BenCao: An Instruction-Tuned Large Language Model for Traditional Chinese Medicine

Traditional Chinese Medicine (TCM), with a history spanning over two millennia, plays a role in global healthcare. However, applying large language models (LLMs) to TCM remains challenging due to its reliance on holistic reasoning, implicit logic, and multimodal diagnostic cues. Existing TCM-domain LLMs have made progress in text-based understanding but lack multimodal integration, interpretability, and clinical applicability. To address these limitations, we developed BenCao, a ChatGPT-based multimodal assistant for TCM, integrating structured knowledge bases, diagnostic data, and expert feedback refinement. BenCao was trained through natural language instruction tuning rather than parameter retraining, aligning with expert-level reasoning and ethical norms specific to TCM. The system incorporates a comprehensive knowledge base of over 1,000 classical and modern texts, a scenario-based instruction framework for diverse interactions, a chain-of-thought simulation mechanism for interpretable reasoning, and a feedback refinement process involving licensed TCM practitioners. BenCao connects to external APIs for tongue-image classification and multimodal database retrieval, enabling dynamic access to diagnostic resources. In evaluations across single-choice question benchmarks and multimodal classification tasks, BenCao achieved superior accuracy to general-domain and TCM-domain models, particularly in diagnostics, herb recognition, and constitution classification. The model was deployed as an interactive application on the OpenAI GPTs Store, accessed by nearly 1,000 users globally as of October 2025. This study demonstrates the feasibility of developing a TCM-domain LLM through natural language-based instruction tuning and multimodal integration, offering a practical framework for aligning generative AI with traditional medical reasoning and a scalable pathway for real-world deployment.