Audit: QRS - Black Cohosh for Health & Longevity
Audit conducted on 16/08/2026 13:07 using AI4L / Opus 5
Summary
| Items | Count |
|---|---|
| Total | 93 |
| Passed | 83 |
| Failed | 0 |
| N/A | 10 |
| Pass Rate | 100.00% |
- Total = Passed + Failed + N/A
- Pass Rate = Passed / (Passed + Failed) × 100
- N/A items are excluded from the pass rate calculation
1. General Rules
| # | Description | Result | Comments |
|---|---|---|---|
| 1.1 | Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER. | 🟢 | Every protocol value, tier item, gate item, marker range and cadence traces to a named ER passage. |
| 1.2 | Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing. | 🟢 | “No circadian dependence is established” and “No established target” carried through verbatim. |
| 1.3 | The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”). | 🟢 | Contraindications retain absolute framing; the “Evening” timing headline keeps the ER’s “no circadian dependence” caveat in its sub. |
| 1.4 | The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc. | 🟢 | Gates draw from Key Interactions & Contraindications; tiers from Expected Benefits and Potential Risks & Side Effects only. |
| 1.5 | PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact. | 🟢 | No citations, PMIDs, NCT identifiers or brand names appear anywhere in the QRS. |
| 1.6 | The QRS does not introduce new attributions. | 🟢 | No attributions of any kind are present. |
2. Focus, Tone & Audience
| # | Description | Result | Comments |
|---|---|---|---|
| 2.1 | The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing. | 🟢 | Measured, non-promotional register matching the ER’s contested-evidence framing. |
| 2.2 | The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging | 🟢 | Quantified targets and thresholds paired with plain-language explanation. |
| 2.3 | The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor | 🟢 | Descriptive statements of practice, not instructions. |
| 2.4 | The QRS avoids language that implies medical or clinical advice | 🟢 | Cadence and gates are stated as observed practice, not as directives. |
| 2.5 | The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising” | 🟢 | No recommending or advising verbs used. |
| 2.6 | The QRS never addresses “the reader” directly — it presents evidence, not guidance | 🟢 | No second-person pronouns anywhere in the file. |
| 2.7 | The QRS is written in plain language, avoiding unnecessary medical jargon | 🟢 | Retained technical terms (statins, CYP2D6 substrates) are ER-sourced labels; glosses such as “cholesterol-lowering drugs” are preserved. |
| 2.8 | Information is presented in a concise and very compact manner | 🟢 | Tier lines, gate items and marker rows are single condensed statements. |
| 2.9 | It DOES NOT address the reader directly | 🟢 | Confirmed by full-text scan for second-person forms. |
| 2.10 | The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review. | 🟢 | Baseline liver panel, species authentication and monitoring cadence assume a proactive reader. |
| 2.11 | The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort. | 🟢 | Repeat liver panels, monthly heart-rate checks and a symptom diary are presented without hedging on effort. |
| 2.12 | The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort. | 🟢 | Functional-range targets rather than conventional lab flags throughout. |
| 2.13 | Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience. | 🟢 | At-a-glance foregrounds the unresolved efficacy question and preparation identity over dose. |
| 2.14 | The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim. | 🟢 | The string “anti-aging” does not occur; the title uses “Health & Longevity”. |
| 2.15 | The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “injection” not “shot”; “adverse event” not “bad reaction”). Direct quotes from sources are exempt. | 🟢 | Body sections use formal terms; the at-a-glance plain-language wording is mandated by item 7.4 and mirrors the ER Conclusion. |
3. Template Integrity
| # | Description | Result | Comments |
|---|---|---|---|
| 3.1 | The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why” | 🟢 | All fourteen fixed strings present and unmodified (lines 445, 491, 541, 570, 591, 621, 643, 647–649, 784). |
| 3.2 | All “…” from the [qrs_template] are present in the the QRS. | 🟢 | All 67 named variable spans are present, from page_title through qualitative_item_6. |
| 3.3 | Spans that are not addressed in a checklist item are left unchanged | 🟢 | The three website= spans (evidence_review, audit, full_review) are intact and untouched. |
4. Formatting
| # | Description | Result | Comments |
|---|---|---|---|
| 4.1 | When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied” | N/A | No source ER section mapped by the QRS is empty. |
| 4.2 | Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label. | 🟢 | “Standard dose”, “Single versus split dosing”, “Timing”, “Time to effect”, “Reassessment point”, “Intended duration” all match the ER bold labels. |
| 4.3 | Labels are not paraphrased, abbreviated, or invented. | 🟢 | No invented labels; marker names match the ER biomarker table exactly. |
| 4.4 | The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels. | 🟢 | Zero emoji characters in the file; the ER’s “⚠️ Conflicted” markers are correctly dropped. |
| 4.5 | The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page. | 🟢 | Discretionary sections are condensed to the minimum (four tier lines each for benefits and risks); remaining volume is mandated by items 9.2, 14.2 and 15.2. |
5. Metadata
| # | Description | Result | Comments |
|---|---|---|---|
| 5.1 | The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content. | 🟢 | Lines 2–14, immediately after the doctype on line 1. |
| 5.2 | Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML. | 🟢 | Opening --- on line 3, closing --- on line 13. |
| 5.3 | The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet. | 🟢 | Enclosed in an HTML comment; no metadata value is echoed into the body. |
| 5.4 | All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. | 🟢 | Only duration: "00:04" is quoted, and it contains a colon. |
| 5.5 | The filename of the source ER is stated as “er_filename: [er_filename]” | 🟢 | Line 4: er_filename: black_cohosh_2026-0825-1030_Opus_ER.md. |
| 5.6 | Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]” | 🟢 | Line 5: 26.7.02, matching the QRS.md version badge. |
| 5.7 | Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430) | 🟢 | Line 6: 2026-0816-1241. |
| 5.8 | The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]” | 🟢 | Line 7: Opus. |
| 5.9 | The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT) | 🟢 | Single word, no version suffix. |
| 5.10 | The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]” | 🟢 | Line 8: Opus 5. |
| 5.11 | The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4) | 🟢 | “Opus 5” — nickname plus version, no qualifier. |
| 5.12 | The filename of the document is stated as “qrs_filename: [filename of this document]” | 🟢 | Line 9 matches the actual file on disk. |
| 5.13 | All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. | 🟢 | Confirmed across all nine keys. |
6. Page Title & Header
| # | Description | Result | Comments |
|---|---|---|---|
| 6.1 | [page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &) |
🟢 | Line 22: “Black Cohosh for Health & Longevity - Quick Reference Sheet”. |
| 6.2 | [header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &) |
🟢 | Line 417: “Black Cohosh for Health & Longevity”. |
| 6.3 | [header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY] | 🟢 | Line 421: 08/16/2026, matching qrs_creation_date: 2026-0816-1241. |
| 6.4 | [header_subline_model] is set to [qrs_creator_ai_fullname] | 🟢 | Line 425: Opus 5. |
| 6.5 | No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker. | 🟢 | The ER’s “Also known as” line is correctly omitted; header carries only the template subline. |
7. At-A-Glance Section
| # | Description | Result | Comments |
|---|---|---|---|
| 7.1 | [at_a_glance] is dense, execution-oriented summary of the ER Conclusion section |
🟢 | All five clauses map to the ER Conclusion paragraphs. |
| 7.2 | [at_a_glance] is no longer than 60 words | 🟢 | 59 words. |
| 7.3 | Every fact in [at_a_glance] is supported by a distinct passage in the ER. | 🟢 | Non-hormonal action, contested efficacy, sleep signal and preparation-over-dose each trace to a separate Conclusion sentence. |
| 7.4 | It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead | 🟢 | No acronyms; “womb tissue” and “menstrual cycling ends” replace uterine/vasomotor terminology. |
| 7.5 | It DOES NOT cite specific trials (names, years, sample sizes, p-values) | 🟢 | No trial name, year or sample size appears. |
| 7.6 | It DOES NOT cite effect sizes, relative risks, or statistical results | 🟢 | No numeric result of any kind. |
8. Contraindications
| # | Description | Result | Comments |
|---|---|---|---|
| 8.1 | The section is derived from the ER Key Interactions & Contraindications section |
🟢 | Sourced from the ER’s “Populations who should avoid Black Cohosh” list. |
| 8.2 | [stop_items] represent the Contraindications from the ER | 🟢 | All five ER avoidance populations are present, none added. |
| 8.3 | Individual [stop_items] are formatted as <li></li> | 🟢 | Five discrete <li> elements (lines 573–586). |
| 8.4 | Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. | 🟢 | The ER’s “given historical use to induce labour and absent safety data” rationale is correctly stripped from the pregnancy item. |
| 8.5 | Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). | 🟢 | “twice the upper limit of normal”, “(any Child-Pugh class)” and “below 50 beats per minute” all retained. |
| 8.6 | When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. | N/A | The ER uses no ranking notation inside parentheses in this section. |
| 8.7 | The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision. |
🟢 | The section is populated, and the ER does name five such populations. |
| 8.8 | If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. | N/A | The section is not empty. |
9. Key Interactions
| # | Description | Result | Comments |
|---|---|---|---|
| 9.1 | The section is derived from the ER Key Interactions & Contraindications section |
🟢 | Sourced from the ER’s nine interaction bullets. |
| 9.2 | [caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications | 🟢 | All nine ER interaction bullets present, in ER order; no overlap with the five contraindications. |
| 9.3 | Individual [caution_items] are formatted as <li></li> | 🟢 | Nine discrete <li> elements (lines 594–611). |
| 9.4 | Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. | 🟢 | Caution/Monitor verdicts, consequences and mitigations are all stripped; only label plus drug list remains. |
| 9.5 | Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). | 🟢 | Every named example drug is retained; ER em-dash lists are normalised into parentheses without loss. |
| 9.6 | When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. | N/A | The ER uses no ranking notation inside parentheses in this section. |
| 9.7 | The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used. |
🟢 | The section is populated, and the ER does name nine such interactions. |
| 9.8 | If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. | N/A | The section is not empty. |
10. Protocol
| # | Description | Result | Comments |
|---|---|---|---|
| 10.1 | The section is derived from the ER Protocol section |
🟢 | All three cells trace to ER Therapeutic Protocol bullets. |
| 10.2 | The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section |
🟢 | Standard dose, single versus split dosing, and timing are the three executable decisions in that section. |
| 10.3 | If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing. | N/A | The ER Therapeutic Protocol section supplies twelve bullets, well above three. |
| 10.4 | All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section. |
🟢 | All nine action fields populated from ER text; no placeholders remain. |
11. Time to Effect
| # | Description | Result | Comments |
|---|---|---|---|
| 11.1 | The three sets of [time] items cover the three most important time-to-effect aspects from the ER | 🟢 | Onset (4 weeks), reassessment checkpoint (12 weeks) and intended duration (6 months) are the ER’s only time-anchored parameters. |
| 11.2 | The sets are picked and ordered by the magnitude of the related benefit | 🟢 | All three attach to the High-tier vasomotor benefit and are ordered along its decision timeline. |
| 11.3 | If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing. | N/A | Three distinct time aspects are available and used. |
| 11.4 | All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER. | 🟢 | All nine time fields populated; subs quote the ER near-verbatim. |
| 11.5 | If the ER does not provide any information on time to effect, the section is removed completely from the Protocol Panel |
N/A | The ER Practical Considerations section provides an explicit “Time to effect” bullet. |
12. Benefits
| # | Description | Result | Comments |
|---|---|---|---|
| 12.1 | The section is derived from the ER Expected Benefits section |
🟢 | All eight ER benefit headings are represented at their ER tier. |
| 12.2 | Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative] | 🟢 | All four spans present and populated (lines 543–563). |
| 12.3 | Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. | 🟢 | Each tier reduces to a semicolon-separated list of bare outcomes; no Magnitude data carried over. |
| 12.4 | Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. | 🟢 | No parentheses appear in any benefits item. |
| 12.5 | If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing. | N/A | All four ER benefit tiers contain items. |
13. Risks
| # | Description | Result | Comments |
|---|---|---|---|
| 13.1 | The section is derived from the ER Potential Risks & Side Effects section |
🟢 | All six ER risk headings are represented at their ER tier. |
| 13.2 | Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative] | 🟢 | All four spans present and populated (lines 623–637). |
| 13.3 | Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. | 🟢 | No odds ratios, confidence intervals or adulteration percentages carried over. |
| 13.4 | Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. | 🟢 | The ER’s “(Slow Heart Rate)” gloss is correctly stripped; no parentheses remain. |
| 13.5 | If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing. | N/A | All four ER risk tiers contain items. |
14. Monitoring
| # | Description | Result | Comments |
|---|---|---|---|
| 14.1 | The section is derived from the ER Monitoring section |
🟢 | Rows mirror the ER Monitoring Protocol & Defining Success biomarker table. |
| 14.2 | All measurable/quantifiable biomarkers from the Monitoring section are listed |
🟢 | All nine listed: ALT, AST, GGT, ALP, total bilirubin, resting heart rate, FSH, estradiol, TSH, with ER targets intact. |
| 14.3 | [monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty. |
🟢 | Baseline, 4–8 weeks, every 3–6 months, monthly heart rate and week-12 diary all carried from the ER’s opening paragraph. |
15. Qualitative Assessment
| # | Description | Result | Comments |
|---|---|---|---|
| 15.1 | The section is derived from the ER Monitoring section |
🟢 | Sourced from the ER’s qualitative marker bullet list. |
| 15.2 | All subjective/qualitative biomarkers from the Monitoring section are listed |
🟢 | All six ER qualitative bullets present verbatim, none omitted or added. |
Issues 16/08/2026 13:07
Pass rate 100.00%. No issues found.
Issues 16/08/2026 13:00
- 13.4 — Parenthetical gloss kept over ER term: [risks_low] (line 633) reads “Symptomatic slow heart rate”, preserving the parenthetical “(Slow Heart Rate)” from the ER heading “Symptomatic Bradycardia (Slow Heart Rate)” (ER line 252) while dropping the ER’s own term, which is also inconsistent with the contraindication item that uses “Symptomatic bradycardia”.
Fixes 16/08/2026 13:00
- 13.4 — Parenthetical gloss kept over ER term: Changed [risks_low] from “Symptomatic slow heart rate; weight gain” to “Symptomatic bradycardia; weight gain”, restoring the ER’s own term and dropping the preserved parenthetical gloss.
Issues 16/08/2026 12:52
- 13.4 — Parenthetical kept in risks tier: [risks_low] at line 633 retains the parenthetical gloss “(slow heart rate)” carried over from the ER heading “Symptomatic Bradycardia (Slow Heart Rate)”; parenthetical content in the tiered risk items must be stripped.
Fixes 16/08/2026 12:52
- 13.4 — Parenthetical stripped from risks tier: Changed [risks_low] from “Symptomatic bradycardia (slow heart rate); weight gain” to “Symptomatic slow heart rate; weight gain”, removing the parenthetical gloss while keeping the plain-language wording.
Issues 16/08/2026 12:48
- 1.2 / 1.3 — Hedged ER claim asserted flatly: [at_a_glance] (lines 434-437) states “It does not raise estrogen or stir breast or womb tissue”, while the ER Conclusion (line 466) says “it has not been shown to thicken the womb lining or stir breast tissue”.
- 12.3 / 12.4 — “(conflicted)” qualifier in Benefits: [benefits_high] (line 545) appends “(conflicted)” to the hot flash item, adding a parenthetical evidence-strength qualifier that the tier label already encodes.
- 13.3 / 13.4 — “(conflicted)” qualifier in Risks: [risks_medium] (line 630) and [risks_low] (line 636) append “(conflicted)” to idiosyncratic liver injury and weight gain, adding parenthetical qualifiers that the tier labels already encode.
Fixes 16/08/2026 12:48
- 1.2 / 1.3 — Restored ER hedge in At-A-Glance: [at_a_glance] now reads “It does not raise estrogen and has not been shown to stir breast or womb tissue”, matching the ER Conclusion’s hedged phrasing; the opening clause was shortened to “symptoms after menstrual cycling ends” to stay within the 60-word limit (59 words).
- 12.3 / 12.4 — “(conflicted)” removed from Benefits: [benefits_high] changed from “Relief of menopausal hot flashes and night sweats (conflicted)” to “Relief of menopausal hot flashes and night sweats”.
- 13.3 / 13.4 — “(conflicted)” removed from Risks: [risks_medium] now reads “Idiosyncratic liver injury; species adulteration in commercial products” and [risks_low] “Symptomatic bradycardia (slow heart rate); weight gain”.