Evidence-Based Intelligent Diagnostic and Therapeutic Visualization System with Large Language Models: Multi-Turn Interaction and Multimodal Treatment Plan Generation
Authors: Yunhan Wang, Yuda Wang, Zhiying Tu, Mingqiang Song, Li Song, Kun Li, Dianhui Chu, Bolin Zhang
Organizations: Harbin Institute of Technology, Weihai, Weihai, Shandong, China · Shandong Key Laboratory of Digital Service Computing Technology and Systems, China · Weihai Municipal Hospital, Weihai, Shandong, China · Shanghai Taizhu Technology Co., Ltd, Shanghai, China · Tianjin Zhifu Qihuang Medical Technology Co., Ltd, Tianjin, China · Harbin Institute of Technology (Weihai) Qingdao Research Institute, Qingdao, Shandong, China
Abstract
Aim: Existing AI-assisted traditional Chinese medicine diagnostic tools suffer from opaque reasoning processes, passive interaction, and limited treatment plan presentation. This study proposes a knowledge-enhanced visual diagnostic system to improve the transparency and interpretability of syndrome differentiation and treatment. Methods: The system is built upon a Neo4j knowledge graph comprising 241 syndromes, 1,263 symptoms, and 2,485 relations. It incorporates a four-stage symptom matching pipeline (exact, semantic, fuzzy, and large language model verification), an information gain-driven proactive questioning strategy optimized with genetic algorithms, and a multimodal treatment presentation integrating artificial intelligence-generated illustrations, three-dimensional meridian-acupoint models, and evidence-based literature. Results: Knowledge graph constraints reduced non-standard outputs by 32%. Case studies validated the effectiveness of the interactive workflow across patient self-assessment, clinician-assisted diagnosis, and traditional Chinese medicine education. Automated paired-comparison evaluation across 30 cases further demonstrated significant improvements in diagnostic trust (Cohen's d = 1.82, p < 0.001), reduced cognitive load (improvements in four of five dimensions), and higher credibility of evidence-based references (4.21 vs. 2.95). Conclusions: The proposed system enhances the transparency of traditional Chinese medicine diagnostic reasoning and the interpretability of treatment plans through knowledge graph-driven visualization and multimodal interaction, offering a practical solution for trustworthy artificial intelligence-assisted traditional Chinese medicine applications.
Traditional Chinese Medicine (TCM) diagnosis, particularly through tongue inspection, faces persistent challenges in subjectivity and reproducibility. The application of multimodal artificial intelligence to TCM clinical tasks, such as syndrome differentiation and prescription generation, is significantly hampered by the semantic gap between visual tongue features and textual reasoning, as well as the lack of large-scale, standardized datasets. To address these challenges, we introduce MMIR-TCM, a novel framework that emulates the diagnostic process of TCM experts by integrating multimodal large language model(MLLM) with memory-augmented segmentation and retrieval-augmented generation (RAG). Employing a three-stage architecture, MMIR-TCM integrates a training-free Memory-SAM module for robust tongue extraction, a fine-tuned Qwen3-VL model for structured tongue diagnosis generation, and a Qwen3-based RAG component for evidence-grounded clinical decision support generation. The framework was developed and validated using MedTCM, a new large-scale multimodal dataset that we introduce specifically for advanced TCM research. To properly evaluate our framework's clinical accuracy, which existing metrics fail to capture, we also developed TDEU, a domain-specific evaluation metric incorporating semantic understanding and diagnostic importance. Our comprehensive experiments demonstrate that MMIR-TCM significantly outperforms leading models, including GPT-4o and Gemini 2.5 Flash.
Conversational diagnosis requires multi-turn history-taking, where an agent asks clarifying questions to refine differential diagnoses under incomplete information. Existing approaches often rely on the parametric knowledge of a model or assume that patients provide rich and concrete information, which is unrealistic. To address these limitations, we propose a conversational diagnosis system that explores a diagnostic knowledge graph to reason in two steps: (i) generating diagnostic hypotheses from the dialogue context, and (ii) verifying hypotheses through clarifying questions, which are repeated until a final diagnosis is reached. Since evaluating the system requires a realistic patient simulator that responds to the system's questions, we adopt PatientSim, a persona-driven patient simulator, together with patient profiles from MIMIC-IV. We further adapt it with low-specificity symptom reporting to reflect how real-world patients describe symptoms vaguely during early clinical encounters. Experiments show improved diagnostic accuracy and efficiency over strong baselines, and physician evaluations support the realism of our simulator and the clinical utility of the generated clarifying questions. Our code will be released upon publication.
Large language models (LLMs) are increasingly used for health-related decision support. Yet most evaluations treat diagnosis as a single-shot task with complete information provided upfront, often as a multiple-choice selection. This diverges from clinical practice, where diagnosis is interactive and open-ended, involving sequential hypothesis refinement through targeted questioning. We address this gap. We build MeDxBench, a large-scale benchmark of 4,421 clinical cases across 20 specialties. We further propose MeDxAgent, a multi-agent consultation system for interactive diagnosis, and systematically study its prompt-, flow- and agent-level design choices. MeDxAgent achieves a 10.3% accuracy gain over the baseline on MeDxBench, closing 52.3% of the gap to a full-information oracle. We find that specific design choices: collecting demographics first, passing summarized dialogue for diagnosis, and feeding candidate diagnoses for targeted questioning, improve accuracy, mirroring how physicians reason, though their effect emerges fully only in combination. Code and dataset will be released upon publication.