MMIR-TCM: Memory-Integrated Multimodal Inference and Retrieval for TCM Clinical Decision Support
Authors: Lihui Luo, Joongwon Chae, Ziyan Chen, Yang Liu, Siyi Cheng, Weihan Gao, Zelin Zeng, Xiaoming Yin, +8 more
Abstract
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.
Deep learning has shown promise for automated tongue diagnosis in traditional Chinese medicine (TCM), yet the design space remains underexplored. We conducted a systematic ablation study spanning 20+ model versions under rigorous 5-fold cross-validation on TongueDx2 (5,109 images, 976 expert-annotated) and a merged dataset of 11,101 samples. We compared six backbone architectures, four loss functions, five augmentation strategies, and six training strategies. The best 976-sample model achieved weighted-F1 of 0.6625 using ConvNeXt-Tiny with restrained augmentation and weak-group ensemble, while the best 11,101-sample model reached weighted-F1 of 0.7761. Six key design principles emerged: (1) ConvNeXt-Tiny offers optimal parameter efficiency; (2) BCE substantially outperforms Asymmetric Loss (+2.7%); (3) restrained color augmentation is critical; (4) weak-group ensemble replacement (+2.1%) outperforms probability averaging; (5) data scaling yielded +20.6% improvement; (6) expanding from 13 to 45 label dimensions caused catastrophic collapse (0.78 to 0.22). These principles are generalizable to multi-label medical image classification with class imbalance.
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.
Vision-based assessment can provide convenient and cost-effective evaluation in Traditional Chinese Medicine (TCM) rehabilitation training, where action quality assessment (AQA) from computer vision offers a promising solution. Existing automatic AQA frameworks for physical therapy typically rely on skeletal data captured from a single viewpoint, which is inefficient for TCM techniques such as acupuncture or Tuina that involve dense hand self-occlusion and complex hand-object interactions. To address these challenges, we propose CME-AQA, a cross-view, multimodal vision-based assessment framework that integrates visual-pose fusion to enhance understanding of environmental context and leverages both first-person and third-person videos during training to improve inference robustness. We collected two dual-view datasets, TCM-AQA61-A (Acupuncture) and TCM-AQA61-T (Tuina), each containing synchronized first-person and third-person recordings of 61 subjects with expert annotations. Experimental results show that our approach achieves superior or comparable mean performance against competitive baselines, achieving over 10% relative improvement in weighted F1 over the best competing method on key rating tasks such as Needle Depth and Quick Needle Insertion, while also reducing mean absolute error in quantitative measures such as insertion time and manipulation frequency. Testing on a CPR dataset further demonstrates comparable performance on several posture-based criteria, suggesting applicability to related structured simulated clinical skill assessments where participant motion is central to evaluation. Overall, CME-AQA enhances assessment accuracy for structured TCM rehabilitation training and facilitates more convenient and effective training-oriented skill evaluation.