Abstract: From the perspective of the knowledge history, the development of traditional Chinese medicine (TCM) knowledge related to esophageal cancer began with early records of "difficulty in swallowing" during the Qin and Han dynasties. Through the accumulation of symptom-treatment experience during the Wei and Jin dynasties, it shifted towards theoretical exploration during the Song and Yuan dynasties, clarifying the pathogenesis of stomach cold, phlegm qi, and blood stasis, and so on. By the Ming and Qing dynasties, a rudimentary system for the syndrome differentiation of esophageal cancer was gradually formed, and the characteristic of "esophageal stricture" in this disease was identified. Finally, in the late Qing dynasty, Western medicine introduced the concept of "cancerous swelling". The current theory of cancer toxin pathogenesis, with cancer toxin pathogenesis at its core, innovatively integrates related knowledge, representing a reconstruction and transformation of traditional knowledge in the context of the new era. The relevant knowledge from past dynasties serves as both the premise and foundation for the innovation of the cancer toxin pathogenesis theory, and it also inspires new vitality in clinical practice through this theory, providing insights and methodologies for the innovation of modern TCM theory.