1. Observation
What was actually seen, heard, felt, reported or measured, including uncertainty and missing information.
Research status. MLMN is a developing conceptual and
documentation framework proposed by Koichi Ishihara. It is not a
validated diagnostic instrument, treatment protocol or claim of clinical
effectiveness.
The central proposition
East Asian medical practice often uses several explanatory systems in the same encounter. MLMN records those systems as interacting layers so that observations, inferences, operations and later responses can be reviewed separately.
The framework does not assume that all layers must agree. A contradiction may indicate missing observation, a change over time, a difference between textual lineages or a limit in the current model. Preserving the contradiction is often more useful than hiding it inside a single label.
The ten layers
| Layer | Coordinate | Opening question |
|---|---|---|
| L1 | Constitution | What predispositions, reserves and long-standing tendencies shape this person? |
| L2 | Etiology | What may have initiated or continued the disorder: climate, emotion, diet, exertion or another condition? |
| L3 | Zang-Fu | Which functional relationships among the zang and fu are implicated? |
| L4 | Qi, Blood and Fluids | How are movement, nourishment, fluid transformation, deficiency or accumulation expressed? |
| L5 | Meridians | What pathways and surface findings are suggested by meridians and acupoint responses? |
| L6 | Six Conformations | How might the dynamic be described through the six conformations and changes of exterior/interior, cold/heat and deficiency/excess? |
| L7 | Sanjiao | How are distribution and obstruction organised across upper, middle and lower regions? |
| L8 | Ministerial Fire | How is the activating movement associated with ministerial fire regulated, displaced or weakened? |
| L9 | Environment | How do season, climate, place and living conditions modify the presentation? |
| L10 | Time | When did change begin, what sequence followed and under what conditions does it recur? |
Four record types must remain distinguishable
2. Interpretation
Which model is being used, what it explains and which findings conflict with it.
3. Operation
What was done, including selection, sequence, intensity, duration and the reason for each decision.
4. Update
What changed, when it changed and which earlier assumption should be retained, revised or rejected.
A network rather than a ladder
The ten layers are not ranked from primitive to advanced, and they are not ten competing diagnoses. A causal proposal in one layer may alter the interpretation of findings in another. Time and environment can change the meaning of an apparently stable pattern. The record therefore needs explicit links, not merely a checklist.
What must be tested
- Whether different practitioners can apply the layer definitions with acceptable consistency.
- Whether the framework captures clinically relevant information that ordinary records omit.
- Whether explicit contradictions and temporal updates improve teaching, review and hypothesis generation.
- How classical claims, modern scholarship and clinical observations should be assigned different evidence statuses.
- Which parts of the framework should be revised or abandoned after external criticism and empirical testing.
Clinical boundary. This framework does not diagnose a
person, select treatment or guarantee outcomes. Urgent or persistent
symptoms require assessment by an appropriately qualified healthcare
professional.