TCM AI: what an AI can and cannot do in Chinese medicine
An AI in Chinese medicine can carry the reasoning of the tradition and cannot carry its examination. It can hold the materia medica, the nature, flavour, channels, actions, dose, and prohibitions of the herbs; the classical formulas with their source text and their chief, deputy, assistant, and envoy logic; the point functions; and the pattern differentiation of the eight principles, the zang-fu, the six stages, and the four levels, and it can work through them for a question in the order the tradition uses, pattern before principle, principle before formula. What it cannot do is the half of the method that happens in the room: it cannot feel a pulse at the three positions and three depths, see a tongue under daylight, palpate the abdomen or the channels, smell the breath, hear the quality of a voice, or watch how a person walks in. Everything it concludes is conditional on what it is told.
The four examinations
The Nanjing sets out the four examinations, looking (wang), listening and smelling (wen), asking (wen), and palpating (qie), and grades the physician by how many of them he needs. Asking is the only one an AI performs in full, and the tradition ranks asking third of the four. Looking it performs in part when a photograph is given, with the limits a photograph has: a tongue under a lamp is not a tongue in daylight, and a complexion on a screen is not a complexion. Listening and smelling it does not perform, and the odour of a damp-heat patient or the breathless voice of Lung qi deficiency is lost to it. Palpation it does not perform at all. Tongue-image analysis and pulse-sensor devices exist and are studied in Chinese hospitals as aids, and they remain aids; the pulse of the Mai Jing is read through a trained finger against a living wrist.
What it does well
It reasons from signs. Given the signs a person reports, tongue, thirst, sleep, digestion, timing, temperature, sweat, it can lay out the patterns that produce them and say which signs separate one from another, so that the person can recognise their own; this is the method of the textbook's differentiation, and an AI applies it consistently and without fatigue. It explains a prescription already given, herb by herb and role by role, which practitioners rarely have time to do. It teaches the materia medica and the formulas from the texts, Shanghan Lun, Jingui Yaolue, Bencao Gangmu, and the modern canon, in the tradition's own terms and with the pharmaceutical names. It checks a proposed combination against the eighteen incompatibilities and nineteen antagonisms, the pregnancy prohibitions, the toxic-class processing rules, and the known interactions with prescribed drugs, which is exactly the kind of knowledge that is complete, fixed, and forgotten under pressure. It prepares the questions a person brings to a practitioner and the words to describe what they feel. It gives the classical dose range as the texts record it, and it distinguishes the Liver of Chinese medicine from the liver of anatomy without confusing them.
Where it fails
A pattern reached from self-report is provisional, and the danger of an AI is not that it knows too little but that it states a provisional pattern with the certainty of one confirmed by the pulse. The pairs that the pulse and tongue separate are the ones it confuses: Liver qi stagnation and Liver Blood deficiency, both wiry; Kidney yin and Kidney yang deficiency, both with a sore back and both tired; Spleen qi deficiency and dampness obstructing, one empty and one full. It cannot notice what the person does not mention, and the unmentioned sign, a wet tongue, a sallow face, a smell, is often the deciding one. It cannot adjust a formula week by week against the pulse's response, which is the practitioner's craft rather than the textbook's knowledge. It cannot process Fu Zi or judge by taste when the decoction is safe. It does not dispense, and a formula that names toxic-class herbs or the base herbs of the eighteen incompatibilities is written by a hand that has handled them. It has read the classics in translation and in terminology such as Wiseman's, and it should paraphrase them and say so rather than invent a quotation, a chapter, or a study, which it will do if it is not held to the texts.
How the tradition places it
The Neijing's physician looks, listens, asks, and palpates, and is judged by the examination before the prescription. An AI is a learned reader with two of the four gates closed and one half open. Its right place in the medicine is the one the tradition already has for the scholar-physician who has read everything and treats no one: the reasoner, the teacher, the second opinion on a prescription, the keeper of the prohibitions and the doses, and the preparation for the room where the examination happens. What it says about a pattern is the tradition's reasoning; what confirms the pattern is the tongue and the pulse, and those belong to the person and to the hand that reads them.