“未病-已病”窗口期的中医临床诊疗模式构建:中医状态学视阈下客观化多模态数据的融合

Construction of the clinical diagnosis and treatment model during the “pre-disease to disease” window period in traditional Chinese medicine: integration of objective multimodal data from the perspective of traditional Chinese medicine stateology

  • 摘要: “治未病”思想是中医学的基本理念之一,其贯穿中医诊疗体系始终,并发挥着至关重要的作用。然而现阶段“未病-已病”窗口期的中医诊疗模式存在临床参数采集维度缺失、多模态异构数据难以表征融合、干预及疗效评价动态精准性不足等问题。基于此,本文以李灿东教授中医状态学理论为方法指引,聚焦客观化多模态数据融合,提出一种面向“未病-已病”窗口期的中医个体化诊疗新模式。该模式首先提出重构“证”的认知体系,整合宏观、中观及微观等多源异构数据,形成三维评测指标体系的思路;通过引入图神经网络、卷积神经网络、注意力机制及知识图谱引导的权重分配,实现多源数据的协同表征、对齐与融合。其次,规划构建特征级与决策级的多模态融合模型,以建立指标与中医状态要素的映射关系,筛选窗口期病理演变关键指标;提出利用夏普利加性解释(SHAP)、Ablation-CAM++等方法增强模型可解释性的技术路径。最后,以状态评估为落脚点,提出基于长短期记忆(LSTM)网络、门控循环单元(GRUs)等算法,构建基于时序数据分析的个体诊疗动态评估方法的构想,并引入因果推断框架与半监督学习策略,实现个体干预效应量化评估与可解释的疗效反馈,形成从数据表征与融合、权重调整、可解释性分析到动态诊疗反馈的完整技术路径。旨在弥补现有中医“未病-已病”窗口期诊疗模式的不足,为中医“治未病”临床实践提供可操作的方法论遵循。

     

    Abstract: The philosophy of “treating disease before its onset” is a fundamental concept of traditional Chinese medicine (TCM), permeating its diagnostic and therapeutic framework, and is central to clinical practice. However, current TCM diagnostic and treatment models for the “pre-disease to disease” window period face several limitations, including the lack of comprehensive clinical parameters, difficulties in characterizing and integrating heterogeneous multimodal data, and insufficient dynamic precision in interventions and efficacy evaluations. To address these issues, guided by Professor Candong Li’s theory of TCM stateology, this study focuses on integrating objective multimodal data. It proposes a new model for personalized TCM diagnosis and treatment targeting the “pre-disease to disease” window period. This approach first proposes the idea of restructuring the conceptual framework of “symptom” and integrating multi-source heterogeneous data at macroscopic, mesoscopic, and microscopic levels to form a three-dimensional assessment indicator system. By integrating graph neural networks, convolutional neural networks, attention mechanisms, and knowledge graph-guided weight allocation, this approach enables collaborative representation, alignment, and fusion of multi-source data. Subsequently, it plans to construct a multimodal fusion model at both feature and decision levels, in order to establish mappings between indicators and TCM state elements, and to screen key indicators characterizing pathological evolution during the window period. Furthermore, it proposes a technical path for enhancing model interpretability using methods such as SHapley Additive exPlanations (SHAP) and Ablation-CAM++. Finally, with state assessment as the core, it proposes the concept of constructing a dynamic evaluation method for individualized diagnosis and treatment based on time-series data analysis using algorithms such as long short-term memory (LSTM) networks and gated recurrent units (GRUs). Moreover, a causal inference framework and semi-supervised learning strategies are introduced to enable quantitative evaluation of individual intervention effects and to provide interpretable therapeutic feedback, forming a complete technical path from data representation and fusion, weight adjustment, and interpretability analysis, to dynamic diagnosis feedback. This study aims to address deficiencies in the current TCM diagnosis and treatment model during the “pre-disease to disease” window period and to provide an operational framework for the clinical practice of TCM’s “treating disease before its onset”.

     

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