Most multimodal classifiers assume that all useful evidence is available upfront, whereas clinical inquiry is sequential. We present a synthetic evaluation framework separating objective multimodal inference from active inquiry. An objective model maps synthetic tongue, bilateral multipressure pulse, and acoustic observations to eight syndrome families. A provenance-bearing Knowledge Core and training-only answer model support Bayesian narrowing over 33 fine terms using 25 typed questions, while seven safety questions remain outside the diagnostic posterior. Weak shared symptom factors limit fine-term influence on objective phenotypes, and an objective-only probe tests leakage. In a preregistered 600-case synthetic evaluation, objective family accuracy was 87.0%. Cost-sensitive expected information gain (cost-EIG) raised family accuracy to 95.5% and exact fine-term accuracy to 42.5%, versus 92.7% and 33.0% for an unoptimized fixed-order baseline. Selective family accuracy reached 96.9% at 95.3% coverage. However, cost-EIG asked more questions on average than fixed order (9.795 versus 9.352). Missing-audio routing retained 94.0% family accuracy, and a workflow invariant enforced abstention when all objective modalities were absent. Permuting fine-term answer likelihoods reduced family accuracy to 78.7%. Five of six frozen checks passed, but the question-efficiency hypothesis failed. Comparisons are descriptive because only aggregate, not paired case-level, outputs were retained. These results establish a reproducible synthetic workflow, not clinical diagnostic or treatment validity.
Alpha-TCM makes two contributions under a central thesis: auditable systems should separate domain knowledge, case evidence, probabilistic inference, and downstream authority. First, it proposes a nine-layer TCM-oriented architecture covering semantic definitions, multimodal acquisition, quality control, provenance-bearing knowledge, probabilistic inference, longitudinal updating, constrained decisions, language interaction, and human governance. Each layer specifies its information contract, failure boundary, dependencies, and validation status. This is a system-design proposal, not a claim of complete clinical implementation. Second, a controlled synthetic prototype instantiates Layers 1-5 to audit the knowledge-evidence interface. Four conditional-Gaussian encoders process synthetic tongue images, pulse waveforms, inquiry fields, and text, while a frozen bridge predicts a five-dimensional synthetic outcome. A versioned contextual prior is compiled independently of the renderer. Fusion removes duplicated reference-prior information before adding context. Equal-information controls, prior regularization, graded contamination, and structural corruption test contextual benefits, Bayesian specificity, and conflict detection. Across ten paired seeds and four training sizes, contextual knowledge improved mean absolute error over marginal committee fusion at 600 and 1,200 cases, but not over equal-information neural controls. Fully incorrect context harmed performance at every size, while prior effects were inconsistent and conflict scores did not track case-level damage. The results support contextual structure in low-data synthetic settings, not a specifically Bayesian advantage. The prototype establishes no claims about TCM theory or clinical, diagnostic, therapeutic, causal, longitudinal, or transfer validity.