基于认知科学的中医痰病理论研究
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摘要
认知科学技术与信息科学技术、生命科学技术一起,被科学界誉为二十一世纪的世界三大中心科学技术。基于任何一种理论、任何一个领域都无法脱离人类认知这一基本出发点,所以可以说,认知科学技术贯穿于人类迄今为止所发展起来的一切概念、理论、专业、行业之中。推而广之,人类所取得的一切文明成果——物质的和精神的,本质上都是人类认知成果的体现。
中医药理论体系形成于二千多年前的秦汉时期,以《黄帝内经》、《难经》、《神农本草经》及《伤寒杂病论》为其代表。历经二千多年的传承,总体而言,传统中医理论在本质上没有发生显著的创新和发展。但有一个例外,那就是成形于隋代的中医痰病学说,堪称在整个传统中医理论,尤其是在中医病因病机方面的一大理论创新,并在其后历代中医家们的理论研究及临床实践中,扮演着独特的角色,发挥着重要的作用,这一现象在整个中医学术的发展史中是极少见的。本文即以中医痰病为认知对象,依托中医基础理论的经典——《黄帝内经》中相关理论及观点,结合现代认知科学理论,如原型范畴理论、具身认知科学理论、概念整合理论、概念隐喻理论等,试图从对中医痰病的认知研究这一新的视角,对传统中医痰病的概念和理论进行探讨,进而揭示其中所反映的认知规律,说明中医之痰“是什么”,古代中医“为什么这么说”等一系列中医痰病概念和理论的认知本源问题。本论文正文分为五个部分。第一部分,对痰病的古今研究进行了系统回顾,旨在了解痰病理论的历史沿革及现状。第二部分,对中医概念和理论的现代认知科学研究进行了初步整理。总体上而言,对中医概念和理论的认知科学研究尚处在初级探索阶段,表现为当前整个中医学界对从认知语言学、认知心理学、认知逻辑学等现代认知科学的视角对传统中医理论进行研究尚缺乏学科重视和总体规划,相关研究的学术圈规模小,其研究思路、方法以及研究成果也未能深入推广。第三部分,从语言文字学的角度,对痰字、痰义的源流进行了深入的文献学考证。考证结论为,痰字来源于“淡”字的通假,在隋代《诸病源候论》开始以痰字和痰义正式见诸医学文献,此后历代沿用至今。第四部分,是本文的主体部分。主要从认知语言学的角度,对痰作为一个病因概念以及一个病证概念,从痰原型、痰范畴、痰认知模式、痰认知扩展等方面进行了澄清和探讨,进而得出以下几个基本结论：其一,痰病因作为中医病因之一,其生成机制为在气机失调的前提下,已经气化的津液与内外邪气相互作用后产生的病理产物。痰的病因原型是气痰；其二,痰证候作为中医证候之一,其所侧重的是各型痰证的临床症状和体征,痰的证候原型为有形之痰或舌苔腻、气机失调表征；其三,基于隐喻转换生成的本质属性,从“津血同源”的相似性角度来考察,来源于津液的痰与来源于血液的瘀具有认知交互性。在病因病机方面,痰可致瘀,瘀能生痰。在临床治疗方面,痰瘀同治具有重要的临床意义。第五部分,基于以上四部分的研究成果,对痰病辨证论治进行了认知地总结。从认知逻辑学之动态认知逻辑的理论角度,痰病辨治是一个医患之间信息交换的动态认知过程,在这个过程中,医生的信念也随之动态地变化,这也是中医辨证论治思维的逻辑特征；从认知语言学之原型范畴理论角度,痰病辨治应该围绕痰病因和痰证候原型来进行,扬弃痰的“有形无形论”、“怪病多痰论”、“病痰饮者,当以温药和之”等诸多陈见,从标本两方面对痰证进行辨证论治。
Cognitive science technology, information science technology, and life sciences and biotechnology, are regarded as three central science technologies of twenty-first century in the world by scientific community. Based on the starting point that any theory and any area can't separate from human cognition, that's to say, the cognitive science technology is throughout all concepts, theories, specialties, and professions which have been developed by human beings so far. By an extension of this logic, all the achievements of civilization made by human including material progress and spiritual one, in essential, are embodiments of human cognitive achievements.
The theoretical system of traditional Chinese medicine (TCM) was formed two thousand years ago, in the Qin and Han dynasties. It is represented by Huangdi's Internal Classic, The Classic of Difficult Issues, Shen Nong's Classic of the Materia Medica, and Treatise on Cold Damage and Miscellaneous Diseases. Generally speaking, through two thousand years of heritage, the theory of TCM doesn't bring about significant innovation and development in essential. But there is one exception. The thought of phlegm disease formed in Sui dynasty is considered as a major theoretical innovation in the entire theory of TCM, especially in the aspects of etiology and pathogenesis. The thought of phlegm disease performs on a unique part and plays an important role in the theoretical research and clinical practice of practitioners after Sui dynasty. This phenomenon is rare in the whole academic development history of TCM. Taking phlegm disease in TCM as cognitive object, the article, from the new point of cognitive study of phlegm disease in TCM, endeavors to probe into the concept and theory of phlegm disease in TCM, and reveals the reflective cognitive rules in order to explain a series of their cognitive origin like what phlegm is in TCM, and why the phlegm is illustrated like this in ancient Chinese medicine on the basis of the relative theories and viewpoints recorded in Huangdi's Internal Classic combining with theories of modern cognitive science such as prototype theory, embodied cognitive science theory, conceptual integration theory, and conceptual metaphor theory and so forth. The main body of the paper is divided into five parts. Part one, the past and present researches of phlegm disease is systematically reviewed in order to understand the historical evolution and the status quo of phlegm disease theory. Part two, the modern cognitive science research of concept and theory in TCM is preliminarily summarized. Overall, the research is still in the primary stage of exploration, which is reflected from the following aspects:lack of attention to discipline and comprehensive planning to study TCM theory from these modern cognitive science perspectives like cognitive linguistics, cognitive psychology, and cognitive logic in the whole TCM field at present, small scale of the academic circles in relative researches, and failing to thoroughly promote their research ideas, methods, and achievements. Part three, from the perspective of language philology, the origins of the Chinese character of tan痰and the meaning of phlegm have been deeply explored. The conclusion after textual research is that tan originates from the Chinese character of dan淡(interchangeability of words or characters). The Chinese character of tan痰and the meaning of phlegm have been formally recorded in Treatise on the Origins and Manifestations of Various Diseases in Sui dynasty, which have been using in medical literature since then. Part four, as the mainbody of the dissertation. This part, in the light of cognitive linguistics, clarifies and discusses the phlegm as an etiological concept and a concept of syndrome from the aspects of prototype, scope, cognitive pattern, and cognitive extension. Based on this, we can draw several conclusions. First of all, phlegm as one of the TCM etiologies, the mechanism of its production is at the premise of qi disorder, and the transformed body fluids interacting with external and internal pathogens. The etiological prototype of phlegm is qi phlegm. Secondly, the syndrome of phlegm is as one of TCM syndromes. It emphasizes on the clinical symptoms and signs of phlegm syndrome in each pattern. The syndrome prototype of phlegm displays as tangible sputum or greasy tongue coating, and sings of qi disorder. Finally, on the basis of essential property from metaphor transformational generation, and from the point of similarity of body fluids and blood from the same source, phlegm resulting from body fluids has cognitive interactivity with stasis deriving from the blood. In the etiology and pathogenesis, phlegm leads to blood stasis, and the blood stasis can generate phlegm. In clinic, concurrent treatment of phlegm and blood stasis is of great significance. Part five, cognitively sum up the phlegm disease syndrome differentiation and treatment based on the research results of the above four parts. From the point of view of dynamic epistemic logic in cognitive logic, the differentiation and treatment of phlegm disease is a dynamic cognitive process of information exchange between doctor and patient. In the process, the doctor's belief will also change dynamically, which embodies the logical character of the thought of syndrome differentiation and treatment in TCM. From prototype theory of cognitive linguistics perspective, the differentiation and treatment of phlegm disease should be focused on the prototype of phlegm etiology and phlegm syndrome, to develop the useful and discard the useless of many stereotypes like theory of tangibility and intangibility of phlegm, theory of strange diseases due to phlegm, and patient suffering from phlegm and retained fluid, warm herbs should be given for harmonization, and makes syndrome differentiation and treatment on phlegm from the root and branch.
中医药理论体系形成于二千多年前的秦汉时期,以《黄帝内经》、《难经》、《神农本草经》及《伤寒杂病论》为其代表。历经二千多年的传承,总体而言,传统中医理论在本质上没有发生显著的创新和发展。但有一个例外,那就是成形于隋代的中医痰病学说,堪称在整个传统中医理论,尤其是在中医病因病机方面的一大理论创新,并在其后历代中医家们的理论研究及临床实践中,扮演着独特的角色,发挥着重要的作用,这一现象在整个中医学术的发展史中是极少见的。本文即以中医痰病为认知对象,依托中医基础理论的经典——《黄帝内经》中相关理论及观点,结合现代认知科学理论,如原型范畴理论、具身认知科学理论、概念整合理论、概念隐喻理论等,试图从对中医痰病的认知研究这一新的视角,对传统中医痰病的概念和理论进行探讨,进而揭示其中所反映的认知规律,说明中医之痰“是什么”,古代中医“为什么这么说”等一系列中医痰病概念和理论的认知本源问题。本论文正文分为五个部分。第一部分,对痰病的古今研究进行了系统回顾,旨在了解痰病理论的历史沿革及现状。第二部分,对中医概念和理论的现代认知科学研究进行了初步整理。总体上而言,对中医概念和理论的认知科学研究尚处在初级探索阶段,表现为当前整个中医学界对从认知语言学、认知心理学、认知逻辑学等现代认知科学的视角对传统中医理论进行研究尚缺乏学科重视和总体规划,相关研究的学术圈规模小,其研究思路、方法以及研究成果也未能深入推广。第三部分,从语言文字学的角度,对痰字、痰义的源流进行了深入的文献学考证。考证结论为,痰字来源于“淡”字的通假,在隋代《诸病源候论》开始以痰字和痰义正式见诸医学文献,此后历代沿用至今。第四部分,是本文的主体部分。主要从认知语言学的角度,对痰作为一个病因概念以及一个病证概念,从痰原型、痰范畴、痰认知模式、痰认知扩展等方面进行了澄清和探讨,进而得出以下几个基本结论：其一,痰病因作为中医病因之一,其生成机制为在气机失调的前提下,已经气化的津液与内外邪气相互作用后产生的病理产物。痰的病因原型是气痰；其二,痰证候作为中医证候之一,其所侧重的是各型痰证的临床症状和体征,痰的证候原型为有形之痰或舌苔腻、气机失调表征；其三,基于隐喻转换生成的本质属性,从“津血同源”的相似性角度来考察,来源于津液的痰与来源于血液的瘀具有认知交互性。在病因病机方面,痰可致瘀,瘀能生痰。在临床治疗方面,痰瘀同治具有重要的临床意义。第五部分,基于以上四部分的研究成果,对痰病辨证论治进行了认知地总结。从认知逻辑学之动态认知逻辑的理论角度,痰病辨治是一个医患之间信息交换的动态认知过程,在这个过程中,医生的信念也随之动态地变化,这也是中医辨证论治思维的逻辑特征；从认知语言学之原型范畴理论角度,痰病辨治应该围绕痰病因和痰证候原型来进行,扬弃痰的“有形无形论”、“怪病多痰论”、“病痰饮者,当以温药和之”等诸多陈见,从标本两方面对痰证进行辨证论治。
Cognitive science technology, information science technology, and life sciences and biotechnology, are regarded as three central science technologies of twenty-first century in the world by scientific community. Based on the starting point that any theory and any area can't separate from human cognition, that's to say, the cognitive science technology is throughout all concepts, theories, specialties, and professions which have been developed by human beings so far. By an extension of this logic, all the achievements of civilization made by human including material progress and spiritual one, in essential, are embodiments of human cognitive achievements.
The theoretical system of traditional Chinese medicine (TCM) was formed two thousand years ago, in the Qin and Han dynasties. It is represented by Huangdi's Internal Classic, The Classic of Difficult Issues, Shen Nong's Classic of the Materia Medica, and Treatise on Cold Damage and Miscellaneous Diseases. Generally speaking, through two thousand years of heritage, the theory of TCM doesn't bring about significant innovation and development in essential. But there is one exception. The thought of phlegm disease formed in Sui dynasty is considered as a major theoretical innovation in the entire theory of TCM, especially in the aspects of etiology and pathogenesis. The thought of phlegm disease performs on a unique part and plays an important role in the theoretical research and clinical practice of practitioners after Sui dynasty. This phenomenon is rare in the whole academic development history of TCM. Taking phlegm disease in TCM as cognitive object, the article, from the new point of cognitive study of phlegm disease in TCM, endeavors to probe into the concept and theory of phlegm disease in TCM, and reveals the reflective cognitive rules in order to explain a series of their cognitive origin like what phlegm is in TCM, and why the phlegm is illustrated like this in ancient Chinese medicine on the basis of the relative theories and viewpoints recorded in Huangdi's Internal Classic combining with theories of modern cognitive science such as prototype theory, embodied cognitive science theory, conceptual integration theory, and conceptual metaphor theory and so forth. The main body of the paper is divided into five parts. Part one, the past and present researches of phlegm disease is systematically reviewed in order to understand the historical evolution and the status quo of phlegm disease theory. Part two, the modern cognitive science research of concept and theory in TCM is preliminarily summarized. Overall, the research is still in the primary stage of exploration, which is reflected from the following aspects:lack of attention to discipline and comprehensive planning to study TCM theory from these modern cognitive science perspectives like cognitive linguistics, cognitive psychology, and cognitive logic in the whole TCM field at present, small scale of the academic circles in relative researches, and failing to thoroughly promote their research ideas, methods, and achievements. Part three, from the perspective of language philology, the origins of the Chinese character of tan痰and the meaning of phlegm have been deeply explored. The conclusion after textual research is that tan originates from the Chinese character of dan淡(interchangeability of words or characters). The Chinese character of tan痰and the meaning of phlegm have been formally recorded in Treatise on the Origins and Manifestations of Various Diseases in Sui dynasty, which have been using in medical literature since then. Part four, as the mainbody of the dissertation. This part, in the light of cognitive linguistics, clarifies and discusses the phlegm as an etiological concept and a concept of syndrome from the aspects of prototype, scope, cognitive pattern, and cognitive extension. Based on this, we can draw several conclusions. First of all, phlegm as one of the TCM etiologies, the mechanism of its production is at the premise of qi disorder, and the transformed body fluids interacting with external and internal pathogens. The etiological prototype of phlegm is qi phlegm. Secondly, the syndrome of phlegm is as one of TCM syndromes. It emphasizes on the clinical symptoms and signs of phlegm syndrome in each pattern. The syndrome prototype of phlegm displays as tangible sputum or greasy tongue coating, and sings of qi disorder. Finally, on the basis of essential property from metaphor transformational generation, and from the point of similarity of body fluids and blood from the same source, phlegm resulting from body fluids has cognitive interactivity with stasis deriving from the blood. In the etiology and pathogenesis, phlegm leads to blood stasis, and the blood stasis can generate phlegm. In clinic, concurrent treatment of phlegm and blood stasis is of great significance. Part five, cognitively sum up the phlegm disease syndrome differentiation and treatment based on the research results of the above four parts. From the point of view of dynamic epistemic logic in cognitive logic, the differentiation and treatment of phlegm disease is a dynamic cognitive process of information exchange between doctor and patient. In the process, the doctor's belief will also change dynamically, which embodies the logical character of the thought of syndrome differentiation and treatment in TCM. From prototype theory of cognitive linguistics perspective, the differentiation and treatment of phlegm disease should be focused on the prototype of phlegm etiology and phlegm syndrome, to develop the useful and discard the useless of many stereotypes like theory of tangibility and intangibility of phlegm, theory of strange diseases due to phlegm, and patient suffering from phlegm and retained fluid, warm herbs should be given for harmonization, and makes syndrome differentiation and treatment on phlegm from the root and branch.
引文
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