基于隐喻认知的胸痹之"阳微阴弦"病机分析OA

The term Yangwei Yinxian(weak pulse at yang and wiry pulse at yin)is a concise summary of the pulse presentation and pathogenesis of chest qi-obstruction by Zhang Zhongjing,the Medical Sage of the Eastern Han Dynasty,in his Jin Gui Yao Lve(Essentials from the Golden Cabinet).Successive generations of physicians have offered various interpretations of Yangwei Yinxian,and the primary divergence lies in the understanding of yin and yang within this context.Traditional Chinese medicine(TCM)posits that the upper jiao connects to the heart and lung,and the sanjiao,as a system of pathways for transporting and transforming fluids and governing qi activity,connects to the chest,which is a cavity that receives and regulates qi.From the perspective of metaphorical analysis of the symptoms of chest qi-obstruction and its Yangwei Yinxian pathogenesis,the ontological metaphor of"container-pathway"provides an intuitive structural framework for conceptualizing and understanding the chest,sanjiao,and chest qi-obstruction,and the process metaphors facilitate the explanation of its Yangwei Yinxian pathogenesis.Based on metaphorical cognition,the symptoms of chest qi-obstruction and its Yangwei Yinxian pathogenesis can be interpreted as follows:Under physiological conditions,the chest-sanjiao system maintains a dynamic yin-yang balance during qi transformation and fluid transport,but when the decline of yang and growth of yin exceed a critical threshold,chest qi-obstruction arises,leading to a qualitative transformation and then resulting in the retention and stagnation of pathogenic yin factors,such as phlegm-fluid retention,within the chest-sanjiao system;for the Yangwei Yinxian pathogenesis of chest qi-obstruction,the root lies in yang deficiency of the upper jiao(manifesting as a weakened process of reception and diffusion by the chest),while the branch is due to the qualitative transformation occurring after the excessive decline of yang and growth of yin(leading to the retention and upward rebellion of pathogenic yin).The analytical approach by combining ontological metaphor and process metaphor can elucidate the dynamic and holistic nature of TCM etiology and pathogenesis theory,being helpful for a deeper understanding of TCM concepts and potentially offering new perspectives for the interpretation and innovation of TCM theory.