arXiv:2605.25566cs.AI2026-05

用逻辑推理让大模型看病更透明,诊断可解释且可验证。

Uncertainty Reasoning with Large Language Models for Explainable Disease Diagnosis

论文配图:Uncertainty Reasoning with Large Language Models for Explainable Disease Diagnosis
图 1 · 摘自论文原文
  • 结合大模型与形式逻辑,将病历转为可验证的符号知识
  • 症状用模糊谓词表示,诊断路径可审计可调整
  • 适合需要可解释性的医疗AI研究与临床辅助系统

临床决策需处理不完整、模糊且以自然语言表达的患者叙述。尽管大语言模型(LLMs)擅长从文本中提取隐含信息,但缺乏可验证性和可解释性,难以建立可信的医疗AI。本文提出一种神经符号推理框架,将LLM与形式逻辑对齐,实现可解释且可形式化验证的疾病诊断。将患者描述与临床指南嵌入神经知识库,由LLM提取结构化医学实体、时间关系和模糊症状模式,并解码为基于模糊逻辑与声明式规则的符号知识库。采用两阶段推理:(1) 归纳式符号泛化,从编码叙述中捕捉诊断模式;(2) 通过逻辑编程引擎进行推断验证,生成并确认符合临床标准的诊断。每个症状作为带有概率权重的模糊谓词,推理由路径可审计、可调节,兼容医生反馈。相比纯统计方法,本系统支持迭代优化:若LLM生成诊断与真实情况不符,可通过形式规则追溯、解释并修正。融合逻辑透明性、LLM适应性与概率鲁棒性,实现与人类对齐的医疗推理,具备强泛化能力与可验证的逐步推理链。在公开基准上验证,结果表明性能接近顶尖LLM,同时提供可解释推理路径与形式可验证诊断结论。

原文摘要 · Abstract (English)

Clinical decision-making requires reasoning over incomplete, imprecise, and linguistically expressed patient narratives. While large language models (LLMs) excel at extracting latent information from natural language, they lack the verifiability and interpretability essential for trustworthy medical AI. We propose a neuro-symbolic reasoning framework that aligns LLMs with formal logic to enable explainable and formally verifiable medical diagnosis. Patient descriptions and clinical guidelines are embedded into a neural knowledge base, where LLMs extract structured medical entities, temporal relations, and fuzzy symptom patterns, which are decoded into a symbolic knowledge base expressed in fuzzy logic and declarative rules. We perform two-stage reasoning: (1) inductive symbolic generalization to capture diagnostic patterns from encoded narratives, and (2) inference verification via a logic programming engine to derive and validate diagnoses consistent with clinical standards. Each symptom is treated as a fuzzy predicate with probabilistic weights, and inference paths are auditable, adjustable, and compatible with physician feedback. Unlike purely statistical methods, our system supports iterative refinement: misalignment between LLM-generated diagnoses and ground truth can be traced, explained, and corrected through formal rules. By combining logic-based transparency, LLM adaptability, and probabilistic robustness, the framework enables human-aligned healthcare inference with strong generalization and verifiable, step-by-step reasoning chains. We validate our framework on public benchmarks, demonstrating effective reconciliation of symbolic reasoning and LLMs with real-world clinical narratives. Results show performance comparable to state-of-the-art LLMs, while additionally providing interpretable reasoning paths and formally verifiable diagnostic conclusions.

医疗AI可解释性逻辑推理

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