基于系统复杂性科学及其方法论的中医诊疗认知规律研究

【作者】 王连心；

【导师】 孟庆刚；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2009， 博士

【摘要】 中医诊疗过程是医者运用望、闻、问、切四种诊断方法,获取患者所反映出来的各类状态信息,根据它们的内在联系,以八纲(阴、阳、表、里、寒、热、虚、实)为总纲领,以气血津液辨证和脏腑辨证为基础,结合六经、卫气营血和三焦等辨证方法,进行综合、分析、归纳,以寻找病证的根源和病变的本质,“立象表意”,做出某种判断,进而在中医“理、法、方、药”理论的指导下,确定适当的治疗方法和配伍用药的过程,同时,也是医者对患者信息获取、理解、分析、综合与应用的认知与智能决策过程,医者为认知者,患者为认知对象,这一过程是动态的,复杂的。同一患者呈现在不同医者面前,所获得的诊疗决策有时不尽相同,这是因为医者对患者信息的认知不同,可见,动态诊疗过程中,医者的认知起决定作用。本文在中医基础理论指导下,基于系统复杂性科学及其方法论,探讨中医诊疗的认知规律,从基于系统复杂性科学的中医诊疗过程研究、系统复杂性科学视角下的中医诊疗信息处理研究、医者认识特点研究以及共性思维提取等四方面进行论述,并建立综合集成研讨体系,描述与记录医者思维,形成共性诊疗预案,以期指导临床实践。1.目的1.1基于系统复杂性科学研究医者认知在诊疗过程中的决策作用;1.2基于智能信息处理技术,揭示医者个体对患者的信息处理及医者自身的认知特点;1.3建立面向中医诊疗及医者认知的综合集成研讨体系,获取共性思维预案,为诊疗标准的建立与诊疗思维的传承探讨一种新的方法。2.方法2.1在中医基础理论指导下,从系统复杂性科学的视角,基于发生认识论探讨中医学思维方式的特点、中医诊疗过程的特点以及诊疗过程中医者动态的认知特点。2.2采用解析与整合的方法处理患者的本体论信息,建立数据库,通过解析将患者的数据信息分类存储于数据库中,运用横向整合的统计方法参与试验设计,分析数据信息,揭示数据之间隐含的内在规律和处理具有模糊特点的中医症状信息。2.3在JDK 6的开发环境下(IDE工具Eclipse 3.3、MyEclipse 6/7),采用MVC模式,建立由数据库Oracle 9i和应用服务器Tomcat 6.0组成的整体测评系统,基于认知测评方法研究医者自身的认知特点。2.4基于信息科学和智能信息处理技术,研究医者如何对患者信息进行获取、分析与综合,并通过灰局势决策与灰模式关联决策处理不确定的少数据信息。2.5建立面向中医诊疗及医者认知的综合集成研讨体系,运用层次分析法(AHP),使医者个人对问题的隐藏区和盲区,在交互过程中和他人的开放区不断扩大,同时在心智层次上,隐性知识和显性知识相互转化,形成共性诊疗思维预案。3.结果3.1中医学是一个开放的复杂巨系统,思维方式具有系统思维、层次性、取象思维、合和思维、非线性等特点;中医诊疗是一个具有开放性、复杂性、动态性、巨型性、层次性、整体涌现性、非线性等特征的开放复杂巨系统。患者也是一个开放的复杂巨系统,不同的生理情况、生活环境、情感心理与知识结构,在临床上呈现不同的表象特征;医者同样是一个开放的复杂巨系统,除具备人的自然属性外,在诊疗过程中,更多的体现了其社会性和思维属性,并且,诊疗过程中起决定作用的是医者的认知。3.2统计分析方法可以较为科学地揭示数据之间隐含的内在规律,可以用于处理具有模糊特点的中医诊疗过程的患者本体论信息,并且在传统的统计方法具有症状权值不明确、量化过程中主观因素起主导作用、不同度量单位的指标经常要在一个对象上同时考虑等局限性时,根据数据信息的结构特点和研究目的,相关分析、多元回归分析、贝叶斯、数学决策等方法可引入对患者的本体论信息研究中。3.3中医诊疗信息既具有可量度、可识别、可转换、可存储、可处理、可传递、可再生、可压缩、可利用、可共享等信息的基本特征,又具有朴素的数学特点、时空特性、模糊性与复杂性、不确定性等自身的特点,灰色系统理论及其方法是处理不确定信息较为合适的方法。3.4医者的情绪心态、思维方式、知识结构、临床经验等因素皆对临床诊疗决策产生重要影响,运用量表法能把握医者的认知特点。3.5开放复杂巨系统的方法论——从定性到定量的综合集成法,作为解决开放的复杂性问题的唯一方法,对不同医者的认知进行描述,并将其认知内容汇集到一起,经过定量计算,反复对比,使定性认识上升到定量认识,产生1+1＞2的智能飞跃,使医者的临床诊疗经验从隐性知识转化为显性知识,获得共性诊疗见解,即“集智慧之大成”。4.结论4.1中医学与中医诊疗都是开放的复杂巨系统,医者、患者都具有开放的复杂特性,且诊疗过程中起决定作用的是医者的认知。4.2统计分析方法可以揭示数据内部的隐含规律,是处理患者信息较为合适的方法,但要根据数据信息的不同特点选取不同的统计分析模型。4.3医者的诊疗思维具有可描述、可传承的特点,量表法是认知心理学的重要方法之一,基于量表法进行测量,可把握医者自然人层面的认知特点。4.4医者对患者信息的认知具有不确定性与相对确定性的特点,灰色系统理论是处理不确定信息的方法,可用于中医诊疗及智能决策研究。4.5会诊的形式自古至今一直存在,综合集成法是解决复杂性问题的唯一方法,基于计算机技术建立的综合集成研讨厅体系,使医者的隐性知识经过由定性到定量的反复对比,转化为显性知识,形成共性诊疗思维预案。更多还原

【Abstract】 In the process of traditional Chinese medicine(TCM)diagnosis and treatment,doctors obtain patients’ information by TCM observation,smell,inquisition,Pulse-feeling and Palpation,on the basis of the internal relationship of syndrome,then analyze and compare to search the origin and essence of disease,using various syndrome differentiation methods, such as eight class(Yin-Yang,exterior and interior,cold and heat,asthenia and sthenia ) and six meridians.At last,doctors image modeling through an analysis of representation,carring through syndrome differentiation and treatment,under the guidance of TCM theory.The connotation of informatics embodies in each stage,including the acquisition,expression, classification and cognition of the information,along with the generation and Optimization of strategy.In the dynamic and complex process,doctors are the cognitive subject and patients are the cognitive object.Always different doctors have different opinion even if they face the same patient.Thus,doctor’s cognition is the key.This article investigates the cognitive regulation of TCM under the guidance of basic theory of TCM,based on the system complexity science and its methodology.The article discusses from four aspects,such as research on the process of TCM diagnosis,treatment and information processing based on the system complexity science,study on the cognition characteristics of TCM doctors and the recovery of common thinking.Meanwhile, meta-synthesis hall is established,which can describe andrecord the TCM doctors’ mind and form the common predetermined plan of TCM diagnosis and treatment in order to guide the clinical practice.1 Object1.1 Study on the decision-making role of doctor’s cognition in the process of TCM diagnosis and treatment based on the system complexity science.1.2 Revealing doctor’s own cognitive characteristics and information analysis method based on the intelligent information treatment technique.1.3 Establishing meta-synthesis discussion system facing to the process of TCM diagnosis and treatment and doctor’s cognition,obtaining common thinking preparedness, investigating a new method to establish the standard of diagnosis and treatment meanwhile to inherit TCM thingking.2 Methods and Results2.1 TCM diagnosis and treatment is an open and complex system,which has the characteristics of openness,complexity,dynamics,giant,level,unity,emergence and nonlinearity.Thus,TCM,TCM doctors and patients are the central contents of TCM diagnosis and treatment under the perspective of system complexity science.In the view of generation epistemological,the thinking method of TCM also has the characteristics of integrity,system,level,image,harmony and nonlinearity.TCM doctors become the open and complex system because they have more characteristics of society and thinking except of nature in the process of diagnosis and treatment.Patients are also considered to the open and complex system because of physiology,living environment,structure of emotion and psychology and clinical symbolism.Different doctor probably has different conclusion of diagnosis and treatment even if facing with the same patients because of different cognition pattern.Therefore,the cognition patterns of doctors are the key in the TCM clinical process.2.2 Information is the objective existence,which includes two levels——ontological information and epistemological information.In the process of TCM diagnosis and treatment,patients’ clinical symbolism belongs to the ontological information,while epistemological information includes patients’ information processing and doctors’ own cognitive regulation.To study ontological information,EBM and epidemiology are used for reference to collect data information,meanwhile,statistical analysis method is used to grasp the implicit inner regularity of data.2.3 When we want to analysis how doctors obtain patients’ uncertain information,grey theory and software DPS7.55 are both the effective methods.2.4 Scale study can grasp doctors’ cognition characteristics,which is one effect method of cognitive psychology.Known from the study,doctor’s emotion,psychology,thinking, method,knowledge structure etc.factors play important role of the decision-making of TCM diagnosis and treatment.Furthermore,doctors’ clinical thinking can be grasped and inherited.2.5 Meta-synthesis hall from qualitative analysis to quantitative analysis is the method of open complex giant system,and is the only one method to solve the open complex problem, whose theory foundation is the thinking science.The meta-synthesis hall can describe different doctors’ cognition and assemble the contents of cognition by quantitative calculation and repeated comparison,making qualitative cognition to upward quantitative one,which generates intelligent leap like 1+1 >2 and transforms doctors’ clinical experience from recessive knowledge into dominant one to obtain common opinions of diagnosis and treatment,that is the full completion of intelligence.3 Conclusions3.1 TCM and TCM diagnosis and treatment are all open complex giant system. Meanwhile,doctors and patients are open and complex.Furthermore,doctors’ cognition are the key in the progress of TCM diagnosis and treatment.3.2 Statistical analysis can reveal the internal hidden regularity of data as a suitable method to deal patients’data information,but different analysis model should be choosen according to different characteristics of data.3.3 The doctor’s mind of diagnosis and treatment can be described and inherited.Scale is an important method of cognitive psychology,and can be used to measure doctor’s cognitive characteristics at the level of nature person.3.4 Information includes certainty and uncertainty.Grey system theory is a method to treat uncertainty information.3.5 Meta-synthesis is the only method to solve the complex problem and form the common diagnosis and treatment thinking by transform recessive knowledge to dominant knowledge.更多还原