Treatment" in Chinese Medicine, we propose a research ideas of "Observe symptoms to know how it committed against, and then follow the legislation to treat syndromes" based on Psychology and Logic. Diagnosis and treatment of one or a few syndromes is to solve one or several issues, so "Syndrome Differentiation and Treatment" of Chinese Medicine is a problem-solving process."Observe symptoms to know how it committed against" is to identify and characterize problems, and "follow the legislation to treat syndromes" is to plan solutions and implement plans. In "Syndrome Differentiation and Treatment", which is a series of goal-directed cognitive operation, Chinese Medicine practitioners’belief is constantly changing and proving with the changing information before and after treatment. So this process can be studied by Problem-solving theory of Cognitive Psychology, and to be described by Dynamic Epistemic Logic.The second part is "Observe symptoms", that resolves the progress, trend and ideas of symptoms in Chinese Medicine. It is to solve the problem of "what is syndrome" and "how to study syndrome". This part outlines the key and popular issues of today’s related research of syndromes, such as the concept of syndrome, syndrome standardization, objective of the syndrome, multi-disciplinary intervention of syndrome, etc. Based on it, we propose the trend and ideas of syndrome research, which is to establish a standardized system and diagnostic criteria of syndromes, to find essence of syndromes. However, the difficulties and problems of syndrome research are obvious. The backwardness of methodology, the rigidity of thinking is the two major prominent bottlenecks in the syndrome research. It is to explore the intrinsic logic of Chinese medicine from the point of logic, to analyze the Chinese medicine language from the point of linguistic. Only we study the Chinese language and logic from a fundamental understanding, neither lost the concept of self but also innovative thinking.The third part is "to know how it committed against". We explain "to know how it committed against" from Cognitive Psychology, consider is a problem representation, and it solves the problem of "what and why". The doctors give the corresponding clinical significance of signs and symptoms showed by patients, which is metaphor. Then, the paper has collected some ancient medical case of bulging disease as an example, summarized its common types of etiology and pathogenesis, and has the linguistic analysis of concept metaphor of etiology and pathogenesis.The fourth part is "follow the legislation to treat syndromes". We study belief change of Chinese medicine treatment based on public announcement of Dynamic Logic. The formal structure of "follow the legislation to treat syndromes" can be depicted by public announcement of Dynamic Epistemic Logic.更多还原