563 lines
45 KiB
PHP
563 lines
45 KiB
PHP
<?php
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declare(strict_types=1);
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require dirname(__DIR__) . '/vendor/autoload.php';
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require __DIR__ . '/fixtures/CompleteTcmCase.php';
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use app\adminapi\logic\tcm\PatientAiReportLogic;
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use app\adminapi\service\AiRequiredSource;
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use app\adminapi\service\TcmClinicalFactStateGuard as Guard;
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use app\adminapi\service\TcmClinicalReportStream;
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// Pure lexical role regressions. A lexical pass never certifies a diagnosis,
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// source-citation relevance, or an unquoted positive finding's attribution.
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$checks = 0;
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function roleGrammarExpect(bool $condition, string $message): void
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{
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++$GLOBALS['checks'];
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if (!$condition) throw new RuntimeException($message);
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}
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function roleGrammarCheck(array $ledger, string $text, bool $expected, string $code = ''): void
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{
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$result = Guard::validate($ledger, $text);
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roleGrammarExpect($result['valid'] === $expected,
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json_encode([$text, $result], JSON_UNESCAPED_UNICODE | JSON_UNESCAPED_SLASHES));
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if ($code !== '') roleGrammarExpect(in_array($code, array_column($result['issues'], 'code'), true),
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$text . ': expected ' . $code);
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foreach ([1, 2, 7, 31] as $size) {
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$visible = '';
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$stream = new TcmClinicalReportStream($ledger, static function (string $delta) use (&$visible): bool {
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$visible .= $delta;
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return true;
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});
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$wire = $text . "\r\n\r\n";
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foreach (str_split($wire, $size) as $chunk) if (!$stream->push($chunk)) break;
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roleGrammarExpect($stream->finish() === $expected && $stream->rejected() === !$expected,
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'Stream decision differs at byte chunk size ' . $size . ': ' . $text);
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roleGrammarExpect($expected ? $visible === $wire : $visible === '',
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'Accepted bytes changed or a rejected unit leaked at byte chunk size ' . $size . ': ' . $text);
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}
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}
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$record = [
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'id' => 1, 'diagnosis_date' => '2026-10-23',
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'present_illness' => '口干；无心悸；无明显胸痛；未记录固定刺痛或腰酸耳鸣。',
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'past_history' => '无已知冠心病。', 'allergy_history' => '无已知药物过敏史。',
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'tongue' => '舌质淡红，舌面少津，苔少；无黄腻苔、紫暗或瘀斑。',
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'pulse' => '脉细弱，按之无力；不浮、不滑、不紧。',
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];
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$ledger = Guard::build($record);
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$ids = [];
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foreach ($ledger['sources'] as $source) $ids[$source['field']] = $source['id'];
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foreach (['属', '属于', '为'] as $copula) foreach (['待补', '未记录'] as $state)
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foreach (['依据', '证据', '资料'] as $noun) {
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roleGrammarCheck($ledger, '固定刺痛' . $copula . $state . $noun . '。', true);
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roleGrammarCheck($ledger, '口干' . $copula . $state . $noun . '。', false, 'POSITIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, '心悸' . $copula . $state . $noun . '。', false, 'NEGATIVE_TO_UNKNOWN');
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}
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roleGrammarCheck($ledger, '固定刺痛属待补依据，且舌无紫暗瘀斑。', true);
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roleGrammarCheck($ledger, '固定刺痛属待补依据，舌象未记录。', false, 'RECORDED_TO_UNKNOWN');
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foreach (['患者有固定刺痛，属待补依据。', '患者有固定刺痛属待补依据。',
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'固定刺痛属待补依据且患者有固定刺痛。', '固定刺痛属待补依据，患者有固定刺痛。'] as $text) {
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roleGrammarCheck($ledger, $text, false, 'UNKNOWN_TO_POSITIVE');
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}
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roleGrammarCheck($ledger, '固定刺痛属待补依据，患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
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roleGrammarCheck($ledger, '固定刺痛属待补依据，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '固定刺痛属待补依据，脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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// P2 audit follow-up: a pending record role cannot retract a self-report,
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// chief complaint, or an occurrence already asserted by its own subject.
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foreach (['自述固定刺痛', '主诉固定刺痛', '今晨固定刺痛发作', '固定刺痛发作',
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'今晨自述固定刺痛', '昨日固定刺痛持续了3小时'] as $assertion) {
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roleGrammarCheck($ledger, $assertion . '。', false, 'UNKNOWN_TO_POSITIVE');
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foreach (['属待补依据', '为待补资料', '属于未记录证据'] as $recordTail) {
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roleGrammarCheck($ledger, $assertion . $recordTail . '。', false, 'UNKNOWN_TO_POSITIVE');
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}
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roleGrammarCheck($ledger, '固定刺痛属待补依据，' . $assertion . '为待补资料。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($ledger, $assertion . '属待补依据，舌淡红苔少。', false, 'UNKNOWN_TO_POSITIVE');
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}
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foreach (['自述固定刺痛属未记录固定刺痛。', '主诉固定刺痛为未记录固定刺痛。',
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'今晨固定刺痛发作属未记录固定刺痛。', '自述固定刺痛属未记录而非否认。',
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'主诉：固定刺痛为待补资料。', '肾系定位因自述固定刺痛未记录而待定。'] as $assertedRecord) {
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roleGrammarCheck($ledger, $assertedRecord, false, 'UNKNOWN_TO_POSITIVE');
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}
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foreach (['固定刺痛发作时段属待补依据。', '今晨固定刺痛发作频次为待补资料。',
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'固定刺痛持续时间属于未记录信息。', '自述内容属待补资料。', '主诉内容为待补资料。',
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'固定刺痛、腰酸耳鸣属待补依据。', '本次固定刺痛属待补依据。'] as $neutralRecord) {
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roleGrammarCheck($ledger, $neutralRecord, true);
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}
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roleGrammarCheck($ledger, '口干属待补依据，自述固定刺痛为待补资料。', false, 'POSITIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, '心悸为待补资料，主诉固定刺痛属待补依据。', false, 'NEGATIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, '固定刺痛属待补依据，舌象未记录。', false, 'RECORDED_TO_UNKNOWN');
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$assertedSource = Guard::build(['present_illness' => '自述固定刺痛属待补依据。']);
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roleGrammarCheck($assertedSource, '固定刺痛未记录。', false, 'POSITIVE_TO_UNKNOWN');
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foreach (['肾系定位', '证名判断', '脏腑归属'] as $conclusion) foreach (['未记录', '尚未记录', '未采集'] as $state) {
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roleGrammarCheck($ledger, $conclusion . '因腰酸耳鸣' . $state . '而待定。', true);
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roleGrammarCheck($ledger, $conclusion . '因口干' . $state . '而待定。', false, 'POSITIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, $conclusion . '因心悸' . $state . '而待定。', false, 'NEGATIVE_TO_UNKNOWN');
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}
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roleGrammarCheck($ledger, '腰酸耳鸣未记录而待定。', true);
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roleGrammarCheck($ledger, '肾系定位因舌象未记录而待定。', false, 'RECORDED_TO_UNKNOWN');
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foreach (['患者有腰酸耳鸣，肾系定位因未记录而待定。', '患者有腰酸耳鸣未记录而待定。',
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'肾系定位因腰酸耳鸣未记录而待定且患者有固定刺痛。'] as $text) {
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roleGrammarCheck($ledger, $text, false, 'UNKNOWN_TO_POSITIVE');
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}
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roleGrammarCheck($ledger, '肾系定位因腰酸耳鸣未记录而待定，口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, '肾系定位因腰酸耳鸣未记录而待定，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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foreach (['每次', '每日', '每餐'] as $iteration) foreach (['饮水', '喝水', '进食'] as $measure) {
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roleGrammarCheck($ledger, $iteration . $measure . '不多，舌淡红苔少。', true);
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}
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foreach (['、', '，', '且', '但'] as $boundary) {
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roleGrammarCheck($ledger, '每次饮水不多' . $boundary . '患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
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roleGrammarCheck($ledger, '每次饮水不多' . $boundary . '患者有心悸。', false, 'NEGATIVE_TO_POSITIVE');
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roleGrammarCheck($ledger, '每次饮水不多' . $boundary . '口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, '每次饮水不多' . $boundary . '舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '每次饮水不多' . $boundary . '脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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}
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roleGrammarCheck(Guard::build(['water_intake' => '饮水未记录。']), '每次饮水不多。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($ledger, '每次腰酸耳鸣不多。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($ledger, '每次饮水不多舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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foreach (['', '或', '及', '和', '、'] as $join) foreach (['舌', '舌质', '舌象', '舌体', '舌色'] as $subject) {
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roleGrammarCheck($ledger, $subject . '无紫暗' . $join . '瘀斑。', true);
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}
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$qualified = Guard::build(array_replace($record, ['tongue' => '舌质淡红；无明显紫暗或瘀斑。']));
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$partial = Guard::build(array_replace($record, ['tongue' => '舌质淡红；无紫暗。']));
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$otherField = Guard::build(array_replace($record, ['tongue' => '舌质淡红；无紫暗。', 'tongue_coating' => '无瘀斑。']));
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foreach (['', '或', '及', '和', '、'] as $join) {
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roleGrammarCheck($qualified, '舌无紫暗' . $join . '瘀斑。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($qualified, '舌无明显紫暗' . $join . '瘀斑。', true);
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roleGrammarCheck($partial, '舌无紫暗' . $join . '瘀斑。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($otherField, '舌无紫暗' . $join . '瘀斑。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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}
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roleGrammarCheck($ledger, '舌无紫。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌无紫暗或瘀斑，舌裂纹。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌无紫暗或瘀斑，脉涩。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '2026-10-22舌无紫暗或瘀斑。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌无紫暗或瘀斑（2026-10-22，' . $ids['tongue'] . '）。', false, 'SOURCE_ANNOTATION_INVALID');
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roleGrammarCheck($ledger, '舌无紫暗或瘀斑（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
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foreach (['红绛', '绛红', '紫暗', '淡红'] as $phenotype) {
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$matching = Guard::build(['tongue' => '舌' . $phenotype . '。']);
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roleGrammarCheck($matching, '舌' . $phenotype . '。', true);
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roleGrammarCheck($matching, '舌无' . $phenotype . '。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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}
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foreach (['，舌', '，且舌', ',舌'] as $boundary) {
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roleGrammarCheck($ledger, '无心悸' . $boundary . '淡红苔少，脉细弱。', true);
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roleGrammarCheck($ledger, '无心悸' . $boundary . '红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '无心悸' . $boundary . '无淡红。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '无固定刺痛' . $boundary . '淡红苔少。', false, 'UNKNOWN_TO_NEGATIVE');
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}
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roleGrammarCheck($ledger, '无明显胸痛，舌淡红苔少。', true);
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roleGrammarCheck($ledger, '无胸痛，舌淡红苔少。', false, 'NEGATION_SCOPE_WIDENED');
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roleGrammarCheck($ledger, '无药物过敏史，舌淡红苔少。', false, 'NEGATION_SCOPE_WIDENED');
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foreach (['舌脉未呈黄腻、滑、紧等所见。', '舌未呈紫暗或瘀斑。', '脉未呈滑、紧等所见。',
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'舌象未呈黄腻苔。', '本次脉象未呈浮。',
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'舌脉未呈黄腻、滑、紧等所见，但不能仅凭这些否定完全排除夹实。'] as $text) {
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roleGrammarCheck($ledger, $text, true);
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}
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roleGrammarCheck($qualified, '舌未呈紫暗或瘀斑。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($qualified, '舌未呈明显紫暗或瘀斑。', true);
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roleGrammarCheck($partial, '舌脉未呈黄腻、滑、紧等所见。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌脉未呈黄腻、滑、涩等所见。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌脉未呈红绛、滑、紧等所见。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌未呈滑。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '脉未呈黄腻。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌脉未呈黄腻、滑、紧等所见，患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($ledger, '舌脉未呈黄腻、滑、紧等所见且患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($ledger, '舌脉未呈黄腻、滑、紧等所见，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌脉未呈黄腻、滑、紧等所见，脉涩。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($ledger, '舌象未记录。', false, 'RECORDED_TO_UNKNOWN');
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roleGrammarCheck($ledger, '未记录紫暗或瘀斑。', false, 'NEGATIVE_TO_UNKNOWN');
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roleGrammarCheck($ledger, '舌未呈紫暗或瘀斑（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
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$parsed = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '每次饮水不多，舌淡红苔少');
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roleGrammarExpect(!in_array('negative', array_column($parsed, 'state'), true), 'Quantity 多 is not an absent clinical topic');
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$features = (new ReflectionMethod(Guard::class, 'features'))->invoke(null, 'tongue', '舌紫暗或瘀斑');
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roleGrammarExpect($features === ['紫暗', '瘀斑'], 'The optional tongue subject cannot consume the start of 紫暗');
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$mixed = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '舌脉未呈黄腻、滑、紧等所见');
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roleGrammarExpect(array_column($mixed, 'topic') === ['舌黄腻', '脉滑、紧']
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&& array_column($mixed, 'state') === ['negative', 'negative'], 'Mixed examinations retain separate typed negative parts');
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// v37: discomfort is a complete symptom lexeme; an outer negative survives.
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$gutPositive = Guard::build(array_replace($record, ['present_illness' => '胃肠不适；口干；无心悸；未记录固定刺痛。']));
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$gutUnknown = Guard::build(array_replace($record, ['present_illness' => '口干；无心悸；未记录胃肠不适或固定刺痛。']));
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$gutNegative = Guard::build(array_replace($record, ['present_illness' => '口干；无胃肠不适；未记录固定刺痛。']));
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$gutQualified = Guard::build(array_replace($record, ['present_illness' => '口干；无明显胃肠不适。']));
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roleGrammarCheck($gutPositive, '胃肠不适，口干。', true);
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roleGrammarCheck($gutPositive, '用后监测胃肠不适、汗出、口干及气短。', true);
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foreach (['无胃肠不适。', '患者无胃肠不适。', '未见胃肠不适。'] as $negative) {
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roleGrammarCheck($gutPositive, $negative, false, 'POSITIVE_TO_NEGATIVE');
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roleGrammarCheck($gutUnknown, $negative, false, 'UNKNOWN_TO_NEGATIVE');
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roleGrammarCheck($gutNegative, $negative, true);
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}
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roleGrammarCheck($gutUnknown, '患者有胃肠不适。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($gutUnknown, '胃肠不适每日1次。', false, 'UNKNOWN_TO_POSITIVE');
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roleGrammarCheck($gutUnknown, '胃肠不适未记录。', true);
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roleGrammarCheck($gutPositive, '胃肠不适未记录。', false, 'POSITIVE_TO_UNKNOWN');
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roleGrammarCheck($gutNegative, '胃肠不适未记录。', false, 'NEGATIVE_TO_UNKNOWN');
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roleGrammarCheck($gutNegative, '患者有胃肠不适。', false, 'NEGATIVE_TO_POSITIVE');
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roleGrammarCheck($gutQualified, '无胃肠不适。', false, 'NEGATION_SCOPE_WIDENED');
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roleGrammarCheck($gutQualified, '无明显胃肠不适。', true);
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roleGrammarCheck($gutPositive, '胃肠不适，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
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roleGrammarCheck($gutPositive, '胃肠不适，脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
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$gutParts = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '胃肠不适、汗出、口干');
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roleGrammarExpect(array_column($gutParts, 'state') === ['positive'], 'Discomfort cannot negate following positive symptoms');
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$negativeGutParts = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '无胃肠不适');
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roleGrammarExpect(array_column($negativeGutParts, 'state') === ['negative']
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&& array_column($negativeGutParts, 'topic') === ['胃肠不适'], 'An outer absence retains the complete discomfort object');
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|
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$pendingReview = '新方各成分既往耐受、保健品及其他未记录药物仍待核';
|
||
foreach ([$pendingReview, '新药既往耐受、合并用药尚待复核', '药物相互作用、肝肾功能仍需核查',
|
||
'三味药耐受或保健品待核实'] as $review) {
|
||
roleGrammarCheck($ledger, $review . '。', true);
|
||
roleGrammarCheck($ledger, '本次无已知药物过敏史，但' . $review . '。', true);
|
||
}
|
||
foreach (['，', '且', '但', '而', ''] as $join) {
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '患者有心悸。', false, 'NEGATIVE_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '自述固定刺痛属待补依据。', false, 'UNKNOWN_TO_POSITIVE');
|
||
}
|
||
foreach (['，', '且', '但', '而'] as $join) {
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '心悸未记录。', false, 'NEGATIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
roleGrammarCheck($ledger, $pendingReview . $join . '脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
}
|
||
roleGrammarCheck($ledger, '患者无固定刺痛，' . $pendingReview . '。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, '本次无药物过敏史，但' . $pendingReview . '。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, $pendingReview . '（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, $pendingReview . '今晨固定刺痛发作。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $pendingReview . '2026-10-23患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
$safetyQuantity = Guard::build(array_replace($record, ['water_intake' => '饮水量未记录。']));
|
||
roleGrammarCheck($safetyQuantity, $pendingReview . '每次饮水量不多。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyQuantity, $pendingReview . '且每次饮水量不多。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '固定刺痛仍待核。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '固定刺痛耐受、患者无固定刺痛仍待核。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
|
||
// Existing applicability and no-self-changing-medication instructions did not
|
||
// cause the original rejection. They receive no new blanket exemption.
|
||
foreach (['孕育相关不适用于男性', '不擅停换'] as $instruction) {
|
||
roleGrammarCheck($ledger, $instruction . '。', true);
|
||
roleGrammarCheck($ledger, $instruction . '，患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, $instruction . '且患者有心悸。', false, 'NEGATIVE_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $instruction . '，口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $instruction . '，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
}
|
||
$applicabilityParts = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '孕育相关不适用于男性');
|
||
roleGrammarExpect(in_array('negative', array_column($applicabilityParts, 'state'), true),
|
||
'The discomfort lexeme rule does not reinterpret the applicability predicate');
|
||
foreach (['不适用', '不适于', '不适合', '不适应', '不适宜', '不适当'] as $predicate) {
|
||
$predicateParts = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '该药物' . $predicate . '此情形');
|
||
roleGrammarExpect(in_array('negative', array_column($predicateParts, 'state'), true),
|
||
'A complete applicability/suitability predicate is not the discomfort lexeme: ' . $predicate);
|
||
}
|
||
|
||
// Portable complete safety units, rebuilt against the actual production
|
||
// source projection. A lexical pass does not certify the safety advice.
|
||
$safetySnapshot = (new ReflectionMethod(PatientAiReportLogic::class, 'buildSourceSnapshotFromRows'))->invoke(null, CompleteTcmCase::rows());
|
||
$safetySubmission = (new ReflectionMethod(PatientAiReportLogic::class, 'sanitizeSnapshotForUpstream'))->invoke(null, AiRequiredSource::submission($safetySnapshot));
|
||
$safetyLedger = Guard::build(CompleteTcmCase::current(), $safetySubmission);
|
||
$safetyUnits = [
|
||
'禁忌与用药复核：本次询问为“无已知药物过敏史”（s5），但新方各成分既往耐受、保健品及其他未记录药物仍待核。'
|
||
. '现有ALT 22U/L、肌酐78μmol/L、eGFR 96mL/min/1.73m²、尿ACR 12mg/g，可作启用前基线，不能替代后续监测。'
|
||
. '孕育相关不适用于男性，但胃肠耐受、肝肾变化及过敏反应仍需核查。',
|
||
'禁忌待核：虽本次询问“无已知药物过敏史”（s5），仍须核实三味药既往耐受、其他药物及保健品；用后监测皮疹、胃肠不适、汗出、口干、气短及肝肾功能。'
|
||
. '现用二甲双胍0.5g每日2次，维持既有医嘱，不擅停换；联用期间继续监测空腹、餐后血糖及低血糖相关症状。'
|
||
. '2020-05-02藿香正气散系胃肠不适旧方，早已停用，不续用。',
|
||
];
|
||
foreach ($safetyUnits as $safetyUnit) roleGrammarCheck($safetyLedger, $safetyUnit, true);
|
||
|
||
// v38: absence of a symptom record, classified unknown, remains a data gap.
|
||
foreach (['无', '没有', '未见'] as $missing) foreach (['记录', '资料'] as $recordNoun) foreach (['属', '为'] as $copula) {
|
||
$tail = $recordNoun . $copula . '未知。';
|
||
roleGrammarCheck($ledger, $missing . '固定刺痛' . $tail, true);
|
||
roleGrammarCheck($ledger, $missing . '口干' . $tail, false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $missing . '心悸' . $tail, false, 'NEGATIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $missing . '舌象' . $tail, false, 'RECORDED_TO_UNKNOWN');
|
||
}
|
||
roleGrammarCheck($ledger, '无固定刺痛的记录属于不详。', true);
|
||
roleGrammarCheck($ledger, '无口干信息属未知。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, '无心悸描述属未知。', false, 'NEGATIVE_TO_UNKNOWN');
|
||
foreach (['，', '且'] as $join) {
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知' . $join . '患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知' . $join . '患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知' . $join . '口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知' . $join . '舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
}
|
||
roleGrammarCheck($ledger, '患者有固定刺痛，无固定刺痛记录属未知。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '自述固定刺痛属待补依据，无固定刺痛记录属未知。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知，患者无药物过敏史。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, '无固定刺痛记录属未知（2026-10-22，' . $ids['present_illness'] . '）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
$missingRecordSource = Guard::build(['present_illness' => '无固定刺痛记录属未知。']);
|
||
roleGrammarCheck($missingRecordSource, '无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($missingRecordSource, '患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
$missingRecordParts = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, '无固定刺痛记录属未知');
|
||
roleGrammarExpect(array_column($missingRecordParts, 'state') === ['unknown']
|
||
&& array_column($missingRecordParts, 'topic') === ['固定刺痛'], 'Copular missing-record state retains its exact unknown subject');
|
||
|
||
// Explicit formula method/aim fragments are conceptual. The heading alone
|
||
// grants no exemption to observed findings or subsequent unrelated prose.
|
||
$functionAim = '方义上以养津改善口干舌燥';
|
||
foreach ([$functionAim . '。', '方义上以生津缓解口干舌燥。', '方义层面以养津改善口干舌燥。',
|
||
'方义：以补气恢复推动固摄，以养津改善口干舌燥，并以收敛配合控制自汗。'] as $functionText) {
|
||
roleGrammarCheck($ledger, $functionText, true);
|
||
}
|
||
foreach (['患者舌燥。', '以养津改善口干舌燥。', '方义上患者舌燥。', '方义上以养津改善患者舌燥。',
|
||
'方义上以舌燥改善口干。', '方义上舌燥，以养津改善口干。',
|
||
'患者舌燥，' . $functionAim . '。', $functionAim . '，舌燥。',
|
||
$functionAim . '，舌红绛。', '舌红绛，' . $functionAim . '。',
|
||
$functionAim . '，患者口干，以养津改善口干舌燥。'] as $actualExam) {
|
||
roleGrammarCheck($ledger, $actualExam, false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
}
|
||
foreach (['，', '且', '但', '而', ''] as $join) {
|
||
roleGrammarCheck($ledger, $functionAim . $join . '患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $functionAim . $join . '患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, $functionAim . $join . '自述固定刺痛属待补依据。', false, 'UNKNOWN_TO_POSITIVE');
|
||
}
|
||
foreach (['，', '且', '但', '而'] as $join) {
|
||
roleGrammarCheck($ledger, $functionAim . $join . '口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $functionAim . $join . '心悸未记录。', false, 'NEGATIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $functionAim . $join . '脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
}
|
||
roleGrammarCheck($ledger, $functionAim . '，患者无药物过敏史。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, $functionAim . '，舌无紫暗或瘀斑。', true);
|
||
roleGrammarCheck($ledger, $functionAim . '，舌无紫暗或瘀斑（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, $functionAim . '（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, $functionAim . '今晨固定刺痛发作。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyQuantity, $functionAim . '且每次饮水量不多。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '方义上以养津改善自述固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '方义上以养津改善患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
|
||
$recordAndFunctionUnits = [
|
||
'血：面色少华及脉细可作血不足鉴别，但缺少明确头晕、唇甲色淡等资料，尚不能独立定为血虚；无固定刺痛记录属未知（s2），不能据此排除血瘀。',
|
||
'本例支持证据：神疲、语声低微、动则气短、自汗且活动后加重，脉细弱、按之无力，支持益气；口干欲饮而少量频饮、大便稍干、舌面少津及苔少，支持生津。'
|
||
. '方义上以补气恢复推动固摄，以养津改善口干舌燥，并以收敛配合控制自汗；是否采用仍须结合面诊确认汗出性质及津亏程度。',
|
||
];
|
||
foreach ($recordAndFunctionUnits as $recordAndFunctionUnit) roleGrammarCheck($safetyLedger, $recordAndFunctionUnit, true);
|
||
|
||
// v39: an observation joined without a comma is never a formula aim object.
|
||
$shortFunctionAim = '方义上以养津改善口干';
|
||
$joinedObservations = [
|
||
['并诉称固定刺痛', 'UNKNOWN_TO_POSITIVE'],
|
||
['并诊见舌红绛', 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['同时脉滑', 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['还诉称固定刺痛', 'UNKNOWN_TO_POSITIVE'],
|
||
['又查见舌红绛', 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['并且报告固定刺痛', 'UNKNOWN_TO_POSITIVE'],
|
||
['另查见脉滑', 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['诉称固定刺痛', 'UNKNOWN_TO_POSITIVE'],
|
||
['诊见舌红绛', 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['舌质呈红绛', 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['脉呈滑', 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
];
|
||
foreach ($joinedObservations as [$observation, $code]) {
|
||
roleGrammarCheck($safetyLedger, $shortFunctionAim . $observation . '。', false, $code);
|
||
roleGrammarCheck($safetyLedger, $shortFunctionAim . '，' . $observation . '。', false, $code);
|
||
roleGrammarCheck($safetyLedger, $observation . '，' . $shortFunctionAim . '。', false, $code);
|
||
}
|
||
roleGrammarCheck($ledger, $functionAim . '并口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $functionAim . '同时心悸未记录。', false, 'NEGATIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $functionAim . '还舌象未记录。', false, 'RECORDED_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $functionAim . '又患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, $functionAim . '另无胸痛。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, $functionAim . '并患者无药物过敏史。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, $functionAim . '并自述固定刺痛属待补依据。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $functionAim . '还诊见舌红绛属待补依据。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
roleGrammarCheck($safetyQuantity, $functionAim . '同时每次饮水量不多。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $functionAim . '并舌无紫暗或瘀斑。', true);
|
||
roleGrammarCheck($ledger, $functionAim . '并舌无紫暗或瘀斑（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, $functionAim . '。', true);
|
||
roleGrammarCheck($ledger, '方义上以养津改善口干及舌燥。', true);
|
||
roleGrammarCheck($ledger, '方义上以补气恢复推动固摄，并以养津改善口干舌燥，亦以收敛配合控制自汗。', true);
|
||
|
||
// A diagnostic evidence threshold is UNKNOWN, never a blanket heat/cold denial.
|
||
foreach (['本次没有', '当前无'] as $absence) foreach (['确定', '确认'] as $relation)
|
||
foreach (['热象', '寒象'] as $evidenceHead) {
|
||
$thresholdPrefix = $absence . '足以独立' . $relation;
|
||
$thresholdSuffix = '的阳性' . $evidenceHead . '。';
|
||
roleGrammarCheck($ledger, $thresholdPrefix . '热证' . $thresholdSuffix, true);
|
||
roleGrammarCheck($ledger, $thresholdPrefix . '口干' . $thresholdSuffix, false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $thresholdPrefix . '心悸' . $thresholdSuffix, false, 'NEGATIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $thresholdPrefix . '舌象' . $thresholdSuffix, false, 'RECORDED_TO_UNKNOWN');
|
||
}
|
||
$thresholdPhrase = '本次没有足以独立确定热证的阳性热象';
|
||
$thresholdParts = (new ReflectionMethod(Guard::class, 'parts'))->invoke(null, $thresholdPhrase);
|
||
roleGrammarExpect(array_column($thresholdParts, 'state') === ['unknown']
|
||
&& array_column($thresholdParts, 'topic') === ['热证'], 'An explicit independent threshold retains its unknown diagnostic subject');
|
||
foreach (['本次没有足以确定热证的阳性热象。', '本次没有阳性热象。', '本次无独立寒象。',
|
||
'本次亦无独立阳性寒象。', '本次无寒象。'] as $bareSignDenial) {
|
||
roleGrammarCheck($ledger, $bareSignDenial, false, 'NEGATIVE_NOT_IN_SOURCE');
|
||
}
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '，患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '，患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '，口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '，脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '，患者无药物过敏史。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, $thresholdPhrase . '（2026-10-22，' . $ids['present_illness'] . '）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
$knownHeat = Guard::build(array_replace($record, ['clinical_diagnosis' => '本次已确认热证。']));
|
||
roleGrammarCheck($knownHeat, $thresholdPhrase . '。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, '本次没有足以独立确定患者有固定刺痛的阳性热象。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '本次没有足以独立确定热证并诉称固定刺痛的阳性热象。', false);
|
||
|
||
// The optional Qwen grammar repair ends a negative at an explicit gradual
|
||
// postfix occurrence, while the preceding qualifier and new symptom still count.
|
||
$gradualOccurrenceUnit = '表里：病位在里。依据：无恶寒发热、无明显急性感染诱因，症状逐渐出现，非外感表证。限制依据：s2。';
|
||
roleGrammarCheck($safetyLedger, $gradualOccurrenceUnit, true);
|
||
roleGrammarCheck($safetyLedger, str_replace('无明显急性感染诱因', '无急性感染诱因', $gradualOccurrenceUnit), false, 'NEGATION_SCOPE_WIDENED');
|
||
foreach (['逐渐', '渐次', '陆续'] as $gradual) {
|
||
roleGrammarCheck($ledger, '无心悸，固定刺痛' . $gradual . '出现。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($ledger, '无心悸，口干' . $gradual . '出现。', true);
|
||
roleGrammarCheck($ledger, '无心悸，口干' . $gradual . '出现，舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
roleGrammarCheck($ledger, '无胸痛，口干' . $gradual . '出现。', false, 'NEGATION_SCOPE_WIDENED');
|
||
}
|
||
roleGrammarCheck($safetyLedger, '患者无急性感染诱因。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, '无心悸，胸痛，口干逐渐出现。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($ledger, '无心悸，固定刺痛，口干逐渐出现。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($safetyLedger, '日常记录显示活动后乏力、汗出较明显，无胸痛或晕厥。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($safetyLedger, '2026-10-22活动记录见“活动后乏力、汗出较明显，无胸痛或晕厥”。', true);
|
||
|
||
// v40: a complete evidence-limited exclusion and a locally linked review
|
||
// question must not borrow polarity from an earlier observed statement.
|
||
$syndromeExclusion = '仍不能仅凭证候排除心肺、感染或代谢因素';
|
||
$modalReviewHead = '适用前须确认仍以气虚、自汗、津少为主';
|
||
$linkedReviewQuestion = '并复核气短、自汗有无心肺、感染或代谢原因';
|
||
$linkedReview = $modalReviewHead . '，' . $linkedReviewQuestion;
|
||
roleGrammarCheck($safetyLedger, '自汗及气短虽有虚象，' . $syndromeExclusion . '。', true);
|
||
roleGrammarCheck($safetyLedger, $linkedReview . '。', true);
|
||
roleGrammarCheck($safetyLedger, str_replace('有无', '是否', $linkedReview) . '。', true);
|
||
roleGrammarCheck($safetyLedger, '适用前需核实气短、自汗为主，复核气短有无感染原因。', true);
|
||
roleGrammarCheck($safetyLedger, '适用前应再次确认气虚、自汗为主，再核查气短是否感染原因。', true);
|
||
foreach (['仍不能仅凭证候排除感染。', '仍不得只据证候完全排除感染。',
|
||
'不能仅凭本次资料排除感染。', '不能仅凭当前阴性记录排除感染。'] as $limit) {
|
||
roleGrammarCheck($safetyLedger, $limit, true);
|
||
}
|
||
$reviewAdjacentAssertions = [
|
||
['患者有固定刺痛', 'UNKNOWN_TO_POSITIVE'],
|
||
['患者无固定刺痛', 'UNKNOWN_TO_NEGATIVE'],
|
||
['口干未记录', 'POSITIVE_TO_UNKNOWN'],
|
||
['舌象未记录', 'RECORDED_TO_UNKNOWN'],
|
||
['舌红绛', 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['脉滑', 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
];
|
||
foreach ([$syndromeExclusion, $linkedReview] as $reviewRole) {
|
||
foreach ($reviewAdjacentAssertions as [$assertion, $code]) {
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '，' . $assertion . '。', false, $code);
|
||
roleGrammarCheck($safetyLedger, $assertion . '，' . $reviewRole . '。', false, $code);
|
||
}
|
||
foreach (['并诉称固定刺痛', '还诉称固定刺痛'] as $tail) {
|
||
roleGrammarCheck($safetyLedger, $reviewRole . $tail . '。', false, 'UNKNOWN_TO_POSITIVE');
|
||
}
|
||
foreach (['并诊见舌红绛', '又查见舌红绛'] as $tail) {
|
||
roleGrammarCheck($safetyLedger, $reviewRole . $tail . '。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
}
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '同时脉滑。', false, 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
foreach (['且', '但', '而', '并', '同时', '还', '又', '另', ''] as $join) {
|
||
roleGrammarCheck($safetyLedger, $reviewRole . $join . '患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
}
|
||
foreach (['且', '并', '同时', '还', '又', '另'] as $join) {
|
||
roleGrammarCheck($safetyLedger, $reviewRole . $join . '口干未记录。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . $join . '心悸未记录。', false, 'NEGATIVE_TO_UNKNOWN');
|
||
}
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '今晨固定刺痛发作。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyQuantity, $reviewRole . '每次饮水量不多。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '2026-10-23患者无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '，患者有感染。', false, 'NEGATIVE_TO_POSITIVE');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '，患者无急性感染诱因。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '，患者无药物过敏史。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($safetyLedger, $reviewRole . '（2026-10-22，s2）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
}
|
||
roleGrammarCheck($safetyLedger, $linkedReviewQuestion . '。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($safetyLedger, '有无感染。', false, 'NEGATION_SCOPE_WIDENED');
|
||
roleGrammarCheck($safetyLedger, $modalReviewHead . '，复核无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($safetyLedger, '适用前须确认患者有固定刺痛，' . $linkedReviewQuestion . '。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyLedger, $modalReviewHead . '，并复核患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyLedger, $modalReviewHead . '，并复核气短有无患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyLedger, $modalReviewHead . '，并复核气短有无感染患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
roleGrammarCheck($safetyLedger, $modalReviewHead . '，并复核气短有无感染诊见舌红绛。', false, 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE');
|
||
$multipleQuestionProse = (new ReflectionMethod(Guard::class, 'linkedReviewRequestProse'))->invoke(null,
|
||
$modalReviewHead . '，并复核气短有无感染有无心肺原因');
|
||
roleGrammarExpect(preg_match_all('/有无/u', $multipleQuestionProse) === 2,
|
||
'A multiple-interrogative fragment receives no linked-question normalization');
|
||
roleGrammarCheck($safetyLedger, $modalReviewHead . '，并复核气短有无无固定刺痛。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
roleGrammarCheck($safetyLedger, '仍不能仅凭患者无固定刺痛排除感染。', false, 'UNKNOWN_TO_NEGATIVE');
|
||
$reviewQuestionProse = (new ReflectionMethod(Guard::class, 'reportProse'))->invoke(null, $linkedReview);
|
||
roleGrammarExpect(!str_contains($reviewQuestionProse, '有无') && !str_contains($reviewQuestionProse, '感染'),
|
||
'A linked question is recognized while its typed modal context still exists');
|
||
$exclusionProse = (new ReflectionMethod(Guard::class, 'reportProse'))->invoke(null, '自汗及气短虽有虚象，' . $syndromeExclusion);
|
||
roleGrammarExpect(str_contains($exclusionProse, '有虚象') && !str_contains($exclusionProse, '感染'),
|
||
'The observed prefix remains visible while only the bounded exclusion fragment is normalized');
|
||
$reviewAndExclusionUnits = [
|
||
'反证与局限：寒热均未定，且限制依据：（s2）；因此不能把本方向解释为治疗阴虚火旺，也不能加入温阳或清热立法。'
|
||
. '便稍干、小便略多还可能受饮水、血糖等影响；自汗及气短虽有虚象，仍不能仅凭证候排除心肺、感染或代谢因素。'
|
||
. '若出现明显胸痛、心悸、喘促、浮肿、意识改变或急性高热，应先行现代医学评估，而非继续按原方向处理。',
|
||
'反证与局限：寒热未定，限制依据：（s2）；本方向不能解释为治疗阴虚火旺，亦不据此采用温阳或清热法。'
|
||
. '适用前须确认仍以气虚、自汗、津少为主，并复核气短、自汗有无心肺、感染或代谢原因；症状性质改变时应重新辨证。',
|
||
];
|
||
foreach ($reviewAndExclusionUnits as $reviewAndExclusionUnit) roleGrammarCheck($safetyLedger, $reviewAndExclusionUnit, true);
|
||
|
||
// Actual terminal v41 C2 rejections: an explicit unknown-state noun and the
|
||
// colon immediately before a valid source citation must not become a positive
|
||
// symptom. Neither closed role may erase a known finding or borrow an adjacent
|
||
// assertion, and the stream must preserve the original unmodified units.
|
||
$unknownStateUnits = [
|
||
'血：面色少华、脉细可作血少鉴别，但无血常规、头晕、唇甲色泽等证据，现有资料不足以确定血虚。'
|
||
. '固定刺痛为未记录状态（s2），不能据此排除血瘀。',
|
||
'血：面色少华、脉细仅提示血少鉴别；血常规、头晕、唇甲色泽未记录，现有资料不足以确定血虚。'
|
||
. '固定刺痛属待补依据：（s2），不能判断血瘀与否。',
|
||
];
|
||
foreach ($unknownStateUnits as $unit) roleGrammarCheck($safetyLedger, $unit, true);
|
||
foreach (['为未记录状态', '属待补依据：', '属于未记录状态:'] as $role) {
|
||
roleGrammarCheck($ledger, '固定刺痛' . $role . '。', true);
|
||
roleGrammarCheck($ledger, '固定刺痛' . $role . '（' . $ids['present_illness'] . '）。', true);
|
||
roleGrammarCheck($ledger, '口干' . $role . '。', false, 'POSITIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, '心悸' . $role . '。', false, 'NEGATIVE_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, '舌象' . $role . '。', false, 'RECORDED_TO_UNKNOWN');
|
||
roleGrammarCheck($ledger, '脉象' . $role . '。', false, 'RECORDED_TO_UNKNOWN');
|
||
foreach (['自述固定刺痛', '主诉固定刺痛', '今晨固定刺痛发作', '患者有固定刺痛'] as $assertion) {
|
||
roleGrammarCheck($ledger, $assertion . $role . '。', false, 'UNKNOWN_TO_POSITIVE');
|
||
}
|
||
foreach ([
|
||
['患者有固定刺痛', 'UNKNOWN_TO_POSITIVE'],
|
||
['患者无固定刺痛', 'UNKNOWN_TO_NEGATIVE'],
|
||
['口干未记录', 'POSITIVE_TO_UNKNOWN'],
|
||
['舌象未记录', 'RECORDED_TO_UNKNOWN'],
|
||
['舌红绛', 'TONGUE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
['脉滑', 'PULSE_FEATURE_NOT_IN_CURRENT_SOURCE'],
|
||
] as [$assertion, $code]) {
|
||
roleGrammarCheck($ledger, '固定刺痛' . $role . '，' . $assertion . '。', false, $code);
|
||
roleGrammarCheck($ledger, $assertion . '，固定刺痛' . $role . '。', false, $code);
|
||
}
|
||
foreach (['且', '并', '同时', '还', '又', '另', ''] as $join) {
|
||
roleGrammarCheck($ledger, '固定刺痛' . $role . $join . '患者有固定刺痛。', false, 'UNKNOWN_TO_POSITIVE');
|
||
}
|
||
roleGrammarCheck($ledger, '固定刺痛' . $role . '（s999）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
roleGrammarCheck($ledger, '固定刺痛' . $role . '（2026-10-22，' . $ids['present_illness'] . '）。', false, 'SOURCE_ANNOTATION_INVALID');
|
||
}
|
||
|
||
// Each complete unit preserves byte identity, including split UTF-8 and CRLF.
|
||
$units = [
|
||
'固定刺痛属待补依据（' . $ids['present_illness'] . '），且舌无紫暗或瘀斑（' . $ids['tongue'] . '）。',
|
||
'肾系定位因腰酸耳鸣未记录而待定。每次饮水不多，舌淡红苔少。',
|
||
'舌脉未呈黄腻、滑、紧等所见（' . $ids['tongue'] . '、' . $ids['pulse'] . '）。',
|
||
];
|
||
$wire = implode("\r\n\r\n", $units) . "\r\n\r\n";
|
||
foreach ([1, 2, 7, 31] as $size) {
|
||
$visible = '';
|
||
$stream = new TcmClinicalReportStream($ledger, static function (string $delta) use (&$visible): bool { $visible .= $delta; return true; });
|
||
$pushed = true;
|
||
foreach (str_split($wire, $size) as $chunk) if (!$stream->push($chunk)) { $pushed = false; break; }
|
||
roleGrammarExpect($pushed && $stream->finish() && !$stream->rejected(), 'Complete role units survive byte chunk size ' . $size);
|
||
roleGrammarExpect($visible === $wire, 'Complete accepted role units preserve every byte at chunk size ' . $size);
|
||
}
|
||
|
||
echo 'Clinical fact state bounded role grammar: ' . $checks . " assertions passed (offline, original streaming bytes).\n";
|