AI助手临床校验改为只提示不拦截，资料不全也给出解答

- TcmClinicalReportStream 新增 BLOCKING 开关（默认 false），校验命中时照常交付原文，问题码记入 warnings() - 问答、长报告、结构化分析、报告生成的脉象/事实状态/溯源校验改为随结果返回 clinical_review_warnings - 处方草稿丢弃多余脉象字段、重复药名保留首味，不再整张失败 - 接诊提示词补充互联网面诊仅舌象无脉象、须合理推断给出结论 Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
2026-10-27 15:00:10 +08:00
parent f9cbd42113
commit ea40cfdfed
3 changed files with 102 additions and 29 deletions
@@ -854,6 +854,10 @@ class DiagnosisAiLogic extends BaseLogic
                $result['content'] = $aggregate;
            }
            $formatted = self::formatAssistantResult($prepared, $result);
+            if ($formatted !== null && $clinicalStream !== null && $clinicalStream->warnings() !== []) {
+                $formatted['clinical_review_warnings'] = self::safeClinicalWarnings(array_merge(
+                    $formatted['clinical_review_warnings'] ?? [], array_values($clinicalStream->warnings())));
+            }
            $status = $formatted === null ? 'error' : 'ok';
            return $formatted;
        } finally {
@@ -1075,24 +1079,35 @@ class DiagnosisAiLogic extends BaseLogic
                self::setError('AI报告流与最终内容不一致，未作为完整报告返回');
                return null;
            }
+            $warnings = $result['clinical_review_warnings'] ?? [];
            $facts = TcmClinicalFactStateGuard::validate(self::clinicalLedger($prepared), $visible);
            if (empty($facts['valid'])) {
-                self::rejectClinicalState([], $facts['issues']);
-                return null;
+                if (TcmClinicalReportStream::BLOCKING) {
+                    self::rejectClinicalState([], $facts['issues']);
+                    return null;
+                }
+                $warnings = array_merge($warnings, $facts['issues'] ?? []);
            }
            $provenance = TcmClinicalEvidenceContract::validate($single['_clinical_evidence_index'], $visible, true);
            if (empty($provenance['valid'])) {
-                self::rejectClinicalState([], $provenance['issues']);
-                return null;
+                if (TcmClinicalReportStream::BLOCKING) {
+                    self::rejectClinicalState([], $provenance['issues']);
+                    return null;
+                }
+                $warnings = array_merge($warnings, $provenance['issues'] ?? []);
            }
            // Count exactly the original bytes delivered across both attempts.
            $shape = TcmLongReportContract::validate($visible, (string) $prepared['query']);
            if (!$shape['valid']) {
-                self::$assistantErrorMeta['report_contract'] = $shape;
-                self::$assistantErrorCode = 'TCM_REPORT_INCOMPLETE';
-                self::setError('AI长报告未满足完整性交付要求，未作为完整报告返回');
-                return null;
+                if (TcmClinicalReportStream::BLOCKING) {
+                    self::$assistantErrorMeta['report_contract'] = $shape;
+                    self::$assistantErrorCode = 'TCM_REPORT_INCOMPLETE';
+                    self::setError('AI长报告未满足完整性交付要求，未作为完整报告返回');
+                    return null;
+                }
+                $warnings[] = ['code' => 'REPORT_FINAL_CONTRACT_INVALID', 'source_id' => 'report'];
            }
+            $result['clinical_review_warnings'] = self::safeClinicalWarnings($warnings);
            $result['answer'] = $visible;
            $result['report_stage_count'] = $stageCount;
            $result['clinical_repair_count'] = $repairCount;
@@ -1579,6 +1594,22 @@ class DiagnosisAiLogic extends BaseLogic
        self::rejectClinicalState($result, $stream->issues());
    }

+    /** 只保留安全问题码与来源编号，不回传被校验的正文。 */
+    private static function safeClinicalWarnings(array $issues): array
+    {
+        $safe = [];
+        foreach ($issues as $issue) {
+            if (!is_array($issue)) continue;
+            $code = (string) ($issue['code'] ?? '');
+            $sourceId = (string) ($issue['source_id'] ?? '');
+            if (preg_match('/^[A-Z0-9_]+$/D', $code) !== 1
+                || preg_match('/^(?:s[1-9][0-9]*|report)?$/D', $sourceId) !== 1) continue;
+            $safe[$code . '|' . $sourceId] = ['code' => $code, 'source_id' => $sourceId];
+            if (count($safe) >= 16) break;
+        }
+        return array_values($safe);
+    }
+
    private static function rejectClinicalState(array $result, array $issues = []): void
    {
        self::$assistantErrorMeta = self::safeAssistantErrorMeta($result);
@@ -1662,10 +1693,16 @@ class DiagnosisAiLogic extends BaseLogic
            self::setError($message);
            return null;
        }
-        if (!TcmConsultationPulsePolicy::validate(self::clinicalLedger($prepared), (string) ($result['content'] ?? ''))['valid']) {
-            self::$assistantErrorCode = 'PULSE_EXCLUDED_FROM_ASSESSMENT';
-            self::setError('AI返回了本流程不采集的脉象判断或补采要求，内容未通过校验');
-            return null;
+        // 校验命中只作为复核提示随回答返回，不再拦截整条回答（见 TcmClinicalReportStream::BLOCKING）。
+        $reviewWarnings = [];
+        $pulseReview = TcmConsultationPulsePolicy::validate(self::clinicalLedger($prepared), (string) ($result['content'] ?? ''));
+        if (!$pulseReview['valid']) {
+            if (TcmClinicalReportStream::BLOCKING) {
+                self::$assistantErrorCode = 'PULSE_EXCLUDED_FROM_ASSESSMENT';
+                self::setError('AI返回了本流程不采集的脉象判断或补采要求，内容未通过校验');
+                return null;
+            }
+            $reviewWarnings = array_merge($reviewWarnings, $pulseReview['issues'] ?? []);
        }
        $content = self::cleanText($result['content'] ?? '', self::MAX_REPORT_LENGTH, true);
        if ($content === '') {
@@ -1681,8 +1718,11 @@ class DiagnosisAiLogic extends BaseLogic
        if (($prepared['task'] ?? '') !== 'prescription_generate') {
            $factReview = TcmClinicalFactStateGuard::validate(self::clinicalLedger($prepared), $content);
            if (!$factReview['valid']) {
-                self::rejectClinicalState($result, $factReview['issues']);
-                return null;
+                if (TcmClinicalReportStream::BLOCKING) {
+                    self::rejectClinicalState($result, $factReview['issues']);
+                    return null;
+                }
+                $reviewWarnings = array_merge($reviewWarnings, $factReview['issues'] ?? []);
            }
        }

@@ -1710,6 +1750,7 @@ class DiagnosisAiLogic extends BaseLogic
            'source_diagnosis_ids' => is_array($prepared['source_diagnosis_ids'] ?? null)
                ? array_values(array_map('intval', $prepared['source_diagnosis_ids']))
                : [],
+            'clinical_review_warnings' => self::safeClinicalWarnings($reviewWarnings),
        ];
        if (($result['transfer_manifest_final'] ?? false) === true) {
            foreach (['required_sections', 'items', 'attachment_count', 'submitted_attachment_count', 'skipped_attachment_count',
@@ -1826,8 +1867,8 @@ class DiagnosisAiLogic extends BaseLogic
            }
        }

-        if (array_key_exists('pulse', $decoded) || array_key_exists('pulse_condition', $decoded)
-            || !TcmConsultationPulsePolicy::validate([], $json)['valid']) return null;
+        // 本接诊流程不采集脉象：模型多给的脉象字段直接丢弃，不再让整张处方草稿失败。
+        unset($decoded['pulse'], $decoded['pulse_condition']);

        $clinical = self::cleanText($decoded['clinical_diagnosis'] ?? '', self::MAX_PRESCRIPTION_TEXT, true);
        $herbs = $decoded['herbs'] ?? null;
@@ -1849,7 +1890,9 @@ class DiagnosisAiLogic extends BaseLogic
                ? '辅方'
                : '主方';
            $key = mb_strtolower(preg_replace('/\s+/u', '', $name) ?? $name, 'UTF-8');
-            if ($name === '' || $dosage === false || $dosage <= 0 || $dosage > 10000 || isset($seen[$key])) {
+            // 重复药名保留首次出现的一味，不让整张草稿失败。
+            if (isset($seen[$key])) continue;
+            if ($name === '' || $dosage === false || $dosage <= 0 || $dosage > 10000) {
                return null;
            }
            $seen[$key] = true;
@@ -2054,21 +2097,30 @@ class DiagnosisAiLogic extends BaseLogic
        }
        // Each text keeps its own boundaries; one field cannot grant a source
        // quotation exception to a different field, even with partial data.
+        $reviewWarnings = [];
        foreach ([$analysis['diagnosis_advice'], $analysis['treatment_advice'],
            ...array_column($analysis['risk_assessment'], 'label')] as $analysisText) {
-            if (!TcmConsultationPulsePolicy::validate($evidenceGuard['fact_state_ledger'], $analysisText)['valid']) {
+            $pulseReview = TcmConsultationPulsePolicy::validate($evidenceGuard['fact_state_ledger'], $analysisText);
+            if ($pulseReview['valid']) continue;
+            if (TcmClinicalReportStream::BLOCKING) {
                self::setError('AI返回了本流程不采集的脉象判断或补采要求，内容未通过校验');
                return null;
            }
+            $reviewWarnings = array_merge($reviewWarnings, $pulseReview['issues'] ?? []);
        }
-        if (!TcmClinicalFactStateGuard::validate($evidenceGuard['fact_state_ledger'],
+        $factReview = TcmClinicalFactStateGuard::validate($evidenceGuard['fact_state_ledger'],
            implode("\n", [$analysis['diagnosis_advice'], $analysis['treatment_advice'],
-                implode("\n", array_column($analysis['risk_assessment'], 'label'))]))['valid']) {
-            self::setError('AI正文与病历的已知、阴性或未记录状态不一致，本次分析未通过校验');
-            return null;
+                implode("\n", array_column($analysis['risk_assessment'], 'label'))]));
+        if (!$factReview['valid']) {
+            if (TcmClinicalReportStream::BLOCKING) {
+                self::setError('AI正文与病历的已知、阴性或未记录状态不一致，本次分析未通过校验');
+                return null;
+            }
+            $reviewWarnings = array_merge($reviewWarnings, $factReview['issues'] ?? []);
        }

        return array_merge($analysis, [
+            'clinical_review_warnings' => self::safeClinicalWarnings($reviewWarnings),
            'answer_mode' => 'clinical_analysis',
            'evidence_selection_valid' => null,
            'evidence_format_normalized' => false,
@@ -2190,7 +2242,8 @@ class DiagnosisAiLogic extends BaseLogic
                continue;
            }

-            if (!TcmConsultationPulsePolicy::validate($context['tcm_evidence_guard']['fact_state_ledger'], $content)['valid']) {
+            if (TcmClinicalReportStream::BLOCKING
+                && !TcmConsultationPulsePolicy::validate($context['tcm_evidence_guard']['fact_state_ledger'], $content)['valid']) {
                $failureCount++;
                $results[] = array_merge($resultBase, ['status' => 'error',
                    'error_code' => 'PULSE_EXCLUDED_FROM_ASSESSMENT',
@@ -7,10 +7,17 @@ namespace app\adminapi\service;
 /** Validate complete prose units before exposing their original bytes to clients. */
 final class TcmClinicalReportStream
 {
+    /**
+     * 互联网面诊只有舌象等部分资料，校验规则命中时不再截断回答：
+     * 原文照常交付，问题码记入 warnings() 供医师复核。设为 true 恢复拦截模式。
+     */
+    public const BLOCKING = false;
+
    private string $pending = '';
    private string $accepted = '';
    private bool $stopped = false;
    private array $issues = [];
+    private array $warnings = [];
    private \Closure $forward;
    private ?\Closure $onReject;
    private string $deferred = '';
@@ -69,10 +76,11 @@ final class TcmClinicalReportStream
        if ($this->finalCheckpointQuery === null) return true;
        $candidate = $this->accepted . $this->deferred;
        $review = $this->review($candidate, true);
-        if (empty($review['valid'])) return $this->reject($this->deferred, $review['issues']);
+        if (empty($review['valid']) && !$this->reject($this->deferred, $review['issues'])) return false;
        $this->finalContract = TcmLongReportContract::validate($candidate, $this->finalCheckpointQuery);
-        if (empty($this->finalContract['valid'])) {
-            return $this->reject($this->deferred, [['code' => 'REPORT_FINAL_CONTRACT_INVALID', 'source_id' => 'report']]);
+        if (empty($this->finalContract['valid'])
+            && !$this->reject($this->deferred, [['code' => 'REPORT_FINAL_CONTRACT_INVALID', 'source_id' => 'report']])) {
+            return false;
        }
        if ($this->shouldAbort !== null && ($this->shouldAbort)()) { $this->stopped = true; return false; }
        if ($this->deferred === '') return true;
@@ -86,14 +94,16 @@ final class TcmClinicalReportStream

    public function rejected(): bool { return $this->issues !== []; }
    public function issues(): array { return $this->issues; }
+    public function warnings(): array { return $this->warnings; }
    public function acceptedContent(): string { return $this->accepted; }
    public function finalContract(): ?array { return $this->finalContract; }

    private function release(string $unit): bool
    {
        if ($unit === '') return true;
-        if (in_array(trim($unit), $this->priorAnswerUnits, true) && !$this->isOrdinaryHeadingUnit($unit)) {
-            return $this->reject($unit, [['code' => 'REPORT_CONTINUATION_REPEATED_SECTION', 'source_id' => 'report']]);
+        if (in_array(trim($unit), $this->priorAnswerUnits, true) && !$this->isOrdinaryHeadingUnit($unit)
+            && !$this->reject($unit, [['code' => 'REPORT_CONTINUATION_REPEATED_SECTION', 'source_id' => 'report']])) {
+            return false;
        }
        if ($this->finalCheckpointQuery !== null && !$this->holdingFinal) {
            $offset = 0;
@@ -115,7 +125,7 @@ final class TcmClinicalReportStream
        }
        $candidate = $this->accepted . $unit;
        $review = $this->review($candidate);
-        if (empty($review['valid'])) return $this->reject($unit, $review['issues']);
+        if (empty($review['valid']) && !$this->reject($unit, $review['issues'])) return false;
        if (($this->forward)($unit) === false) {
            $this->stopped = true;
            return false;
@@ -158,6 +168,15 @@ final class TcmClinicalReportStream

    private function reject(string $unit, array $issues): bool
    {
+        if (!self::BLOCKING) {
+            // 非拦截模式：只记录问题码，调用方继续按原流程交付该段原文。
+            foreach ($issues as $issue) {
+                if (!is_array($issue)) continue;
+                $key = ($issue['code'] ?? '') . '|' . ($issue['source_id'] ?? '');
+                if (!isset($this->warnings[$key]) && count($this->warnings) < 32) $this->warnings[$key] = $issue;
+            }
+            return true;
+        }
        if ($this->holdingFinal) {
            $issues[] = ['code' => 'REPORT_FINAL_SECTION_UNDELIVERED', 'source_id' => 'report'];
        }
@@ -27,6 +27,7 @@ final class TcmClinicalResponsePolicy
            . self::consultationInstruction()
            . '完成本次选定任务并直接给出对应分析结果：病历分析、血糖趋势、用药评估、并发症风险、问诊小结、健康建议各按自身问题作答。'
            . '资料不全仍分析已知内容，逐项说明依据、可支持的结论及不确定性；缺什么说明什么，不将整个回答改成资料核对、原文摘录或通用补采清单。'
+            . '本次为互联网面诊，望诊以舌象为主、无脉象：须结合舌象、症状、病史与检验合理推断，明确给出倾向性结论和可执行建议，并标注为推断供医师复核，不得以资料不全为由拒答。'
            . '仅在任务涉及中医辨证时按实采望闻问切及舌象→八纲→气血津液及脏腑定位→证名→治法→中药方义及禁忌组织；证据不足的证名可给有依据的鉴别方向，不能当作确诊。'
            . '事实与病机分开，脏腑、证名和治法的每个限定成分分别举证，一般或正常状态本身不作病理阳性。'
            . '列方须有已知依据、适用条件与禁忌，不凭病名或单症套方；新增主方方向最多一个，不输出新增剂量、频次或疗程。'