对中医研究生辨证论治过程的问卷调查及思考

Questionnaire Survey and Thinking of Syndrome Differentiation and Treatment Process of Traditional Chinese Medicine Graduate Students

目的:利用客观化的研究方法,从认知角度更好地反映中医辨证论治的思维过程,了解其认知特点。方法:利用认知心理学问题解决的研究思路,采用心理学问卷测量方法编制测量工具,随机选取了104名北京中医药大学2010级中医研究生,针对中医辨证论治过程中症状表征、治疗立法、处方用药3个主要环节进行了初步调查和数据分析。结果:症状表征环节,大多数被试者认为"风为阳邪,其性开泄"和"风性动摇"特征分别在诊断外感病和内伤病时最具指导意义;倾向从八纲辨证(寒热、表里、虚实)和六经辨证角度进行症状的综合表征;在判断某个证候的典型症状时具有较一致的倾向;当症状与舌象的寒热、虚实属性发生矛盾时,倾向"取症舍舌"。治疗立法环节,大多数被试者倾向选择"先表后里"、"先实后虚"、"先急后缓"的治疗策略。处方用药环节,大多数被试者倾向选择某首或两首以上的方剂作为治疗方案。结论:首先,问卷结果呈现大多数的一致性,说明被调查的研究生具有较良好的中医药知识架构,中医辨证论治过程呈现出某种学科的规律性。其次,问卷结果也存在着一定的差异,说明辨证主体的认知结构和心理表征方式具有差异性,客观上反映了中医辨证模式的多样性、治疗用药的灵活性等认知特点。

Objective research methods were used in the better revealing of the essence of syndrome differentiation and treatment of traditional Chinese Medicine（TCM） and understanding of cognitive characteristics from cognitive perspective.On the basis of Problem Solving Theory of Cognitive Psychology,psychology methods were used to form a questionnaire.A total of 104 TCM graduate students of year 2010 at Beijing University of Chinese Medicine were randomly selected.A preliminary investigation was given and then analyzed in three main aspects,which are symptom characterization,treatment legislation,prescription and medication of syndrome differentiation and treatment.The results showed that in the aspect of symptom characterization,most students chose significant features,which are ＂wind is yang evil,and its characteristics are opening and venting＂ and ＂characteristics of wind is moving＂ in the diagnosis of exogenous febrile diseases and miscellaneous diseases.Most students tend to choose eight-principles and six-channel differentiation in the characterization of comprehensive symptoms.Most students tend to choose one or two symptoms as typical symptoms of the syndrome.When characteristics of symptoms and tongue appearance are conflicted,most tend to choose ＂symptoms＂ instead of ＂tongue appearance.＂ In the treatment aspect,most tend to choose treatment strategies of ＂external syndrome,excessive syndrome,acute syndrome＂ as priority,and ＂internal syndrome,deficiency syndrome,chronic syndrome＂ as secondary treating aspects.In the prescription and medication aspect,most tend to choose more than one or two formula as medication.It is concluded that results of questionnaire are mostly in consistency.It showed that the investigated graduate students have good TCM knowledge structure.The process of syndrome differentiation and treatment presents some regularity of discipline.And,some differences are still existed in the result.It manifests that the cognitive structures of doctors are different.It shows the cognitive characteristics of pattern diversity and flexibility in syndrome differentiation and treatment.