# GastroTCM: a large language model assistant for gastroenterology in traditional Chinese medicine

## TL;DR

GastroTCM is a specialized AI assistant for Traditional Chinese Medicine gastroenterology that improves accuracy and reduces errors through retrieval-augmented generation and multi-turn dialogue.

## Contribution

GastroTCM introduces a retrieval-augmented LLM with multi-turn dialogue and agent-based reasoning for TCM gastroenterology.

## Key findings

- GastroTCM outperformed baselines in single-turn and multi-turn dialogue evaluations.
- Expert review confirmed higher diagnostic accuracy and safety with fewer hallucinations.
- The RAG module significantly reduced unsupported statements in clinical responses.

## Abstract

Large language models (LLMs) show promise for supporting Traditional Chinese Medicine (TCM) practice, but their clinical utility is limited by domain-specific knowledge gaps, hallucinations, and weak multi-turn reasoning. We present GastroTCM, a specialised LLM assistant for TCM gastroenterology that we built by fine-tuning a Llama3-8B model and augmenting it with a Retrieval-Augmented Generation (RAG) and an agent framework. GastroTCM targets key shortcomings in current TCM diagnostic support through three components: (1) a dedicated TCM gastroenterology vector database for efficient retrieval of high-value, peer-reviewed knowledge; (2) ShareGPT-style multi-turn dialogue optimisation to preserve clinical context across rounds; and (3) an intelligent agent that dynamically adapts its responses to evolving symptom profiles and user intent.

GastroTCM was trained on approximately 20 million tokens of de-identified clinical records, guideline-based content, and expert-curated TCM question–answer pairs and evaluated against strong Chinese LLM baselines (ChatGLM-6B, Qwen-2). In automatic evaluations, GastroTCM outperformed all baselines in single-turn dialogue (BLEU: 0.334 vs. 0.172–0.246) and multi-turn consultations, where it achieved a substantially higher rate of proactive, clinically appropriate interactions (27/60 vs. ≤ 2/60 cases). Expert review by TCM gastroenterologists further confirmed higher diagnostic accuracy and safety, with the RAG module markedly reducing unsupported or hallucinated statements. These findings suggest that domain-specific, retrieval-enhanced LLMs can meaningfully augment—rather than replace—TCM practitioners in gastroenterology, with the potential to improve access to high-quality, explainable decision support in real-world settings.