Srav Health

Clinical signal map · Working document · 2025

From assessment to root cause map

How the 47-question assessment, intake call, and practitioner signal mapping combine to produce the four-column root cause map — and what needs to be built to make that happen.

How we get from assessment to root cause map
1

47-question assessment completed

You answer all questions. Responses are stored as structured data — not free text. Each answer maps to one or more of the five systems (Mind-Body, Nervous System, Hormonal Axis, Gut & Estrobolome, Inflammatory State) and carries a signal weight per modality framework.

Input: 47 structured responses. Output: raw signal data per system, per modality framework. Red flag rules run automatically — any trigger escalates immediately to CGO queue.

AutomatedAI processesRed flag check
2

Prior diagnostics ingested

You upload any existing blood work, hormone panels, or scan reports. AI reads and extracts relevant markers. These are added to the signal data — not as a replacement for the assessment picture, but as additional evidence that may confirm or complicate the pattern hypotheses.

If no diagnostics uploaded, the root cause map is generated from assessment alone and flagged as provisional. Gaps are noted for the intake call.

Async uploadAI extracts markers
3

AI generates provisional root cause map

Using the signal map (question → modality framework → pattern hypothesis), the AI generates four parallel pattern hypotheses — one per modality. Each hypothesis identifies: primary system dysregulation, secondary system, likely pattern name in that framework, and contributing factors. The map also identifies the most likely cluster (A, B, or C) and suggests a default pathway.

Critically labelled: PROVISIONAL — pending intake call and practitioner review. The AI is generating hypotheses, not diagnoses. The language is explicitly probabilistic.

AI generatesFour modality views
4

AI-assisted intake call

Care coordinator uses the provisional map as a structured guide. The AI surfaces the top 3–5 ambiguities or gaps from the assessment — questions where your answers were unclear, contradictory, or where more context would sharpen the pattern. The coordinator explores these specifically. The call adds context, clarifies history, and captures anything the form missed.

After the call, the coordinator adds a brief structured note — not free text — to the case record. The AI updates the provisional map with the new information. A second provisional map is generated.

Care coordinatorAI updates map
5

Practitioners review — parallel, 48-hour target

The provisional map goes to all relevant practitioners simultaneously. Each sees: the full assessment responses, their modality's AI-generated pattern hypothesis, and the other modalities' hypotheses for context. Each practitioner reviews their column — confirming, amending, or overriding the AI hypothesis. They add their clinical reasoning in structured notes.

Lead practitioner is pre-assigned based on condition defaults and presenting cluster. They review first and can add a frame-setting note before others contribute. No practitioner can see another's edits in real time — to preserve independent judgment. Views are revealed simultaneously once all have responded.

Parallel reviewIndependent judgment
6

CGO safety review (when indicated)

Required when: red flag present, new diagnostics to be ordered, named condition, current prescription medication. The CGO reviews the full map — not to override the integrative picture, but to confirm clinical safety and add the conventional medicine perspective as a fifth column. They approve, flag, or escalate.

CGO review is a safety gate, not a clinical hierarchy. If they approve without additions, the map stands. If they add a conventional medicine note, it appears as a fifth column labelled GP/Conventional — not replacing any other column.

CGO when indicatedSafety gate
7

Final root cause map generated

The AI assembles the practitioner-approved views into the final root cause map. The shared therapeutic targets are identified automatically as the overlap between the four modality hypotheses — the language the AI uses to express the shared targets is plain English, not modality-specific terminology. The map also includes: likely cluster, default pathway, suggested diagnostic gaps, and matched programme outline.

Two versions are generated: a full practitioner version (all clinical detail, modality-specific language) and a client version (plain language, pattern described as lived experience, therapeutic targets explained accessibly).

AI assemblesTwo versions
8

Lead practitioner walks you through it

The root cause map is the centrepiece of the lead practitioner call. You see your client version first — the lead practitioner discusses it with you, answers questions, and confirms the therapeutic targets feel right to you. The care plan and 12-week programme are then confirmed on the basis of the approved map.

You always have the option to question, push back on, or reject any part of the map. The map is a starting hypothesis — your lived experience is the final authority on whether it resonates.

Lead practitionerClient confirms
What the root cause map contains

The root cause map has two versions — practitioner (full clinical detail) and client (plain language). Structure is identical; language register differs.

IFM / Systems
  • Primary system dysregulation
  • Secondary system
  • Root cause hypothesis
  • Antecedents / triggers
  • Mediators and perpetuators
  • IFM Matrix node(s)
  • Therapeutic targets
TCM
  • Primary pattern (Zheng)
  • Secondary pattern
  • Organ system involved
  • Qi / Blood / Yin / Yang picture
  • Tongue and pulse hypotheses
  • Treatment principle
  • Therapeutic targets
Ayurveda
  • Vikriti (current imbalance)
  • Dosha pattern
  • Agni state
  • Ama presence
  • Dhatu (tissue) affected
  • Srota (channel) obstruction
  • Therapeutic targets
GP / Conventional
  • Red flag status
  • Differential to rule out
  • Diagnostic gaps
  • Current medication interactions
  • Referral indicated?
  • Conventional parallel
  • Safety notes

Shared therapeutic targets — the overlap layer generated from all four columns. Written in plain English. These are what the 12-week programme works toward, regardless of which modality is leading at any given time. Example: "Regulate your stress response and support cortisol recovery · Restore digestive integrity and support oestrogen clearance · Rebuild energy reserves without further depletion." These targets are what you see and what your care plan is built around.

Client version — what you read

Your pattern — as we see it

A plain-language description of your presenting pattern — written as lived experience, not clinical terminology. Describes what's happening in your body in terms you recognise. Explains the connections between your symptoms. Names the therapeutic targets in accessible language.

Followed by: what each modality sees, written in one sentence each. Not the full clinical picture — just enough for you to understand why each practitioner is involved.

Note: the client version never uses diagnostic labels. It describes patterns and tendencies, not conditions. "Your body has been running on cortisol for so long that your progesterone production has been compromised" rather than "you have HPA axis dysregulation causing secondary progesterone deficiency."

Question → modality signal map (sample — to be completed with practitioners)

This is a working draft of the signal mapping logic. IFM and GP columns are more complete. TCM and Ayurveda columns require practitioner input and validation. This is the primary co-creation task for the practitioner onboarding sessions.

QuestionIFM / Systems signalTCM signalAyurveda signalGP signal
Q8 — Energy level through dayCortisol curve inversion. HPA axis dysregulation. Possible insulin dysregulation post-meal.Spleen Qi deficiency (post-meal crash). Kidney Yang declining (morning). Liver Qi excess (evening).Kapha not utilised in morning. Pitta exhausted midday. Vata spike evening. Irregular Agni.Consider fasting insulin, cortisol curve (AM/PM), thyroid panel.
Q13 — End of demanding dayWired = high cortisol evening, sympathetic dominance. Depleted = adrenal insufficiency, low DHEA.Wired = Liver Qi stagnation, Heart fire. Depleted = Kidney Yin/Yang deficiency, Spleen Qi exhausted.Wired = Vata-Pitta aggravation, Prana Vata disturbed. Depleted = Ojas depletion, Vata dominance.DHEA-S, evening cortisol. Mental health screen if depleted pattern severe.
Q35 — Sleep patterns1–3am = liver detox burden, blood sugar dropping. Night sweats = oestrogen fluctuation or cortisol.1–3am = Liver blood deficiency or Liver Qi stagnation. Night sweats = Yin deficiency, empty heat.1–3am = Pitta time disturbance, liver Agni. Night sweats = Pitta excess, Vata-Pitta.Night sweats → oestrogen/progesterone panel, thyroid. 1–3am → liver function, fasting glucose.
Q27 — Weight (abdominal)Cortisol-driven visceral fat. Insulin resistance. Oestrogen dominance contributing to fat storage.Dampness and Phlegm accumulation in middle jiao. Spleen Qi deficiency failing to transform.Kapha accumulation. Ama in channels. Impaired Agni reducing metabolic transformation.Fasting insulin, HbA1c, DHEA-S, sex hormone panel, waist-hip ratio.
Q40 — DigestionGut dysbiosis. Increased intestinal permeability. SIBO possible. Estrobolome disruption.Spleen-Stomach disharmony. Large Intestine Qi stagnation. Liver overacting on Spleen.Irregular Agni (Vishama Agni). Ama accumulation. Vata in colon.Consider stool microbiome testing, SIBO breath test, food intolerance panel.
Q26 — Period symptomsProstaglandin excess (pain). Oestrogen dominance (flooding). Progesterone deficiency.Blood stasis (pain, clots). Blood heat (heavy flow). Liver Qi stagnation.Apana Vata disturbed (pain). Pitta excess (heavy flow). Vata-Kapha (clots).Red flag: severe pelvic pain → rule out endometriosis. Heavy flow → FBC, ferritin, thyroid.
New Q2 — Liver signalsPhase 2 liver detoxification burden. Impaired oestrogen clearance. Toxic load accumulation.Liver Qi stagnation or Liver Blood deficiency. Liver-Gallbladder heat.Pitta aggravation — Ranjaka Pitta. Rakta dhatu heat. Liver channel obstruction.LFTs, GGT, oestrogen metabolite ratio if indicated.
Q15 — Emotional stateHPA axis — rage/anxiety = high cortisol. Flat = depleted cortisol, low dopamine.Rage = Liver Qi stagnation, Liver fire. Anxiety = Heart-Kidney disharmony. Flat = Spleen/Heart Qi deficiency.Rage = Pitta aggravation. Anxiety = Vata, Prana Vata disturbance. Flat = Kapha, Tamas guna.Mental health screen (PHQ-4). If severe, consider assessment before integrative programme.

This table needs practitioner completion. The IFM and GP columns are drafts — clinically informed but not practitioner-validated. The TCM and Ayurveda columns are directionally correct but must be reviewed, corrected, and completed by registered TCM and Ayurvedic practitioners.

Build sequence — clinical infrastructure
Care principles document
8 principles, promise statement, modality equity statement, condition defaults table.
Done
Patient journey document
Entry → assessment → intake → plan review → lead call → programme → 3-month review. $220 continuation defined.
Done
5-system framework
Mind-Body, Nervous System, Hormonal Axis, Gut & Estrobolome, Inflammatory State. Cluster logic (A, B, C) defined.
Done
Assessment mapping
47 questions retagged to revised systems. 2 new questions added. Retags for Q8, 12, 13, 15, 28, 34 completed.
Done
Question → modality signal map
Each question mapped to what it signals in IFM, TCM, Ayurveda, and GP frameworks. Draft started — requires practitioner co-creation session.
Next — co-create with practitioners
Pattern library (12–15 patterns)
Named configurations across 5 systems. Each in four modality languages. Built from signal map after practitioner validation.
Next — after signal map
Red flag rule set
Explicit hardcoded rules. Specific answer combinations that trigger immediate CGO escalation.
Next — CGO to approve
Root cause map output spec
Four-column structure defined. Client version language register. Shared therapeutic target extraction logic.
Drafted — needs AI implementation
Cluster protocols (A, B, C)
12-week programme structure per cluster. Lead modality, supporting modalities, week-by-week sequence.
After pattern library
Practitioner scope cards
One page per provider type: what they can do independently, what requires shared record note, what requires GP.
Before programme launch
Shared care record template
Structured format for post-session notes. Practitioner version and client-facing version. Escalation flag format.
Before programme launch
Diagnostic panel library
Per-cluster recommended panels. What to look for, what existing diagnostics to synthesise first.
With cluster protocols
Reference library — for practitioner signal-mapping sessions
TCM — Women's Health Pattern Tool
TEAMSI-TCM: Traditional East Asian Medicine Structured Interview
The most directly relevant validated TCM assessment tool. Designed for women's gynaecological conditions. Uses pattern differentiation as a structured interview.
Key use: reference for how symptom-to-pattern mapping has been formalised in clinical research. PubMed ID: 16398591.
View →
TCM — Menopausal Pattern Questionnaire
CaPSP: Pattern Identification Tool for Climacteric and Postmenopausal Syndrome
Validated questionnaire mapping menopausal symptoms to seven TCM patterns including Kidney Yin deficiency, Liver Qi stagnation, Heart-Kidney disharmony.
Key use: reference for the TCM column, particularly for perimenopausal presentations.
View →
TCM — Symptom to Biomedical Mapping
SymMap: Integrative Database of TCM Enhanced by Symptom Mapping
1,717 TCM symptoms mapped to 961 biomedical symptoms by 17 leading TCM experts. Essential bridge between TCM and systems language.
Key use: cross-reference how each TCM pattern signal relates to the biomedical system picture. Available at symmap.org.
View →
Ayurveda — Prakriti Assessment Review
Prakriti Assessment Tools: Critical Review of Scientific Validity (Frontiers in Medicine, 2025)
64 tools evaluated across 94 studies. Most assess Prakriti (constitution) not Vikriti (current imbalance). The 47-question assessment captures Vikriti.
Key use: frame the signal mapping conversation — Vikriti column from assessment, Prakriti assessed separately in consultation.
View →
IFM — Multi-System Clinical Framework
IFM Functional Medicine Matrix: Organising Clinical Imbalances
The most developed multi-system clinical mapping tool in integrative medicine. Seven biological nodes plus lifestyle factors.
Key use: organising structure for the IFM signal column. Each question maps to one or more Matrix nodes.
View →
Integrative — Conceptual Framework
Conceptual Framework for New Models of Integrative Medicine (PMC)
Addresses the challenge of building integrative frameworks without privileging one system. Foundational for the four-column approach.
Key use: philosophical grounding for parallel columns rather than a translated hierarchy.
View →
TCM — Pattern Reliability Research
Can Reliability of the Chinese Medicine Diagnostic Process Be Improved? (PMC)
Structured pattern differentiation forms significantly improve inter-rater reliability. Validates the signal map approach.
Key use: structured signal mapping enhances rather than constrains clinical judgment.
View →