Exploration of Ascending-Descending-Exiting-Entering in Yi Xue Zhong Zhong Can Xi Lu: from classical philosophical theory to a novel diagnostic framework

“Medical Records of Integrating Traditional Chinese and Western Medicine: Yi Xue Zhong Zhong Can Xi Lu” (abbreviated as YXZZCXL), authored by the influential physician Xichun Zhang, a pioneering authority on the integration of Chinese and Western medicine, enriched the path of integrated medicine. The formulas documented in this work are renowned as “formulas of proven efficacy” with excellent clinical efficacy, playing a significant role in the development of modern Traditional Chinese Medicine (TCM). This raises a key question: what is the most effective way to study and understand YXZZCXL? Drawing on their learning journey, clinical practice, and prior research, we propose that commencing with the Qi philosophy concept of “Ascending-Descending-Exiting-Entering” (ADEE) provides a straightforward yet effective approach to comprehending the prescription composition within YXZZCXL and the underlying TCM treatment theories it encompasses. Crucially, this approach serves to synthesize Zhang’s scattered clinical insights into a coherent ADEE framework. The framework helps fill systematic gaps in the structure of his academic thought on formula design and treatment principles. Building upon this foundational ADEE framework, we may achieve a leap from ADEE theory towards the development of a novel Qi-movement-centered ADEE syndrome differentiation method. This method serves as a clinical diagnostic and therapeutic tool, effectively linking TCM’s ADEE theory to formulas exerting corresponding regulatory effects, and is particularly indicated for disorders characterized by abnormal Qi movement. It must be emphasized that utilizing ADEE for formula categorization in this study is not a mechanical exercise; rather, it offers four fundamental conceptual perspectives through which disease mechanisms and treatments can be understood. Notably, due to the lack of systematic elaboration on the specific concept of “Exiting-Entering” in classical Chinese medical texts, this study proposes a preliminary interpretation grounded in TCM Qi theory and invites scholarly discourse to refine its theoretical connotation. This three-stage research pathway—synthesizing classical theory, constructing a theoretical framework, and developing a novel differentiation method—is proposed as a potential model for studying other TCM classics. Overall, the most significant academic contribution of this study lies in the systematic proposal and construction of a novel theoretical framework for treatment based on syndrome differentiation, which emerges centuries after the last major advancement in TCM diagnostic approaches.