TCMScience: An Autonomous Scientist for Traditional Chinese Medicine

Medical benchmarks for language models are built almost entirely on Western biomedicine. Traditional Chinese Medicine (TCM) is a separate system, with its own diagnostic framework and its own literature, and it remains largely unmeasured. The few TCM evaluations that exist are small, narrow, and rarely paired with a human reference. We present TCMQA, an open benchmark of 38,279 questions from Chinese TCM licensing examinations, paired with 15,151 responses from 101 licensed practitioners. We evaluate 29 instruction-tuned models from 9 families, spanning 0.27B to 14.8B parameters. Accuracy ranges over 59 points, and no model approaches saturation. Pretraining data predicts TCM ability far better than scale: a 12B Western-pretrained model reaches 39.6%, while a Chinese-pretrained model an eighth its size reaches 60.8%. Nine models exceed the practitioner majority vote of 64.9%, the best by 21.8 points, and all nine come from that same Chinese-pretrained family. Yet difficulty does not transfer between models and practitioners: accuracy is flat across practitioner-rated difficulty, item-level agreement is near zero for all 29 models, and on $8.4\%$ of items the practitioners are correct where the leading model is wrong. We release the corpus, the practitioner responses, the harness, and per-item model outputs at https://huggingface.co/datasets/TechTCM/TCMQA.

Large language models have advanced medical reasoning, but clinically grounded reasoning in traditional Chinese medicine (TCM) remains challenging because prescription decisions require integrating domain knowledge, syndrome differentiation, treatment principles, herbal prescription composition, and dosage determination. We develop a TCM language model family comprising models with 4 billion, 8 billion, and 14 billion parameters. The artificial intelligence contribution is a staged clinical alignment framework integrating large scale continued pretraining on TCM and clinical records, complementary reasoning supervision, and prescription-centered reinforcement learning (RL). We further formulate herbal prescription generation as a structured RL problem with prescription-level feedback, enabling direct optimization of clinical decision outputs beyond knowledge reproduction and generic instruction following. The engineering application is TCM clinical decision support, particularly herbal prescription recommendation. We evaluate the models on a public benchmark containing 25,620 expert-verified items across 13 TCM knowledge and clinical reasoning tasks and on a private retrospective dataset of 4,348 spleen and stomach disease prescription cases. The 14 billion parameter reinforcement aligned model achieves a prescription generation F1 of 37.0 on the public benchmark, compared with 32.3 for DeepSeek-R1 with 671 billion total parameters, and a herb-level F1 of 52.8 on the clinical dataset with improved dosage agreement. Reinforcement post-training consistently improves prescription recommendation across all scales, while physician-source analysis shows that expert heterogeneity affects reward stability. These findings demonstrate a scalable pathway from domain grounding and reasoning supervision to clinically oriented prescription decision support.

Applying large language models to Traditional Chinese Medicine (TCM) prescription generation reveals three clinically critical gaps: models produce end-to-end mappings without auditable reasoning following the li-fa-fang-yao paradigm (SR Gap), treat each encounter in isolation without follow-up adjustment via sui zheng jia jian (LA Gap), and fail to enforce absolute contraindication rules such as Shi Ba Fan (SC Gap). We propose a progressive four-stage framework (SFT $\to$ PG-CoT $\to$ Dynamic $\to$ K-RL) that addresses each gap: PG-CoT constrains CoT distillation under the li-fa-fang-yao paradigm to produce auditable diagnostic chains, Dynamic SFT models patient trajectories with explicit transition reasoning, and K-RL encodes deterministic pharmacological rules as rule-based DPO preference signals. Across 12 fine-tuned models and 6 zero-shot baselines, our framework substantially improves prescription quality over zero-shot baselines---with a 7B model (Mistral-7B) surpassing zero-shot GPT-5 on all three TCM evaluation metrics.