世界中医药

目的：从认知心理学的角度探讨中医辨证方式的特点及其动态认知过程。揭示不同中医人员对证候表征的多样性及差异性，发现中医专家与初学者在证候表征中的异同.方法：采取认知心理学中问卷调查的方式对不同层次中医人员进行描述性研究，随机选取125人填写问卷，并将样本分组进行描述性统计及卡方检验。运用相应认知心理学及认知语言学的知识对结果进行分析。结果：1）人们的选择随着症状的增加在不断修正；2）较多应用八纲辨证、六经辨证和脏腑辨证；3）专家更关注对病情有诊断意义的症状；4）一般倾向于取症舍舌；5）证的主症往往才能被包含在认知图式中；6）分组卡方检验后发现共有9题具有统计学意义（P<0.05）。结论：问题的表征是很主观化的，不同的人会有不同的认知方式，这种差异来源于之前所积累的知识与经验。人们在诊断过程中会随着病情信息的增加不断对自己的结论和假设做出修正，而收集的症状越全面对给出最恰当的诊断越有帮助。专家在诊断时给出基本属性结论的速度越快，但辨别具体的证时则相对谨慎，需要在症状全面收集后才做定论。在面对一系列症状时，专家们更愿意关注对诊断更有帮助的症状。人们对于凸显的语言或是新的信息的注意往往更多，并且会对其结论产生影响。

English Summary:

To discuss the characteristics and the dynamic cognitive process of TCM syndrome differentiation from the perspective of cognitive psychology. To bring to light the differences and diversities of syndrome representation among individual TCM professionals, between TCM specialist and beginners. Methods: Questionnaire survey in cognitive psychology was used to conduct descriptive study on different levels of TCM professionals. 125 subjects with different levels of TCM knowledge completed questionnaires. They were grouped in order to conduct descriptive statistics and chi-square test. Use cognitive psychology and cognitive linguistics to analyze the results. Results: 1)People constantly revised their choices with the addition of the symptoms. 2)The Eight Principle Pattern Identification and the Differentiation of Six Channels were most widely used. 3)Experts paid more attention to the diagnostic symptoms. 4)Symptoms were more reference than tongue manifestation. 5)The main symptoms of one pattern are more often included in the cognitive schema. 6)The grouped samples has statistically significant differences (P<0.05) in 9 questions. Conclusion:Problem representation very subjective to individual TCM professionals, and these variations come from the accumulated knowledge and experience before. In the diagnostic process, doctors will continually amend their conclusions and assumptions with the addition of symptoms. And the more comprehensive the collection of symptoms is, the more helpful to the most accurate diagnosis. Experts draw the accurate conclusions faster, but they are still relatively cautious. Actually they need to collect more comprehensive symptoms to make a conclusion. When facing with a series of symptoms, experts also tend to be more willing to focus on the symptoms which are more helpful to the diagnosis. Prominent words or new information are paid more attention to and will have an impact on the final conclusions.

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