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The Internet has opened up an unprecedented opportunity to build up powerful large-scale medical expert systems. In these systems, a cost-effective medical knowledge acquisition and management scheme is highly desirable to handle the large quantities of, often conflicting, medical information collected from medical experts in different medical domains and from different regions. To this end, in this paper, we demonstrate that a medical knowledge acquisition/management system can be built upon a three-tier distributed client/server structure. The knowledge in the system is stored/managed in three knowledge bases, and the knowledge flow through these knowledge bases is dependent on the degree of the maturity of the medical know-how. Furthermore, to facilitate the knowledge representation in these knowledge bases as well as information retrieval across the Internet, an 8-digit coding scheme is proposed. At present, a medical knowledge acquisition and management system based on the proposed method is being tested in clinics. The preliminary results showed that the method is a viable solution to build and grow a medical expert system through the Internet.