A medical-inspired framework for ecological assessment, diagnosis, and stepwise restoration

Under the dual pressures of anthropogenic activities and climate change, global aquatic ecosystems are facing a severe ecological crisis. However, the linkage between ecological assessment and restoration practice is often weak in implementation, limiting the effectiveness of adaptive management and contributing to suboptimal restoration outcomes. To address this gap, this study proposes an ecological assessment and restoration framework inspired by the medical diagnosis and treatment paradigm. By analogizing ecosystem health to human healthcare, the framework translates clinical examination categories into ecological assessment modules. This framework establishes an assessment system comprising four diagnostic examination categories: sensory, laboratory, specific, and follow-up examinations. It further defines four graded restoration protocols: follow-up, outpatient, inpatient, and intensive care unit (ICU) emergency care. Taking Meiliang Bay of Lake Taihu, China, as a case study, the framework identified core ecological problems including eutrophication, cyanobacterial bloom risk, submerged macrophyte degradation, and internal nutrient loading, based on a predefined diagnostic scoring and rule-based classification system, and formulated a stepwise restoration plan. The comparison between the pre-restoration survey (May 2019) and the post-restoration survey (May 2024) shows improvements in key monitoring indicators, including decreases of 26.8% in total nitrogen and 32.5% in total phosphorus, and an increase of 57.1% in submerged macrophyte coverage. In contrast to conventional status-oriented assessment approaches, this framework effectively bridges assessment and restoration decision-making, enables stepwise ecological restoration of rivers and lakes, and provides a systematic and transferable solution for complex river and lake ecological challenges.