Traditional Chinese Medicine Recorded by Missionaries... : Chinese Medicine and Culture (2025)

1 Introduction

Medical history is increasingly recognized as a pivotal field within Chinese historiography, with The China Medical Missionary Journal (《博医会报》, CMMJ) emerging as a critical resource. CMMJ (Fig. 1) is esteemed for its historical and scientific significance in the annals of modern Chinese medical evolution. This article rigorously scrutinizes the original documents from CMMJ, particularly the depiction of traditional Chinese medicine (TCM) by medical missionaries. It dissects the missionaries’ evolving views on TCM, tracing the transition from skepticism to endorsement. Additionally, it evaluates the missionaries’ research into Chinese medicinal practices, focusing on their investigation, application, and scientific analysis of Chinese medicine. The article concludes with an assessment of the cumulative influence of these research dimensions on the progression of modern Chinese medical science.

2 Missionaries’ understanding of TCM

2.1 Medical context of the 19th century: a Sino-Western perspective

Western medical science, having undergone significant evolution with the advent of anatomy in the 16th century, physiology in the 17th century, and pathology in the 18th century, experienced a surge in advancement during the 19th century. This period was marked by transformative natural science discoveries—the cell theory, the law of conservation and transformation of energy, and the theory of biological evolution—which collectively accelerated medical and technological progress.¹ Successive developments in high-precision scientific technologies, particularly in bacteriology and pathological anatomy, revolutionized the comprehension of diseases. In stark contrast, TCM has failed to keep pace with the times and still seemed to be shrouded in a veil of conservatism and antiquity. Against the backdrop of China’s near-universal lag behind the West in politics, economy, and culture, it was perhaps inevitable that its medical practices would also fall behind.

Joseph C. Thomson, in his discourse within CMMJ, critiqued the foundational surgical knowledge of TCM as rudimentary and erroneous, asserting a substantial divergence from scientifically accurate understanding.² He emphasized that TCM lacked knowledge of disinfection, and that all diseases were treated with acupuncture and moxibustion, which he saw as an unscientific misuse. Moreover, in his experience, not only did the patients he treated not improve through acupuncture, but their pain was also exacerbated.³ British missionary James Dyer Ball also wrote in Zhong Guo Feng Tu Ren Min Shi Wu Ji (《中国风土人民事物记》 Things Chinese: Or Notes Connected With China): “In some cases, the needle has been known to break in the body of the patient, and has had to remain there until extracted by the skill of the Western practitioner.The needle used looks very much like a sewing-machine needle, but is longer and coarser than that. Some of the Chinese doctors have needles two feet long, and are supposed by ardent admirers to be able to drive these instruments entirely through the patient’s body; but the great size of the needles is in reality intended to represent the greatness of the owner’s skill and reputation”⁴ (Fig. 2). To medical missionaries, TCM, perceived as an empirical accumulation devoid of scientific underpinnings, was often associated with superstition and ignorance, thus being conflated with unscientific methods.

Indeed, facilitating a profound understanding of the cognitive frameworks and therapeutic modalities of TCM for missionaries within a brief period was a formidable task. Prior to the Opium Wars, stringent customs restrictions imposed by the Qing government precluded missionaries from entering China or moving about freely. The Treaty of Wanghia (《望厦条约》 Treaty of Peace, Amity, and Commerce, Between the United States of America and the Chinese Empire) in 1844granted medical missionaries the right to practice and establish hospitals in China’s trading ports, yet it was post the Second Opium War that their medical missionary endeavors and scholarly pursuits truly commenced. The aftermath of the wars, with the signing of unequal treaties, expanded the operational scope of missionaries across China, facilitating a new chapter in their engagement with and understanding of TCM.⁵ Therefore, the disparity in medical backgrounds and the restrictive policy conditions also meant that medical missionaries could not achieve an in-depth understanding of TCM in the short term; they too needed time to understand and discover the uniqueness and scientific nature of TCM.

2.2 The dismissive attitude towards traditional Chinese medicine

From the cultural psychology and practical situation of early medical missionaries in China, facing the widespread belief in TCM and the mainstream status of TCM in medical life, they showed a disdainful attitude towards TCM to open up a situation for missionary medicine. They emphasized the efficacy and achievements of Western medicine to win more medical discourse power. First, they criticized the lack of systematic medical education in China and the mixed quality of medical practitioners. Joseph Edkins expressed his disappointment with the group of Chinese doctors in CMMJ, comparing TCM surgeons who lack knowledge of anatomy and physiology to the “barber” of medieval Europe, referring to those who practice medicine without a medical license and lack of medical literacy and knowledge.⁶ This metaphor vividly experssed the questioning of the medical level of modern Chinese doctors. Medical missionaries generally believed that the lack of specialized medical education was the root cause of the backwardness of Chinese medicine, and they questioned the examination and assessment system for Chinese medical practitioners in CMMJ: “Does the Hanlin College (翰林院) at Peking still confer medical diplomas?” “Mayers, in his Chinese Goverment, has two references to the ‘College of Imperial Physicians (太医院)’. will somebody enlighten us on that ‘College’?”⁷ Therefore, even if the medical level of TCM practitioners was high, they were still subject to criticism in the eyes of medical missionaries. In 1901, H.T. Whiney published an article in CMMJ titled “Medical education in China”, pointing out that compared with American medical education, China’s medical education at that time was “deplorable”. He commented, “Medically China is but little in advance of ‘Darkest Africa’, considered apart from what Western nations have done for her, and the light that has come to her from without in years past has done much to prepare the way for extensive reform both in medicine and in other forms of education and civilization, and the experience of the year nineteen hundred is but the Chinese way of breaking with the past, and will eventuate in furthering many of the medical reforms necessary to enable China to be classed with other important nations of the world”.⁸ It cannot be denied that Whiney’s statements were somewhat exaggerated, but they also offered a perception of the limitations in Chinese medicine at that time.

Furthermore, beyond the imperfections in medical education, the resort to witchcraft (巫术) healing practices was a significant point of contention among missionaries of the time. In 1887, CMMJdocumented a case where a monk, known for his “Folk Remedy (偏方)” for various ailments, would mix incense ash with tea in certain proportions for patients to consume, or perform exorcisms using peculiar rituals to drive away perceived evil spirits from the afflicted.⁹ Such sorcery-based treatments were not uncommon in China, and the missionaries found them absurd, which further fueled their skepticism towards the Chinese medical paradigm.

The missionaries also looked down upon the secret prescriptions of TCM. They recounted a case involving a two-year-old with diphtheria, where the child’s swollen lymph nodes due to inflammation were treated by stuffing an egg into a frog’s mouth, roasting the frog, and then feeding the egg to the child. The author sarcastically remarked, “To the first I side the frog was a mistake, it is a very weak creature, you should have caught a tiger, and have thrust a goose-egg down his throat. This would have been much effective one way or the other”.¹⁰

Another instance involved a recommendation for a woman suffering from severe vomiting and inability to keep food down: “Catch the badger, cut off one foot, roast this thoroughly and pulverise, which may be given to the patient to quiet her troubled stomach”.¹⁰ J.H. McCartney also wrote in CMMJ about a woman who insisted on cutting part of her liver to save her mother, a desire stemming from superstitious beliefs prevalent in Chinese medical texts (Fig. 3). He noted that such superstitious notions heavily influenced the doctor-patient relationship at the time.¹¹

The missionaries viewed TCM of that era as a blend of religious and superstitious folk medical practices, with treatments that bordered on the absurd. They commented, “The practice of medicine in China develops a singular medley of experiences, from the solemn and sad, to the grotesque and ludicrous”.¹² Faced with what they perceived as a backward and decaying state of TCM, the missionaries critiqued and expressed dissatisfaction with the field, applying the scientific rationality, perspective, and standards of TCM to their assessments.

2.3 Affirmation of effective traditional Chinese medicine treatments

As early as the establishment of the China Medical Missionary Association (CMMA), there have been voices affirming TCM, but they were not mainstream and were drowned out. In 1887, CMMJ published: “Chinese medical practice is often absurd enough, but some of their old wives’ remedies are as efficacious as they are simple”.¹³ Through clinical practice, medical missionaries began to share effective treatment experiences of TCM, “A cold in the head is rather beneath the notice of our doctors, but it causes a considerable amount of discomfort all the same. The Chinese remedy is very simple. Any Chinese person can obtain some peppermint leaves,and an infusion of these drunk before going to bed generally effects a speedy cure. For headaches, small discs of fresh radish peel to the temples afford great relief”.¹³ In addition, medical missionaries showed great interest in traditional Chinese nurturing (中医养生) and traditional Chinese Tui Na (中医推拿), Joseph C. Thomson studied the exercise therapy of TCM, stating that during the health preservation exercise process, attention should be paid to the swallowing of saliva and the friction between the tongue and teeth, describing the exercise posture to be like the movements of cows and dragons, emphasizing that the practice should be carried out three times a day, and with long-term uninterrupted practice, physical functions can be supplemented and restored.¹⁴ They also affirmed the medical value of traditional Chinese Tui Na, stating that it can achieve the effect of relieving pain, treating diseases, and aiding sleep, and strongly recommended it to foreign doctors.¹⁵ They also introduced the classic prescriptions from ancient Chinese medicinal books, using Fu Wei San (扶危散 The Powder for Saving the Dying) from Yi Zong Jin Jian (《医宗金鉴》 Golden Mirror of the Medical Tradition) to treat rabies, which could fight fire with fire, making the urine smooth and allowing the evil poison in the body to be quickly discharged.¹⁶ They also introduced that when Chinese people treat edema diseases, they extract a sensory material called “Senso (蟾蜍)” from the skin of toads, and after testing, it is known that this material does indeed contain elements that relieve edema.¹⁷

Medical missionaries began to affirm the effective treatment of TCM and gradually realized the limitations of their previous understanding of it. In 1916, on the 30th anniversary of the founding of CMMJ, the editorial “Chinese medicine and surgery” analyzed the criticism of TCM by missionaries since the 19th century. They admitted that in the past, to win the support of their home country, they often emphasized the backwardness of TCM. However, if TCM had no effect, it would inevitably be abandoned by the Chinese people. The fact that TCM treatment has existed for centuries must have its significance and rationale. They also criticized the previous attitude of completely denying the “secret recipes (秘方)” of TCM and proposed to investigate and analyze TCM without prejudice.¹⁸ With time, the understanding of TCM by medical missionaries also began to deepen. They studied medical ethics and discussed medical principles with TCM practitioners, began to face TCM positively, and to a certain extent, identified with it, reporting and conveying the effective results of TCM in CMMJ.

3 Research and utilization of TCM medicinal materials by missionaries

3.1 Utilization of effective medicinal materials

Upon their initial arrival in China, the missionaries, accustomed to the European and American continents, found their constitutions ill-adapted to the local environment. Consequently, when afflicted by various diseases such as Japanese filariasis and malaria, both traditional Chinese and Western medical treatments sometimes proved ineffective, even posing a risk to life.¹⁹ Based on statistical data, the American Board of Commissioners for Foreign Missions (ABCFM) reported that in the first two decades of their missionary activities, 45missionaries died in the regions where they served. Additionally, 31 were compelled to return to their home country due to health issues affecting themselves or their families. Surveys indicated that the average lifespan of missionaries and their families from other mission boards was also significantly lower than the national average.²⁰ This urgent need for survival accelerated the medical missionaries’ research and utilization of TCM, leading them to summarize the characteristics and therapeutic effects of Chinese medicine, and to begin utilizing indigenous medicinal materials. Missionaries embarked on an active explorations of Chinese medicine. Although they initially held a disdainful attitude towards TCM, they have always been interested in Chinese medicine. As their practice with Chinese medicine deepened, they recognized its advantages and value. Consequently, articles discussing how to use Chinese medicine to treat diseases by missionaries were often published in CMMJ.

In 1890, in CMMJ, A.Wm. Douthwaite published an account of a fern species known as Jin Mao Gou Ji (金毛狗脊 Cibotii Rhizoma), describing it as follows: “Thestalk of this fern is covered with a soft down of fine hair of golden colour ……A plugof this placed in any cavity, will almost always stop oozing and hemorrhage, shortof arterial bleeding, which can be arrested by ligature ……”²¹Jin Mao Gou Jihe documented is identified as Gou Ji (狗脊 Rhizoma Cibotii) fern, a species of the Osmundaceae family, first recorded in the Shen Nong Ben Cao Jing (《神农本草经》 Shennong’s Classic of the Materia Medica) , with the down on the stem capable of stopping bleeding.²² In his seminal work Ben Cao Gang Mu (《本草纲目》 The Grand Compendium of Materia Medica), the Ming dynasty pharmacologist Li Shizhen (李时珍) distinctly mentioned that Jin Mao Gou Ji not only stops bleeding on the exterior but also has the effects of nourishing the liver and kidneys and strengthening the muscles and bones.²³

Missionaries also discovered that Dang Gui (当归 Angelica sinensis) was the most frequently prescribed herb in TCM, noting:“ It is regard as a valuable remedy in the treatment of menstrual and puerperal disorders and of sterility in women ,though it is also used in a variety of other conditions”.²⁴ Consequently, they introduced Angelica sinensis to Europe for the treatment of uterine diseases.

During the cholera outbreak in Fuzhou (福州) from August to September 1918, missionaries found that the use of kaolin significantly reduced the mortality rate and contained the spread of the epidemic. Kaolin, a natural non-metallic mineral with excellent adsorption, plasticity, and dispersibility, appears as a white powder. They highly affirmed its use in CMMJ: “We have had 13deaths out of these 100 cases,but three of these died within an hour or two after entering the hospital. No treatment of any sort could have saved them. Of the cases which received only kaolin, only one death has occurred”.²⁵ The missionaries actively published their findings on the effective use of indigenous medicinal materials in CMMJ, making it a platform for the dissemination of medical academic exchanges.

3.2 Advanced processing

The escalating costs of Western medicines, exacerbated by expensive transportation, have necessitated the quest for efficacious and economical alternatives. In this context, medical missionaries in China turned to the in-depth refinement and processing of Chinese medicine.

Initially, they explored alternative remedies, such as the ventriculi galli mucosa , which Geo. King noted as a valuable digestive aid supported by American research and his clinical practice in China.²⁶ In the absence of santonin and other potent anthelmintic medicines, missionaries, through diligent research and clinical practice, discovered that the plant known as Shi Jun Zi (使君子 Fructus Quisqualis) exhibits effective anthelmintic properties.²⁷ This plant, with a rich historical pedigree in TCM, is officially recognized in the 2010 edition of Zhong Guo Yao Dian (《中国药典》 Chinese Pharmacopoeia) for its ripe, dried fruit, which is harvested in autumn when the fruit’s skin turns purplish-black. It is indicated for the treatment of ascariasis, enterobiasis, abdominal pain due to helminthic infestation, and pediatric malnutrition.²⁸Amidst an environment steeped in Chinese medicine, medical missionaries instinctively integrated the application of these herbal remedies into clinical practice, thereby refining and validating their efficacy through empirical outcomes.

Subsequently, missionaries embarked on the purification and processing of indigenous medicines. As documented by A.Wm. Douthwaite in CMMJ, “Many native drugs are too impure or of too uncertain composition to beof much use to the physician, but some of them can be purified, and nearly allthe apparatus required for that purpose can be made in China. For the manufacture ofSublimed Sulphur, all that is required is an iron pan in which to burn thenative sulphur, a tube to convey the fumes to a large wooden box, on the sidesof which the flowery crystals will be deposited.Camphor may be purified by means of the same apparatus, but of course,it should be slowly evaporated, not burned.Soluble crystals, such as PERCHLORIDE or MERCURY (白降丹 Peh chiang tan) or SULPHATE OF IRON (Ts’ing fan 青礬) can be obtained pure by solution,filtration and re-crystalization......”²¹ These processes, although reliant on local raw materials, were hindered by supply limitations. The innovative work of Wilson in Hanzhong (汉中), Shanxi, who synthesized Nordhauson Sulphuric Acid from local iron sulfates,²¹ broke through these constraints, facilitating the production of a range of chemical medicines. These self-reliant efforts by missionaries in China greatly advanced the study of indigenous medicines, promoting the utilization and refinement of Chinese medicine, reducing the reliance on imported pharmaceuticals, and pioneering medical experimental practices in China. Missionaries did not receive systematic training in TCM theory; however, during the process of advanced pharmaceutical compounding, they became familiar with the knowledge of using Chinese medicine. In some cases, they even surpassed the Chinese in the blending and compounding of certain Chinese medicines. Although they still harbored a dismissive attitude towards TCM, they were more inclined to employ scientific and chemical analysis methods to extract as many active ingredients from Chinese medicine as possible, thereby further fulfilling their medical missionary needs.

3.3 Bernard Emms Read pioneers the scientific classification of Chinese medicines

In 1890, during the first general assembly of CMMA, a committee was established to investigate Chinese medicine. This platform facilitated research into the medicinal value and clinical application of Chinese medicine. Representative researchers included John Glasgow Kerr, A.Wm. Douthwaite, and Joseph C. Thomson, who published a total of nine significant articles in CMMJ. Their research primarily focused on the characteristics and clinical value of Chinese medicine, without venturing into new directions. In contrast, Bernard Emms Read, a missionary from the London Missionary Society, initiated research into the scientific classification and examination of Chinese medicines. He categorized medicines into herbal and mineral medicines, emphasizing the differences between the two in actual research. He divided Chinese medicines into three categories: (1)herbal medicines that meet Western medicine standards, such as Zhang Nao (樟脑 Camphora Cumina), Rou Gui (肉桂 Cortex Cinnamomi), and Ding Xiang (丁香 Flos Caryophylli); (2)herbal medicines with plant properties similar to Western medicine standards, such as Xiang Si Zi (相思子 Abrus Precatorius), Ma Bian Cao (马鞭草 Verbena Officinalis), and Ma You (麻油 Sesamum Indicum); (3)medicines with potential value to modern medicine, such as Che Qian Cao (车前草 Plantago Asiatica), Zi Luo Lan (紫罗兰 Matthiola incana), and Kuan Dong (款冬 Tussilago Farfara).²⁹ When organizing and researching the complex field of Chinese medicinal materials, Read emphasized the standardization of research samples and published requirements and explanations for sample examination in 1923 CMMJ (Table1).

Bernard Emms Read advocated for the scientific classification and research of Chinese medicine, filling a gap in the organization of Chinese medical literature and breaking the preconceived superstitious notions about Chinese medicine held by Westerners. He began to establish the precious value of Chinese medicine worldwide through the form of scientific research reports.

4 Achievements

4.1 Enrich historical medical records

CMMJholds not only historical significance but also scientific medical value in the modern history of Chinese medicine. It has propelled the scientification of medical research and serves as a precious historical record for the study of TCM. Initially, it was primarily aimed at a foreign medical audience, but as research into TCM deepened, it gradually evolved into a comprehensive collection of Chinese medicine, folk, health, and educational materials. CMMJ provided a platform for medical exploration and academic exchange for medical missionaries in China. The medical reports published by these missionaries in CMMJ offered a scientific research paradigm and model for modern China’s medical studies. This research model was inherited by local Western medical organizations, ensuring the continuity and development of the modern scientific occupational activity pattern of medical research in China. The Chinese Medical Association (CMA), drawing on the model of CMMJ, established its publication, Chinese Medical Journal (CMJ).³¹ The research on TCM published by missionaries in CMMJ provided a window for the Western medical community to explore Chinese medicine, especially their attitudinal shift, which also offered Westerners a new perspective on TCM. Although their research was inevitably rudimentary and failed to delve deeply into the field of TCM, their pioneering contributions provided invaluable records for future researchers. Their documentation of TCM is an indispensable historical medical resource for the study of modern China. The missionaries’ research on TCM facilitated the CMMJ’s transformation from a periodical with distinct religious overtones to a scientific medical journal.

4.2 Promoting the progress of modern Chinese medicine

CMMJhas borne witness to the entire process of the attitude shift of medical missionaries in China towards TCM, from disdain to gradual acceptance, and their recommendations of effective TCM therapies and valuable herbal extracts to the West. Their critiques of China’s medical system and health endeavors played a positive role in propelling the development of medical science and health construction in modern China. In their writings on TCM, the missionaries also emphasized the close relationship between etiology and environment, discussing the need for improved sanitary conditions, which to some extent aroused the awareness of health environments and promoted the rise and development of public health during the Republic of China era. Besides expressing skepticism about witchcraft treatments, the missionaries also addressed social maladies such as alcoholism, opium addiction, and foot-binding, which they experienced during their medical missionary work, as spiritual diseases of China. They published these issues in CMMJ, strongly advocating for the abolition of these malpractices, which objectively advanced the reform of Chinese social customs and the progress of ideological civilization. Although the missionaries’ dissatisfaction and sympathy for the backwardness of Chinese medical education were evident in CMMJ, their efforts to change this situation were commendable. Their published views sparked some reflection among the Chinese on their education and laid the groundwork for the construction of the modern Chinese medical system. After the Republic of China was established, medical missionaries began to cooperate with the Chinese government to establish medical schools, set up medical education councils, and vigorously carry out public health campaigns. The report templates published by the missionaries in CMMJ also served as references for the establishment of modern Chinese medical journals. Their scientific research and extraction of Chinese medicine initiated the process of Westernization of TCM in modern China. Overall, Chinese medicine has been the most intriguing subject for missionaries, although some did exhibit a sympathetic understanding towards TCM, having conducted certain explorations and offered a degree of positive evaluation. Nevertheless, their general inclination was predominantly negative towards TCM. Their perception of the distinction between TCM and Chinese medical remains a significant source of contemporary Western society’s assessment of TCM and Chinese medical. This has even influenced the views and understandings of Chinese medical among some Chinese individuals since the 20th century. Consequently, they have championed science and proclaimed the slogan “Fei Yi Cun Yao [废医存药 abolishing Yi (the theory of TCM) and reserving Yao (the medication of TCM)]” which has to some extent promoted the innovation and development of TCM.

4.3 Facilitating the dissemination and communication of medical knowledge

With its rich resources and long history, China was an ideal region for medical missionaries to conduct medical research. The research by medical missionaries on Chinese medicine in CMMJ, using Western scientific knowledge to test and refine the components and efficacy of medicinal material, represented an effective integration of Chinese and Western resources. It allowed Western scientific technology to be applied in the field of Chinese medicine. This exchange was invaluable both technologically and medically, representing a valuable exchange of knowledge and culture between the East and the West. The medical missionaries did not confine their collected medical achievements to publication solely in CMMJ; their works also appeared in other academic journals in Europe and America. The medical missionaries made an indelible contribution to promoting global medical exchange and dissemination. The extensive writings of the medical missionaries on TCM made CMMJ as an essential medium for the Western medical community to understand China. It served not only as a window for “the eastward dissemination of Western medicine (西医东渐)” but also as a bridge for “TCM’s western transmission (中医西传)”. The depiction of TCM by medical missionaries provided the international medical research community with experiences from China, enriching the diversity of global medical content and highlighting the uniqueness of TCM. This uniqueness includes explorations of TCM theory and the systematic organization of traditional Chinese pharmacy. The missionaries were pioneers in breaking down barriers in medical concepts, attempting an integration of Western and Eastern medical practices, and demonstrating a confluence of Western and TCM and comparative studies. They facilitated the development of global medical progress and filled the gaps in TCM.

5 Conclusion

Missionaries’ discourse on TCM in CMMJ reflects a transformative perspective on indigenous Chinese medical practices. Their progressive engagement with the therapeutics of TCM has evolved from a view of it as conservative and antiquated to one that acknowledges its efficacy, as demonstrated through Western methodologies of experimental and clinical medicine. This shift includes affirmation of traditional treatment modalities and appreciation for the efficacy of Chinese herbal remedies, thus opening new positive avenues for the study of modern Chinese medical development. The missionaries’ discussions on Chinese medical education have also facilitated the establishment of contemporary Chinese medical systems. CMMJ, preserving these valuable historical records, holds both medical and cultural significance, serving as a platform for academic inquiry and cultural exchange. The writings of missionaries on TCM represent a confluence of Eastern and Western medical research and cultural interactions, contributing significantly to the study of modern Chinese medical advancements and Sino-Western cultural exchanges. CMMJstands as a testament to the missionaries’ role in the history of cultural exchanges between China and the West.

Funding

None.

Ethical approval

This study does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

LI Yanran drafted and translated the article, YAN Na reviewed and modified the article.

Conflicts of interest

The authors declare no financial or other conflicts of interest.

References