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.
Structural revision, August 2026. MLMN was reorganised into the current nine-layer model. Ministerial fire was removed as an independent layer; Environment is now L8 and Time-phase is L9. Ministerial fire remains a source-grounded pathomechanistic concept linking multiple layers.
Formation history: The unreviewed 16 May 2026 initial manuscript used the former L1–L10 model. Its English abstract, bibliography, verification status and Japanese full-text PDF are available on the dedicated paper page.
The nine layers
| Layer | Coordinate | Opening question |
|---|---|---|
| L1 | Innate and Long-Term Foundation | What predispositions, reserves and long-standing tendencies shape this person? |
| L2 | Pathogenic and Triggering Inputs | What may have initiated or continued the disorder: climate, emotion, diet, exertion or another condition? |
| L3 | Zang-Fu and Functional Change | 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 | Channels and Routes of Manifestation | What pathways and surface findings are suggested by meridians and acupoint responses? |
| L6 | Six-Channel Current Disease Phase and Transition | In which six-channel location and yin-yang division is the current disease dynamic, and in which direction is it moving? |
| L7 | Sanjiao and Whole-Body Distribution | How are distribution and obstruction organised across upper, middle and lower regions? |
| L8 | Environment, Space and Living Conditions | How do climate, temperature, humidity, place, housing, work, social position and repeated exposures modify the presentation? |
| L9 | Temporal Phase, Reversibility and Conditional Future Trajectory | What history, season, clock time, cycle, fixedness, recurrence and response horizon shape what may still change? |
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 nine layers are not ranked from primitive to advanced, and they are not nine competing diagnoses. Each layer is both a shelf that preserves acquired information and a stage used to reconstruct disease formation. 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.
Ministerial fire, kidney-yin deficiency, damp-heat and phlegm-dampness are therefore recorded as source-grounded pathomechanistic concepts that may link several layers. They are not automatically treated as layers or as raw observations.
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.