# Syndrome, Synergy, and Safety: Structured Reasoning and Knowledge-Driven Alignment for TCM Prescription Generation

arXiv: https://arxiv.org/abs/2609.25755 · HTML: https://mlsanity.com/paper/2609.25755/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 10 of its 31 references that are in the map.
- First posted on arXiv 22 Sep 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- LLM alignment / RLHF / preference optimisation / [Medical LLM alignment](https://mlsanity.com/alignment/medical-llm-alignment/)

## Builds on (most cited first, 10 of 10)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Constitutional AI: Harmlessness from AI Feedback](https://mlsanity.com/paper/2212.08073/) (2022)
- [Qwen3 Embedding: Advancing Text Embedding and Reranking Through Foundation Models](https://mlsanity.com/paper/2506.05176/) (2025)
- [DeepSeek-V3 Technical Report](https://mlsanity.com/paper/2412.19437/) (2024)
- [Baichuan 2: Open Large-scale Language Models](https://mlsanity.com/paper/2309.10305/) (2023)
- [RLAIF vs. RLHF: Scaling Reinforcement Learning from Human Feedback with AI Feedback](https://mlsanity.com/paper/2309.00267/) (2023)
- [HuaTuo: Tuning LLaMA Model with Chinese Medical Knowledge](https://mlsanity.com/paper/2304.06975/) (2023)
- [The Llama 4 Herd: Architecture, Training, Evaluation, and Deployment Notes](https://mlsanity.com/paper/2601.11659/) (2026)
- [TCMBench: A Comprehensive Benchmark for Evaluating Large Language Models in Traditional Chinese Medicine](https://mlsanity.com/paper/2406.01126/) (2024)

## Abstract (arXiv)

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 → PG-CoT → Dynamic → 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.