Living inheritance of traditional Chinese medicine: paradigm reconstruction based on longitudinal medical records and an evidence ladder for cardiovascular diseases

<sec><p indent="0mm">Traditional Chinese medicine (TCM) embodies profound theoretical and practical wisdom, yet its inheritance and development face significant challenges in the context of modern medicine’s rapid advancement. Traditional inheritance models, reliant on experiential accumulation and master-apprentice transmission, lack dynamic tracking mechanisms and robust scientific validation systems. This hinders their ability to meet modern demands for precision and objectivity and constrains TCM’s international competitiveness. Addressing this, the present study constructs an innovative paradigm for the “living inheritance” of TCM, using cardiovascular diseases (CVDs) as a demonstrative focus. This paradigm integrates “dynamic empirical knowledge mining, scientific evidence transformation, and humanistic evaluation iteration”. </sec><sec> The study comprises two core modules: methodological design and multidimensional evaluation. The methodological design module systematically establishes an “individual-group-intergenerational” academic evolution framework. This is achieved through: (1) longitudinal medical records analysis: employing semi-quantitative strategies to track the temporal evolution of individualized diagnosis and treatment by master TCM practitioners, capturing dynamic pattern differentiation and therapeutic adjustments over extended periods <sc>(≥3 years).</sc> A standardized specification for recording complex cases was developed. (2) Evidence-based transformation of master practitioner experience: building a dynamic evidence chain via a stepwise approach. This involves in-depth analysis of effective longitudinal records and master interviews to extract core prescriptions and treatment logic, case-control studies to identify factors influencing treatment efficacy and optimize formulas, and prospective studies (including randomized controlled trials [RCTs] and real-world studies [RWS]) to scientifically validate clinical effectiveness and applicability boundaries in diverse settings. (3) Cross-generational integration of humanistic and academic thought: integrating classical literature and the evolving experiences of successive generations of masters (e.g., Wang Qingren, Guo Shiqiu, Weng Weiliang) to form cohesive academic lineages (e.g., the “disease-pattern-symptom combined” diagnostic system, the “treating heart disease must resolve stasis” theory, and the 12-method Blood-Activating &amp; Stasis-Resolving system). </sec><sec> The multidimensional evaluation module establishes a dual-track assessment system integrating pattern quantification and humanistic efficacy: (1) syndrome differentiation precision via objective four-examination techniques: developing standardized, quantifiable methods for inspection (facial/lingual imaging, infrared thermography), auscultation &amp; olfaction (acoustic analysis, exhaled VOC detection), inquiry (structured TCM syndrome scales), and palpation (digital pulse wave analysis using sensors compliant with ISO standards). This aims to create reproducible international protocols linking TCM signs/symptoms to modern cardiovascular indicators (e.g., coronary stenosis, LVEF, BNP). (2) Humanistic efficacy evaluation via co-created medical records: centering patient narratives through semi-structured interviews, reflective diaries, and patient-reported outcomes. This captures subjective experiences, expectations, and quality-of-life impacts, integrating them with objective clinical data using natural language processing and machine learning to form a composite assessment model that reflects patient-centered values. </sec><sec> This research provides a universal methodological framework designed to overcome key bottlenecks in TCM inheritance: fragmentation of experiential knowledge, the “black box” nature of individualized treatments, and subjective efficacy evaluation. By enabling the visualization of dynamic therapeutic trajectories, transforming individual expertise into validated group evidence, and incorporating the patient perspective, the paradigm facilitates the transition from static documentation to the “living inheritance” of TCM knowledge, particularly within cardiovascular medicine. It offers a replicable pathway for integrating TCM into modern healthcare systems, enhancing its global influence, and advancing the modernization of traditional medicine. Future directions include leveraging AI/IoT for enhanced data collection and analysis, fostering interdisciplinary cardiovascular TCM talent, expanding application in complex CVDs, and strengthening international adaptation through evidence standard alignment, data interoperability mechanisms, and cross-cultural communication strategies. </sec>