With the development of HUANGs’ school of acupuncture and moxibustion of Zhuang medicine in clinical practice and international exchange, the number of overseas patients has gradually increased, and the translation of overseas clinical case records faces risks of semantic shift and dilution of medical connotations in cross-cultural contexts. Taking overseas clinical case records of HUANGs’ school of acupuncture and moxibustion of Zhuang medicine in Guangxi as the primary object of analysis, this study employs methods including textual analysis of case records, structural comparison, and terminology categorization to systematically examine their structural and terminological characteristics as well as key issues arising in translation. The study reveals significant differences between Zhuang medicine case records and Western medical records in terms of narrative structure, disease cognition, and cultural context. From the perspectives of structural translation and terminological translation, this paper proposes a normative framework that balances the preservation of Zhuang medicine characteristics with the needs of cross-cultural understanding. This framework includes hierarchical presentation of case record components, functional interpretation of disease names and acupuncture terminology, and process-oriented supplementation of therapeutic effect descriptions. The aim is to enhance the accuracy and usability of case records in international communication and academic dissemination, and to provide references for the standardized organization and database construction of Zhuang medicine clinical case records.