{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:45:18Z","timestamp":1789598718044,"version":"build-2803163510"},"reference-count":31,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n ChatGPT-4.0 and the ChatGLM series are novel conversational large language models (LLMs). ChatGLM includes 3 versions: ChatGLM4 (with internet connectivity but no knowledge base pretraining), ChatGLM4+Knowledge base (combining internet search capabilities with knowledge base pretraining), ChatGLM3-6B (offline knowledge base pretraining but no internet connectivity). The ability of ChatGPT-4.0 and ChatGLM to apply medical knowledge in the Chinese environment has been preliminarily verified, but the potential of the 2 models for clinical assistance in traditional Chinese medicine (TCM) is still unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to explore the performance of ChatGPT-4.0, ChatGLM4, ChatGLM4+Knowledge base, and ChatGLM3-6B in providing AI-assisted diagnosis and treatment for metabolic dysfunction-associated fatty liver disease within a TCM clinical framework, thereby assessing their potential as TCM clinical decision support tools.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study evaluated 4 LLMs by providing them with medical records of 87 metabolic dysfunction-associated fatty liver disease cases treated with TCM and querying them about TCM treatment plans. The answering texts from 4 LLMs were evaluated using predefined scoring criteria, focusing on 3 critical dimensions: ability in syndrome differentiation and treatment principles, confusion of concepts between TCM and Western medicine, and comprehensive evaluation of question-answering texts (comprising 6 components: ability to integrate Chinese and Western medicine, ability to formulate treatment plans, health management capacity, disease monitoring ability, self-positioning awareness, and medication safety).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the evaluation module of \u201cAbility in syndrome differentiation and treatment principles,\u201d the performance ranking of the 4 models was: (1) ChatGLM4+ Knowledge Base, (2) ChatGLM4, (3) ChatGLM3-6B, and (4) ChatGPT-4.0. Regarding the assessment of confusion between TCM and Western medicine concepts, ChatGPT-4.0 exhibited conceptual confusion in 32 out of 87 cases, while the ChatGLM series of LLMs showed no such confusion (except for ChatGLM3-6B, which had 1 instance). In the \u201cComprehensive evaluation of question-answering texts\u201d module (comprising 6 components: ability to integrate Chinese and Western medicine, ability to formulate treatment plans, health management capacity, disease monitoring ability, self-positioning awareness, and medication safety), the ranking was: (1) ChatGLM4+ Knowledge Base, (2) ChatGPT-4.0, (3) ChatGLM4, and (4) ChatGLM3-6B.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Our study results demonstrated that real-time internet connectivity played a critical role in LLM-assisted TCM diagnosis and treatment, while offline models showed significantly reduced performance in clinical decision support. Furthermore, pretraining LLMs with TCM-specific knowledge bases while maintaining internet search capabilities substantially enhanced their diagnostic and therapeutic performance in TCM applications. Importantly, general-purpose LLMs required both domain-specific medical fine-tuning and culturally sensitive adaptation to meet the rigorous standards of TCM clinical practice.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/66503","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T22:15:59Z","timestamp":1756160159000},"page":"e66503-e66503","source":"Crossref","is-referenced-by-count":4,"title":["Performance Assessment of ChatGPT-4.0 and ChatGLM Series in Traditional Chinese Medicine for Metabolic Associated Fatty Liver Disease: Comparative Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1522-2607","authenticated-orcid":false,"given":"Xionghui","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3792-8833","authenticated-orcid":false,"given":"Tianxiao","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5296-6964","authenticated-orcid":false,"given":"Bo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0358-6034","authenticated-orcid":false,"given":"Zhi","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2436-2371","authenticated-orcid":false,"given":"Kaihan","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0037-4059","authenticated-orcid":false,"given":"Changquan","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"issue":"12","key":"R1","doi-asserted-by":"publisher","first-page":"2283","DOI":"10.14309\/ajg.0000000000002483","article-title":"Towards AI-augmented clinical decision-making: an examination of ChatGPT\u2019s utility in acute ulcerative colitis presentations","volume":"118","author":"Levartovsky","journal-title":"Am J Gastroenterol"},{"key":"R2","author":"FENG","journal-title":"West China Med J"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-56874-w","article-title":"CPMI-ChatGLM: parameter-efficient fine-tuning ChatGLM with Chinese patent medicine instructions","volume":"14","author":"Liu","journal-title":"Sci Rep"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2023.105173","article-title":"Performance and exploration of ChatGPT in medical examination, records and education in Chinese: pave the way for medical AI","volume":"177","author":"Wang","journal-title":"Int J Med Inform"},{"issue":"Suppl","key":"R5","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.3350\/cmh.2022.0367","article-title":"MAFLD: how is it different from NAFLD?","volume":"29","author":"Gofton","journal-title":"Clin Mol Hepatol"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"ITC1","DOI":"10.7326\/ANNALS-24-02933","article-title":"Metabolic dysfunction-associated steatotic liver disease","volume":"178","author":"Ali","journal-title":"Ann Intern Med"},{"issue":"4","key":"R7","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.jhep.2016.05.026","article-title":"Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver","volume":"65","author":"Sung","journal-title":"J Hepatol"},{"issue":"10","key":"R8","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1111\/apt.16631","article-title":"Dose-response relationships of accelerometer-measured sedentary behaviour and physical activity with non-alcoholic fatty liver disease","volume":"54","author":"Tsunoda","journal-title":"Aliment Pharmacol Ther"},{"issue":"12","key":"R9","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000014918","article-title":"A randomized controlled trial on the effectiveness of 8-week high-intensity interval exercise on intrahepatic triglycerides, visceral lipids, and health-related quality of life in diabetic obese patients with nonalcoholic fatty liver disease","volume":"98","author":"Abdelbasset","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"311","DOI":"10.14309\/ajg.0000000000001584","article-title":"Objectively measured physical activity is inversely associated with nonalcoholic fatty liver disease: the Rotterdam study","volume":"117","author":"van Kleef","journal-title":"Am J Gastroenterol"},{"issue":"6","key":"R11","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1056\/NEJMoa2309000","article-title":"A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis","volume":"390","author":"Harrison","journal-title":"N Engl J Med"},{"issue":"10019","key":"R12","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1016\/S0140-6736(15)00803-X","article-title":"Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study","volume":"387","author":"Armstrong","journal-title":"Lancet"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1001\/jamainternmed.2016.9607","article-title":"Thiazolidinediones and advanced liver fibrosis in nonalcoholic steatohepatitis: a meta-analysis","volume":"177","author":"Musso","journal-title":"JAMA Intern Med"},{"issue":"18","key":"R14","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1056\/NEJMoa0907929","article-title":"Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis","volume":"362","author":"Sanyal","journal-title":"N Engl J Med"},{"issue":"14","key":"R15","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1001\/jama.2011.1437","article-title":"Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT)","volume":"306","author":"Klein","journal-title":"JAMA"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctcp.2021.101376","article-title":"Effects of acupoint therapy on nonalcoholic fatty liver disease: a systematic review and meta-analysis","volume":"43","author":"Bi","journal-title":"Complement Ther Clin Pract"},{"issue":"3","key":"R17","first-page":"208","volume":"38","author":"Wang","journal-title":"Zhen Ci Yan Jiu"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000018775","article-title":"Acupoint embedding therapy improves nonalcoholic fatty liver disease with abnormal transaminase: a PRISMA-compliant systematic review and meta-analysis","volume":"99","author":"Dai","journal-title":"Medicine (Baltimore)"},{"issue":"Pt A","key":"R19","doi-asserted-by":"publisher","first-page":"116967","DOI":"10.1016\/j.jep.2023.116967","article-title":"Chaihu shugan powder influences nonalcoholic fatty liver disease in rats in remodeling microRNAome and decreasing fatty acid synthesis","volume":"318","author":"Zheng","journal-title":"J Ethnopharmacol"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","DOI":"10.1186\/s12906-019-2577-6","article-title":"Qianggan extract improved nonalcoholic steatohepatitis by modulating lncRNA\/circRNA immune ceRNA networks","volume":"19","author":"Zhu","journal-title":"BMC Complement Altern Med"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1016\/j.phymed.2023.155111","article-title":"Xie Zhuo Tiao Zhi formula modulates intestinal microbiota and liver purine metabolism to suppress hepatic steatosis and pyroptosis in NAFLD therapy","volume":"121","author":"Qiu","journal-title":"Phytomedicine"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.phymed.2022.154208","article-title":"The improvement of nonalcoholic steatohepatitis by Poria cocos polysaccharides associated with gut microbiota and NF-\u03baB\/CCL3\/CCR1 axis","volume":"103","author":"Tan","journal-title":"Phytomedicine"},{"issue":"2","key":"R23","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1007\/s12072-021-10138-1","article-title":"Gut-liver axis modulation of Panax notoginseng saponins in nonalcoholic fatty liver disease","volume":"15","author":"Xu","journal-title":"Hepatol Int"},{"issue":"18","key":"R24","doi-asserted-by":"publisher","first-page":"10620","DOI":"10.3390\/ijms231810620","article-title":"Polysaccharide from salviae miltiorrhizae radix et rhizoma attenuates the progress of obesity-induced non-alcoholic fatty liver disease through modulating intestinal microbiota-related gut\u2013liver axis","volume":"23","author":"Li","journal-title":"IJMS"},{"issue":"13","key":"R25","doi-asserted-by":"publisher","DOI":"10.3390\/foods12132492","article-title":"Ginsenoside Rh4 improves hepatic lipid metabolism and inflammation in a model of NAFLD by targeting the gut liver axis and modulating the FXR signaling pathway","volume":"12","author":"Yang","journal-title":"Foods"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","DOI":"10.1186\/s12944-023-01969-y","article-title":"Puerarin ameliorates metabolic dysfunction-associated fatty liver disease by inhibiting ferroptosis and inflammation","volume":"22","author":"Yang","journal-title":"Lipids Health Dis"},{"issue":"4","key":"R27","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.jphs.2017.11.007","article-title":"Akebia saponin D alleviates hepatic steatosis through BNip3 induced mitophagy","volume":"136","author":"Gong","journal-title":"J Pharmacol Sci"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1080\/13880209.2020.1845747","article-title":"Effects of wogonoside on the inflammatory response and oxidative stress in mice with nonalcoholic fatty liver disease","volume":"58","author":"Jiang","journal-title":"Pharm Biol"},{"issue":"19","key":"R29","doi-asserted-by":"publisher","DOI":"10.3390\/ijms221910604","article-title":"MERTK+\/hi M2c macrophages induced by baicalin alleviate non-alcoholic fatty liver disease","volume":"22","author":"Lai","journal-title":"Int J Mol Sci"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.816032","article-title":"Gentiana scabra restrains hepatic pro-inflammatory macrophages to ameliorate non-alcoholic fatty liver disease","volume":"12","author":"Zheng","journal-title":"Front Pharmacol"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1007\/s10620-024-08722-0","article-title":"Disparities in metabolic dysfunction-associated steatotic liver disease prevalence, diagnosis, treatment, and outcomes: a narrative review","volume":"70","author":"Miller","journal-title":"Dig Dis Sci"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e66503","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:28:45Z","timestamp":1785536925000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e66503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":31,"URL":"https:\/\/doi.org\/10.2196\/66503","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]},"article-number":"v9i12e66503"}}