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This study introduces TCMQA, a large-scale benchmark evaluating language models on Traditional Chinese Medicine using licensed practitioner responses as ground truth. The results demonstrate that pretraining data origin significantly outperforms model scale, with smaller Chinese-pretrained models surpassing larger Western counterparts in this domain-specific task. However, the analysis reveals a critical lack of alignment between model outputs and human expert consensus, highlighting persistent gaps in reasoning reliability for specialized medical applications.
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TCMQA: A 38K-Question Traditional Chinese Medicine Benchmark with a Licensed-Practitioner Reference

arXiv2 min read

arXiv:2609.33014v1 Announce Type: new Abstract: Medical benchmarks for language models are built almost entirely on Western biomedicine. Traditional Chinese Medicine (TCM) is a separate system, with its own diagnostic framework and its own literature, and it remains largely unmeasured. The few TCM evaluations that exist are small, narrow, and rarely paired with a human reference. We present TCMQA, an open benchmark of 38,279 questions from Chinese TCM licensing examinations, paired with 15,151 responses from 101 licensed practitioners. We evaluate 29 instruction-tuned models from 9 families, spanning 0.27B to 14.8B parameters. Accuracy ranges over 59 points, and no model approaches saturation. Pretraining data predicts TCM ability far better than scale: a 12B Western-pretrained model reaches 39.6%, while a Chinese-pretrained model an eighth its size reaches 60.8%. Nine models exceed the practitioner majority vote of 64.9%, the best by 21.8 points, and all nine come from that same Chinese-pretrained family. Yet difficulty does not transfer between models and practitioners: accuracy is flat across practitioner-rated difficulty, item-level agreement is near zero for all 29 models, and on $8.4\%$ of items the practitioners are correct where the leading model is wrong. We release the corpus, the practitioner responses, the harness, and per-item model outputs at https://huggingface.co/datasets/TechTCM/TCMQA.

Abstract:Medical benchmarks for language models are built almost entirely on Western biomedicine. Traditional Chinese Medicine (TCM) is a separate system, with its own diagnostic framework and its own literature, and it remains largely unmeasured. The few TCM evaluations that exist are small, narrow, and rarely paired with a human reference. We present TCMQA, an open benchmark of 38,279 questions from Chinese TCM licensing examinations, paired with 15,151 responses from 101 licensed practitioners. We evaluate 29 instruction-tuned models from 9 families, spanning 0.27B to 14.8B parameters. Accuracy ranges over 59 points, and no model approaches saturation. Pretraining data predicts TCM ability far better than scale: a 12B Western-pretrained model reaches 39.6%, while a Chinese-pretrained model an eighth its size reaches 60.8%. Nine models exceed the practitioner majority vote of 64.9%, the best by 21.8 points, and all nine come from that same Chinese-pretrained family. Yet difficulty does not transfer between models and practitioners: accuracy is flat across practitioner-rated difficulty, item-level agreement is near zero for all 29 models, and on $8.4\%$ of items the practitioners are correct where the leading model is wrong. We release the corpus, the practitioner responses, the harness, and per-item model outputs at this https URL.

Computation and Language (cs.CL); Artificial Intelligence (cs.AI)

arXiv:2609.33014 [cs.CL]

(or arXiv:2609.33014v1 [cs.CL] for this version)

https://doi.org/10.48550/arXiv.2609.33014 Focus to learn more arXiv-issued DOI via DataCite (pending registration)

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