TCM-DiagCommit: A TCM-SD-Derived Benchmark for Evidence-Conditioned Syndrome Selection and Commitment

Abstract

Traditional Chinese Medicine (TCM) syndrome differentiation is usually evaluated as static final-label selection over complete clinical records. This setting hides three diagnostic behaviors: whether a model distinguishes semantic-neighbor syndrome labels from easy random distractors, whether it updates predictions as evidence fields are revealed, and whether it should commit under uncertainty. We introduce TCM-DiagCommit, a benchmark derived from the public TCM-SD/ZY-BERT resource while retaining its source syndrome labels; it converts 1,834 source cases into 23,842 task rows over 148 syndrome labels. The benchmark combines random, profile-neighbor, and full-vocabulary candidate ladders with staged t1/t2/t3 evidence. It also includes fixed-label tongue/pulse perturbations and insufficient-evidence variants. A benchmark-defined action contract scores commit, acquire, defer, and abstain. Across five zero-shot DirectLLM calibrations, random10 top-1 accuracy is 63.2% to 66.4%, but hard20 falls to 24.7% to 30.3% and full148 to 14.8% to 22.3%; on hard20, WT(all) wrong-terminal commits remain 62.2% to 74.3%. These results show that final-answer accuracy alone is insufficient for diagnostic benchmark evaluation: answer selection, evidence use, and benchmark commitment scoring should be measured separately.