Patient-Conditioned Dual Hypergraph Reasoning for Auditable Traditional Chinese Medicine Prescription Support

Traditional Chinese medicine (TCM) prescription support requires patient-specific reasoning from clinical narratives to syndromes, treatment principles, herbs, and doses. Direct language-model generation can produce fluent prescriptions, but its decisions are difficult to audit against explicit clinical evidence. Static TCM knowledge resources provide useful priors, but they cannot determine which diagnostic and prescription relations should be emphasized for an individual patient. We propose a patient-conditioned dual hypergraph framework for auditable TCM prescription support. The first hypergraph organizes symptom, tongue, pulse, and other clinical evidence around syndrome and treatment-principle reasoning. The second hypergraph organizes syndrome, treatment, disease-context, herb, retrieval, and dose-prior evidence for prescription construction. Unlike static knowledge graphs or fixed hypergraphs, both hypergraphs are dynamically weighted by the patient representation. This design enables individualized activation of diagnostic and prescription paths, supporting personalized syndrome differentiation and herb-dose recommendation while preserving case-level auditability. Experiments on TCM-SD show that dynamic weighting in the first hypergraph improves MacBERT syndrome differentiation to 0.8297 accuracy and 0.3288 macro-F1. On TCM-BEST4SDT, the second hypergraph achieves the best mean Herb-F1 of 0.3111 across three seeds, and the full connected pipeline reaches 0.3074 Herb-F1, close to the oracle setting. A 50-case real-world CAP audit further suggests practical review potential, while highlighting the need for prospective dose-safety validation.

CIV-DG: Conditional Instrumental Variables for Domain Generalization in Medical Imaging

Cross-site generalizability in medical AI is fundamentally compromised by selection bias, a structural mechanism where patient demographics (e.g., age, severity) non-randomly dictate hospital assignment. Conventional Domain Generalization (DG) paradigms, which predominantly target image-level distribution shifts, fail to address the resulting spurious correlations between site-specific variations and diagnostic labels. To surmount this identifiability barrier, we propose CIV-DG, a causal framework that leverages Conditional Instrumental Variables to disentangle pathological semantics from scanner-induced artifacts. By relaxing the strict random assignment assumption of standard IV methods, CIV-DG accommodates complex clinical scenarios where hospital selection is endogenously driven by patient demographics. We instantiate this theory via a Deep Generalized Method of Moments (DeepGMM) architecture, employing a conditional critic to minimize moment violations and enforce instrument-error orthogonality within demographic strata. Extensive experiments on the Camelyon17 benchmark and large-scale Chest X-Ray datasets demonstrate that CIV-DG significantly outperforms leading baselines, validating the efficacy of conditional causal mechanisms in resolving structural confounding for robust medical AI.