388 lines
20 KiB
PHP
388 lines
20 KiB
PHP
<?php
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namespace app\api\logic\tcm;
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/**
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* 霍大夫升糖指数（GI）知识库
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*/
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class GiKnowledge
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{
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public const LEVEL_LOW = 'low';
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public const LEVEL_MEDIUM = 'medium';
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public const LEVEL_HIGH = 'high';
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/** @var array<string, array<string, list<string>>> */
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private static array $foods = [
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self::LEVEL_LOW => [
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'五谷类' => ['全蛋面', '荞麦面', '粉丝', '黑米', '黑米粥', '通心粉', '藕粉'],
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'蔬菜类' => ['魔芋', '粟米', '大白菜', '黄瓜', '芹菜', '茄子', '青椒', '海带', '金针菇', '香菇', '菠菜', '番茄', '豆芽', '芦笋', '花椰菜', '洋葱', '生菜'],
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'豆类' => ['黄豆', '眉豆', '鸡心豆', '豆腐', '豆角', '绿豆', '扁豆', '四季豆'],
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'水果类' => ['苹果', '水梨', '橙子', '桃', '提子', '沙田柚', '雪梨', '车厘子', '柚子', '草莓', '樱桃', '金桔', '葡萄'],
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'奶类' => ['牛奶', '低脂奶', '脱脂奶', '驼奶粉', '驼奶', '低脂乳酪', '红茶', '优格', '无糖豆浆'],
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],
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self::LEVEL_MEDIUM => [
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'主食类' => ['红米饭', '糙米饭', '西米', '乌冬面', '面包', '麦片', '番薯', '芋头'],
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'蔬菜类' => ['薯片', '番茄', '莲藕', '牛蒡'],
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'肉类' => ['鱼肉', '鸡肉', '鸭肉', '猪肉', '羊肉', '牛肉', '虾子', '蟹'],
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'水果类' => ['木瓜', '提子干', '菠萝', '香蕉', '芒果', '哈密瓜', '奇异果', '柳丁'],
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'其他' => ['蔗糖', '蜂蜜', '红酒', '啤酒', '可乐', '咖啡'],
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],
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self::LEVEL_HIGH => [
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'主食类' => ['白饭', '馒头', '油条', '糯米饭', '白面包', '燕麦片', '拉面', '炒饭', '爆米花'],
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'肉类加工品' => ['贡丸', '肥肠', '蛋饺'],
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'蔬菜类' => ['薯蓉', '南瓜', '焗薯'],
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'水果类' => ['西瓜', '荔枝', '龙眼', '凤梨', '枣'],
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'其他' => ['葡萄糖', '砂糖', '麦芽糖', '汽水', '柳橙汁', '蜂蜜'],
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],
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];
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/** @var list<array{breakfast:string,drinks:string,lunch:string,dinner:string,tips:string}> */
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private static array $mealTemplates = [
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[
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'breakfast' => '驼奶粉（温水冲服）、玉米碴子粥、煮鸡蛋、拌黄瓜',
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'drinks' => '白天多喝温开水；早餐冲驼奶粉，别喝甜饮料、果汁。',
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'lunch' => '清炖鲤鱼、豆腐炖白菜、清炒豆角、米饭小半碗',
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'dinner' => '玉米面饼一个、瘦肉丝、凉拌茄子',
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'tips' => '中午鱼豆肉吃足；早中晚淀粉别重复，一顿一种主食就够。',
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],
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[
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'breakfast' => '驼奶粉（温水冲服）、小米粥、煮鸡蛋、小碟咸菜（少盐）',
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'drinks' => '温开水为主；驼奶粉跟早餐一起吃，下午也记得喝水。',
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'lunch' => '去皮炖鸡肉、芹菜炒豆干、木耳炒鸡蛋',
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'dinner' => '蒸红薯（小半块）、清炒菠菜、豆腐汤',
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'tips' => '午餐最讲究蛋白；晚上才吃薯，别跟中午再配大米饭。',
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],
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[
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'breakfast' => '驼奶粉（温水冲服）、豆腐脑（少卤）、煮鸡蛋',
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'drinks' => '早餐饮驼奶粉；白天喝白开水，别碰含糖饮料。',
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'lunch' => '清炖鸡肉、炖芸豆、番茄炒蛋、贴饼子一个',
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'dinner' => '挂面一小碗、清蒸小鱼、拌海带丝',
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'tips' => '中午饼配肉豆，蛋白管够；面条放晚上，别三顿都是粥饭。',
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],
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[
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'breakfast' => '驼奶粉（温水冲服）、高粱米粥、茶叶蛋、拌萝卜丝',
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'drinks' => '温开水；早餐驼奶粉按说明冲，别加糖。',
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'lunch' => '炖牛肉（瘦）、豆腐炒韭菜、清炒油菜、杂豆饭小半碗',
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'dinner' => '蒸南瓜（小半碗）、鸡蛋羹、拍黄瓜',
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'tips' => '中午肉蛋豆要多吃；南瓜算晚饭主食，别再加馒头稀饭。',
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],
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[
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'breakfast' => '驼奶粉（温水冲服）、棒子面粥、水煮蛋、大拌菜（少油）',
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'drinks' => '多喝温开水；驼奶粉放早餐，忌可乐汽水果汁。',
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'lunch' => '清炖鲫鱼、番茄炒蛋、炖扁豆、糙米饭小半碗',
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'dinner' => '玉米面饼一个、清炒豆芽、豆腐脑',
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'tips' => '午饭鱼蛋豆齐上；玉米面放晚上，跟中午米饭分开。',
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],
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[
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'breakfast' => '驼奶粉（温水冲服）、小米粥、煮鸡蛋、拌生菜',
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'drinks' => '白天小口多次喝温水；早餐冲好驼奶粉再吃饭。',
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'lunch' => '白切鸡（去皮）、炖豆腐、清炒豆角、二米饭小半碗',
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'dinner' => '杂面馒头一个、瘦肉炒芹菜、凉拌黄瓜',
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'tips' => '中午蛋白打主力；三顿别都喝粥吃面，一顿一种淀粉。',
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],
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];
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public static function summaryText(): string
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{
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$path = root_path() . 'app/api/logic/tcm/data/gi_huo_summary.txt';
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if (is_file($path)) {
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$text = trim((string) file_get_contents($path));
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if ($text !== '') {
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return $text;
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}
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}
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return '低 GI（≤55）优先；中 GI（56-69）适量；高 GI（≥70）尽量避免。多选全谷物、蔬菜、豆类，少加工、少精制糖。';
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}
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/** 农村/口语别名 → 标准名（便于「能不能吃」匹配） */
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private static array $aliases = [
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'棒子面' => '荞麦面', '玉米碴' => '粟米', '地瓜' => '番薯', '红薯' => '番薯',
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'洋芋' => '芋头', '土豆' => '芋头', '窝头' => '通心粉', '贴饼子' => '通心粉',
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'二米饭' => '红米饭', '稀饭' => '白饭', '白稀饭' => '白饭', '糖糕' => '麦芽糖',
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'驼奶' => '驼奶粉',
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];
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/**
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* @return array{level:string,level_label:string,category:string,advice:string}|null
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*/
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public static function lookupFood(string $name): ?array
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{
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$name = trim($name);
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if ($name === '') {
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return null;
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}
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$canonical = self::$aliases[$name] ?? $name;
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foreach ([self::LEVEL_LOW, self::LEVEL_MEDIUM, self::LEVEL_HIGH] as $level) {
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foreach (self::$foods[$level] as $category => $items) {
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foreach ($items as $item) {
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if ($canonical === $item || $name === $item
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|| mb_strpos($item, $canonical) !== false || mb_strpos($canonical, $item) !== false
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|| mb_strpos($item, $name) !== false || mb_strpos($name, $item) !== false) {
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return [
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'level' => $level,
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'level_label' => self::levelLabel($level),
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'category' => $category,
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'food' => $item,
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'advice' => self::adviceForLevel($level, $name),
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];
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}
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}
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}
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}
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return null;
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}
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/** 供 AI 参考：老农民家常、集市易得食材示例 */
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public static function ruralMealHints(): string
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{
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return implode("\n", [
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'【早餐】须安排驼奶粉温水冲服（低 GI 奶类，稳血糖），可与粥、蛋、菜同餐。',
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'【喝的】单独说明：温开水为主；早餐驼奶粉；严禁含糖饮料、果汁、酒。',
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'【午餐】蛋白质要最高：至少 2 样高蛋白（鱼/鸡鸭/瘦肉/蛋/豆腐/豆干），肉蛋豆是午饭主角。',
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'【淀粉不重复】粥/饭/面/饼/窝头/红薯/土豆/玉米/南瓜等算淀粉；早中晚各最多 1 种，且三顿不能同一种、不要顿顿大主食。',
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'推荐蛋白：鸡蛋、豆腐、豆干、自家鸡鸭蛋、瘦肉、鲫鱼鲤鱼；',
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'推荐蔬菜：白菜、萝卜、黄瓜、豆角、茄子、菠菜、芹菜；',
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'淀粉示例（全天选 3 种不同的）：玉米碴粥、二米饭小半碗、贴饼子、杂面窝头、挂面小碗、蒸红薯；',
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'少吃：白馒头、油条、粘豆包、糯米饭、西瓜、含糖饮料、糕点。',
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'说话要土话、短句，像村里大夫叮嘱。',
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]);
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}
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public static function levelLabel(string $level): string
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{
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return match ($level) {
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self::LEVEL_LOW => '低升糖',
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self::LEVEL_MEDIUM => '中升糖',
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default => '高升糖',
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};
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}
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public static function adviceForLevel(string $level, string $food): string
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{
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return match ($level) {
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self::LEVEL_LOW => "「{$food}」升糖慢，老农民家常能吃，当菜当饭都行，有助于稳血糖。",
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self::LEVEL_MEDIUM => "「{$food}」升糖中等，可以吃但要少搁点，别当主食猛吃，配着蔬菜鸡蛋更好。",
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default => "「{$food}」升糖快，血糖高时尽量别吃或少吃，尤其别空腹猛吃。",
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};
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}
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/**
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* @param int|null $templateIndex 指定模板下标（换一换时轮换）
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* @return array{breakfast:string,lunch:string,dinner:string,tips:string,avoid:list<string>,source:string}
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*/
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public static function fallbackDailyMeals(int $diagnosisId, ?int $templateIndex = null): array
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{
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$templates = self::$mealTemplates;
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$count = count($templates);
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if ($templateIndex !== null) {
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$idx = (($templateIndex % $count) + $count) % $count;
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} else {
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$idx = abs(crc32(date('Y-m-d') . ':' . $diagnosisId)) % $count;
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}
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$meal = $templates[$idx];
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$plan = [
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'breakfast' => $meal['breakfast'],
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'drinks' => $meal['drinks'] ?? '白天多喝温开水；早餐冲驼奶粉，别喝甜饮。',
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'lunch' => $meal['lunch'],
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'dinner' => $meal['dinner'],
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'tips' => $meal['tips'],
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'avoid' => ['白面馒头', '油条', '粘豆包', '西瓜', '含糖饮料', '稀饭配糖'],
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'source' => 'rule',
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];
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$checked = DietMealValidator::validateAndNormalize($plan);
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$out = $checked['plan'];
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$out['source'] = 'rule';
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$out['rules_summary'] = DietMealValidator::metaSummary($checked['meta']);
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return $out;
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}
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/**
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* 根据血糖统计给出「运动降糖」建议（规则化，按控制好坏调整强度）
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*
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* @param array<string,mixed> $stats7 近7天统计
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* @param array<string,mixed> $stats30 近30天统计
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* @return array{level:string,level_label:string,headline:string,items:list<string>,intensity:string,note:string}
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*/
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public static function exercisePlan(array $stats7 = [], array $stats30 = []): array
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{
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// 优先用记录更全的口径判断；都没记录则用近7天
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$primary = ((int) ($stats30['record_days'] ?? 0) > 0) ? $stats30 : $stats7;
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$recordDays = (int) ($primary['record_days'] ?? 0);
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$compliance = (int) ($primary['compliance'] ?? 0);
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$highDays = (int) ($primary['high_days'] ?? 0);
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if ($recordDays <= 0) {
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$level = 'unknown';
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} elseif ($compliance < 50 || $highDays * 2 >= $recordDays) {
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$level = 'high'; // 偏高多、达标率低 = 控制不佳
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} elseif ($compliance < 80) {
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$level = 'medium';
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} else {
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$level = 'good';
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}
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$note = '餐后 1 小时内开始动，别空腹剧烈运动；身上带几块糖，头晕、心慌、出虚汗就马上停下歇着。';
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switch ($level) {
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case 'high':
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return [
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'level' => 'high',
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'level_label' => '血糖偏高 · 多动',
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'headline' => '近期血糖偏高，三顿饭后都动一动，最能帮着把糖降下来。',
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'items' => [
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'早饭后快走 15 分钟，走到微微出汗',
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'午饭后快走或原地踏步 20–30 分钟，降餐后血糖最管用',
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'晚饭后慢走 30 分钟，吃完别马上坐下、躺下',
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],
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'intensity' => '中等强度 · 每天累计约 60 分钟',
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'note' => $note,
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];
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case 'medium':
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return [
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'level' => 'medium',
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'level_label' => '基本平稳 · 再稳稳',
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'headline' => '血糖大体平稳，坚持餐后活动，把它稳住。',
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'items' => [
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'三餐后各散步 20 分钟，午饭后可以走快些',
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'每天加一段八段锦或太极拳，10–15 分钟',
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'能走楼梯少坐电梯，多干点家务、地里活',
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],
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'intensity' => '中低强度 · 每天累计 40–50 分钟',
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'note' => $note,
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];
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case 'good':
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return [
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'level' => 'good',
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'level_label' => '控制不错 · 保持',
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'headline' => '血糖控制得不错，保持规律活动就行。',
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'items' => [
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'餐后散步 15–20 分钟，雷打不动',
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'每天一段八段锦、太极或柔和拉伸',
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'天好多到院里、地里走动，别久坐',
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],
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'intensity' => '中低强度 · 每天累计 30–40 分钟',
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'note' => $note,
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];
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default:
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return [
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'level' => 'unknown',
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'level_label' => '先记血糖 · 再调运动',
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'headline' => '血糖记录还少，先按基础来：饭后多走动。',
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'items' => [
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'三餐后都散步 15–20 分钟',
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'每天一段八段锦或太极拳',
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'少久坐，坐 1 小时就起来活动几分钟',
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],
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'intensity' => '中低强度 · 每天累计约 30 分钟',
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'note' => $note,
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];
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}
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}
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/**
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* @return array{food:string,level:string,level_label:string,advice:string,source:string}
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*/
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public static function fallbackAsk(string $question): array
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{
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$food = self::extractFoodName($question);
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$hit = self::lookupFood($food);
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if ($hit) {
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return [
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'food' => $hit['food'],
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'level' => $hit['level'],
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'level_label' => $hit['level_label'],
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'advice' => $hit['advice'],
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'source' => 'rule',
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];
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}
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return [
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'food' => $food,
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'level' => '',
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'level_label' => '未知',
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'advice' => '库里没查到「' . $food . '」。一般多吃小米玉米、白菜豆角豆腐鸡蛋，少吃白馒头油条甜口；拿不准问村医。',
|
||
'source' => 'rule',
|
||
];
|
||
}
|
||
|
||
public static function extractFoodName(string $question): string
|
||
{
|
||
$q = trim($question);
|
||
$q = preg_replace('/^(能不能吃|可以吃|能吃|可不可以吃|请问|我想问)/u', '', $q) ?? $q;
|
||
$q = preg_replace('/(吗|呢|？|\?)+$/u', '', $q) ?? $q;
|
||
$q = trim($q);
|
||
return $q !== '' ? $q : $question;
|
||
}
|
||
|
||
/**
|
||
* 血糖照护 AI 关闭时的规则化方案（监测 + 中医调理方向）
|
||
*
|
||
* @param array<string,mixed> $stats7
|
||
* @param array<string,mixed> $stats30
|
||
* @param array<string,mixed> $extra syndrome_type, symptoms 等
|
||
* @return array<string,mixed>
|
||
*/
|
||
public static function fallbackBloodCarePlan(array $stats7 = [], array $stats30 = [], array $extra = []): array
|
||
{
|
||
$exercise = self::exercisePlan($stats7, $stats30);
|
||
$level = (string) ($exercise['level'] ?? 'unknown');
|
||
$compliance = (int) (($stats30['record_days'] ?? 0) > 0 ? ($stats30['compliance'] ?? 0) : ($stats7['compliance'] ?? 0));
|
||
$syndrome = trim((string) ($extra['syndrome_type'] ?? ''));
|
||
$symptoms = trim((string) ($extra['symptoms'] ?? ''));
|
||
|
||
$summary = match ($level) {
|
||
'high' => '近阶段血糖偏高天数偏多，要把监测、饮食和运动一起抓紧，别只靠感觉。',
|
||
'medium' => '血糖大体可控，但还有波动，坚持记录和餐后活动，能更稳。',
|
||
'good' => '近期血糖控制不错，保持现在的节奏，定期复查别松懈。',
|
||
default => '先坚持记血糖、看趋势，再按下面几条慢慢调整生活方式。',
|
||
};
|
||
|
||
$bloodAdvice = match ($level) {
|
||
'high' => '空腹、餐后都测，偏高那天记下吃了啥、动了没。主食换杂粮、每餐先吃菜和蛋白，甜饮糕点先停。三餐后按上面运动建议动起来，头晕心慌马上停、吃点糖。',
|
||
'medium' => '每周至少 4 天空腹+餐后配对记录。主食定量、晚餐别过饱，少喝粥配咸菜。餐后散步 20 分钟，睡眠规律，情绪紧张也会抬糖。',
|
||
'good' => '保持每周 3–4 次监测即可，注意节假日和串门聚餐别放松。继续低 GI 家常饭，运动别停，体重稳一点更好。',
|
||
default => '先把血糖记满 7 天再看趋势。吃饭定时定量，多喝白开水，少甜少油，饭后多走动。',
|
||
};
|
||
|
||
$tcmBase = '消渴病多与肺脾肾气虚、阴虚燥热或痰湿瘀血相关，需结合面诊脉象。';
|
||
if ($syndrome !== '') {
|
||
$tcmBase = '就诊辨证倾向「' . $syndrome . '」。';
|
||
} elseif ($symptoms !== '') {
|
||
$tcmBase = '结合您登记的症状（' . mb_substr($symptoms, 0, 40) . '…），宜辨证论治。';
|
||
}
|
||
|
||
$tcmPlan = match ($level) {
|
||
'high' => $tcmBase . '调理思路：益气养阴、清热生津为主，可配合健脾化湿；食疗如山药、麦冬、桑叶代茶饮方向；艾灸可选足三里、胰俞等穴（需医师指导）。勿自行加大西药或乱用偏方，务必复诊调方。',
|
||
'medium' => $tcmBase . '调理思路：健脾益气、滋阴润燥，少食肥甘，宜清淡易消化；可配合八段锦、太极拳；中药汤剂需医师面诊后开具，此处不给具体方名剂量。',
|
||
'good' => $tcmBase . '调理思路：顾护脾胃、养阴防燥，季节更替注意保暖；维持规律作息与情志舒畅，按医嘱定期复诊即可。',
|
||
default => $tcmBase . '建议到中医科面诊，明确证型后再定汤药、针灸方案；平时可饮食清淡、作息规律，配合记录血糖供医师参考。',
|
||
};
|
||
|
||
$watchPoints = match ($level) {
|
||
'high' => ['空腹≥7 或餐后明显升高要联系村医', '脚麻脚痛、视力模糊及时就诊', '用药时间饭点别乱改'],
|
||
'medium' => ['外出走亲也别忘了测糖', '感冒发烧会让血糖乱，多监测', '睡前别加餐太多'],
|
||
'good' => ['每 3–6 个月复查糖化血红蛋白', '血压血脂一并管', '家人提醒别擅自停药'],
|
||
default => ['坚持每日或隔日记录', '记录与饮食运动一起给大夫看', '不适及时线下就诊'],
|
||
};
|
||
|
||
return [
|
||
'summary' => $summary,
|
||
'blood_advice' => $bloodAdvice,
|
||
'tcm_plan' => $tcmPlan,
|
||
'watch_points' => $watchPoints,
|
||
'next_steps' => '下周继续记血糖；饮食可参考本页「AI 饮食建议」；若连续 3 天偏高或出现胸闷脚肿，请尽快线下就诊或视频问诊。',
|
||
'control_level' => $level,
|
||
'control_label' => (string) ($exercise['level_label'] ?? ''),
|
||
'disclaimer' => '本建议供日常参考，不能替代医师面诊、开方与调药。',
|
||
'source' => 'rule',
|
||
];
|
||
}
|
||
}
|