Abstract: Chen Xiuyuan was a renowned medical scientist and educator in the Qing Dynasty, whose medical works exerted a profound and far-reaching influence. Taking the version of Xu Lingtai's Classified Prescriptions of the Shanghan Lun collected by Lanzhou University as an example, from the perspective of reading history, we can conduct an in-depth analysis of the formation and evolutionary process of Chen Xiuyuan's medical thought and his works. Xu Lingtai's Classified Prescriptions of the Shanghan Lun collected by Lanzhou University is a rare annotated version by Chen Xiuyuan. Chen left nearly 300 marginal notes and annotations while studying this book. These notes not only directly contributed to Reading Notes on the Shanghan Lun and Changsha's Heart Method, but also served as important materials for the compilation of two later medical works: Concise Annotations on the Shanghan Lun and Annotated Explanations of Shanghan Medical Essentials. Together, these reading traces and his surviving medical works reveal the evolutionary trajectory of Chen Xiuyuan's medical thought: in his early years, he was deeply influenced by Ke Qin and Xu Lingtai's theory of syndrome classification by prescriptions; in his later years, however, he shifted to the academic stance of defending the ancient theories. Meanwhile, it also reflects that the compilation styles and methods of his medical works were significantly shaped by the types of classics he read.