“因发知受”的层级认知逻辑与模型建构

Hierarchical Cognitive Logic and Model Construction of “Speculating Pathogenesis by Symptoms and Signs”

摘要: “因发知受”是中医诊断的核心思维方法，但现有研究多侧重推理类型归纳，尚缺乏对认知结构的统一刻画及边界反思。围绕“因发知受”能否被构建为一个可解释的认知模型及其适用范围何在的问题，通过结合中医基础理论中“取象比类”“司外揣内”“审证求因”等思维和认知科学，构建“因发知受”的层级认知模型，形成一个“生成–筛选”的认知系统：类比推理构造可能的病因空间，溯因推理生成诊断假说，最佳说明推理(IBE)完成假说筛选，三者完成取象、反推、择优的认知进路。通过与双过程理论、贝叶斯诊断模型、人工智能诊断推理等现有模型的比较，本模型在知识开放性、筛选多维性等方面形成了差异化贡献。但该模型推理过程中可能存在类比偏差、溯因偏差、IBE偏差三类认知局限。理解这一认知模型有助于规范辨证思维，提高临床诊断的准确性与可解释性。

Abstract: “Speculating Pathogenesis by Symptoms and Signs” is a core diagnostic approach in Traditional Chinese Medicine (TCM), but the existing research focuses on the induction of reasoning types, and there is still a lack of unified description and boundary reflection of cognitive structure. Addressing the questions of whether “Speculating Pathogenesis by Symptoms and Signs” can be constructed as an interpretable cognitive model and what its scope of application is, this study integrates cognitive sciences—including concepts from TCM’s foundational theories such as “taking analogies and making comparisons,” “observing the external to infer the internal,” and “ examining symptoms to identify causes,” along with cognitive science, we construct a hierarchical cognitive model of “Speculating Pathogenesis by Symptoms and Signs”, forming a “generation-screening” cognitive system: analogical reasoning constructs a space of possible etiologies, abducive reasoning generates diagnostic hypotheses, and the best explanation (IBE) completes hypothesis screening. The three complete the cognitive approach of taking an image, reverse reasoning and selecting the best. Through comparison with existing models such as the dual-process theory, Bayesian diagnostic models, and artificial intelligence-based diagnostic reasoning, this model makes distinctive contributions in terms of knowledge openness and multidimensional screening capabilities. However, three types of cognitive limitations—analogy bias, abduction bias, and IBE bias—may exist in the model’s reasoning process. Understanding this cognitive model helps standardize dialectical thinking and improve the accuracy and interpretability of clinical diagnosis.