In 2015, the Chinese scientist Tu Youyou was awarded the Nobel Prize in Physiology or Medicine.
Her discovery was not an acupuncture treatment, nor was it a traditional Chinese herbal remedy in the form in which it had been used for centuries.
It was something rather more interesting.
Tu Youyou and her colleagues had taken an ancient Chinese medical observation, subjected it to systematic scientific investigation, and eventually isolated a completely new pharmaceutical compound from a medicinal plant.
That compound, artemisinin, has become one of the most important treatments for malaria and has saved millions of lives.
The story is fascinating not simply because of what was discovered, but because of the unusual meeting of two very different ways of approaching medicine: the accumulated observations of traditional Chinese medicine and the experimental methods of modern pharmacology.
The problem: a disease that was becoming harder to treat
Malaria is caused by parasites transmitted by mosquitoes. Once inside the human body, the parasites invade red blood cells and can cause recurrent fever, chills and, in severe cases, organ damage and death.
By the 1960s, malaria was becoming an increasingly serious problem because some parasites were developing resistance to existing drugs.
In China, the government responded by launching a large-scale research programme known as Project 523, involving hundreds of scientists and numerous research institutions.
Tu Youyou was appointed to lead a research team in 1969.
Her approach was unusual.
Rather than concentrating exclusively on developing new synthetic chemicals, she began looking through the enormous body of Chinese medical literature for substances that might have been used traditionally for conditions resembling malaria.
According to Tu’s own account, she and her colleagues collected and reviewed thousands of traditional prescriptions and remedies.
Among the plants that attracted their attention was qinghao (青蒿).
Today, the plant relevant to artemisinin is identified botanically as Artemisia annua, or sweet wormwood.
But finding the plant was only the beginning.
An ancient medical text provides an unexpected clue
The really remarkable part of the story came when Tu went back to the old literature.
One of the texts she examined was Zhou Hou Bei Ji Fang — A Handbook of Prescriptions for Emergencies — written by the physician Ge Hong around the fourth century.
The text included a reference to using qinghao for what was interpreted as intermittent fever associated with malaria.
But there was something unusual about the way the plant was prepared.
Rather than boiling the herb in water, the instruction described soaking it and extracting its juice.
This caught Tu’s attention.
At the time, her team had already been experimenting with extracts of qinghao, but the results were inconsistent.
Tu wondered whether the problem was not the plant itself, but the way they were extracting it.
Perhaps heating the plant was destroying the substance they were looking for.
It was a deceptively simple idea.
And it changed everything.
The importance of how a medicine is prepared
Traditional Chinese herbal medicine has always paid considerable attention to preparation.
The same herb can be prepared in different ways — boiled as a decoction, soaked, powdered, processed, or combined with other substances — and these methods are not necessarily interchangeable.
Tu’s work provided a striking example of why this might matter.
Inspired by the ancient description, her team moved away from high-temperature extraction and developed a lower-temperature extraction process.
The results were dramatically better.
In experiments conducted in 1971, one of the extracts showed very high activity against malaria parasites in laboratory animals. Subsequent experiments confirmed the finding.
The next step was to identify exactly what was responsible for the effect.
The answer was a previously unknown chemical compound.
It was eventually named artemisinin, or qinghaosu (青蒿素) in Chinese.
From medicinal plant to modern drug
This is where it is important to understand what actually happened.
It would be misleading to say that Tu Youyou simply took an ancient Chinese remedy and proved that it was an effective modern malaria treatment.
The process was much more complicated — and, in my view, much more interesting.
Traditional medical literature provided a lead.
The researchers then had to identify the appropriate plant, develop a reliable extraction method, isolate the active chemical compound, investigate its pharmacology and toxicity, and test it clinically.
Artemisinin became a modern pharmaceutical rather than simply a traditional herbal preparation.
Clinical studies followed the early laboratory work. Tu’s team reported successful early trials in patients in 1972, and further work established artemisinin and related compounds as highly effective antimalarial drugs.
Today, artemisinin-based combination therapies are among the principal treatments used against malaria.
The World Health Organization describes artemisinin as the core compound of artemisinin-based combination therapies, which remain among the most effective antimalarial treatments.
Tu Youyou was awarded the Nobel Prize in Physiology or Medicine in 2015 for her discovery.
So was this a victory for Chinese medicine?
Yes — but perhaps not in the way you might expect.
It is tempting to tell the story as:
Ancient Chinese medicine discovered a cure for malaria. Modern medicine finally caught up.
That makes for a satisfying story.
But it isn’t really what happened.
The actual story is more subtle.
An observation recorded in an ancient Chinese medical text helped point researchers towards a potentially useful plant and, crucially, towards a particular method of preparing it.
Modern experimental science then transformed that observation into a purified pharmaceutical compound whose safety, effectiveness, pharmacology and clinical applications could be investigated in detail.
In other words, traditional knowledge and modern science did different jobs.
And that is precisely what makes the story so interesting.
Traditional medicine as a source of questions
There is a broader lesson here.
Traditional medical systems contain enormous bodies of accumulated observations.
Some of those observations may turn out to have explanations that fit comfortably within modern biomedical science.
Others may not.
Some traditional treatments may prove ineffective when properly tested.
Others may contain useful compounds or suggest interesting avenues for research.
The point is that we don’t necessarily have to choose between treating traditional medicine as infallible ancient wisdom and dismissing it as worthless superstition.
There is another possibility:
Take the observations seriously enough to investigate them, while being equally prepared to discover that some of them don’t hold up.
That is essentially what happened in the artemisinin story.
Tu Youyou did not simply accept everything contained in the ancient texts.
She searched them, selected promising possibilities, tested them, encountered failures, changed her methods and followed the evidence.
In fact, the discovery involved a considerable amount of unsuccessful experimentation before the breakthrough.
That willingness to go back to the old literature when the initial experiments weren’t working was one of the most important parts of the story.
What does this have to do with Chinese medicine today?
As an acupuncturist, I find this part of the story particularly interesting.
Chinese medicine is sometimes presented as though it exists entirely outside modern scientific medicine.
But historically, the relationship is more complicated.
Chinese medicine is an enormous accumulated body of clinical observations, theories, diagnostic systems and therapeutic techniques developed over many centuries.
That doesn’t mean every traditional claim is scientifically correct.
It does mean that there is a potentially valuable body of knowledge there to investigate.
And the artemisinin story demonstrates one possible way of doing that.
It also reminds us that research into traditional medicine does not have to mean trying to prove that everything traditional is already scientifically true.
Sometimes the more interesting question is simply:
Is there something here worth investigating?
Tu Youyou’s answer to that question changed medicine.
And what about acupuncture?
It is worth making a distinction here.
The discovery of artemisinin is evidence for the value of investigating traditional Chinese medical knowledge, but it is not evidence that acupuncture treats malaria, nor does it prove that every theory or treatment within Chinese medicine is effective.
Those are separate questions.
Acupuncture has to be evaluated on its own terms and according to the condition being treated.
But the artemisinin story does provide an intriguing historical example of what can happen when researchers approach an old medical tradition with both curiosity and scepticism.
Not blind belief.
Not automatic dismissal.
Curiosity first — followed by testing.
A 1,700-year-old clue and a very modern lesson
Perhaps the most remarkable aspect of the Tu Youyou story is the continuity across time.
Somewhere around 1,700 years ago, a Chinese physician recorded an observation about a medicinal plant.
Many centuries later, a scientist searching through that literature noticed something unusual about the way the plant had been prepared.
That observation led to an experiment.
The experiment led to a discovery.
The discovery led to a drug.
And that drug has gone on to save millions of lives.
It is a wonderful reminder that medical knowledge doesn’t always develop in a straight line.
Sometimes an idea can lie dormant for centuries before somebody asks the right question of it.
And sometimes the most productive way forward is neither to reject the past nor to accept it unquestioningly, but to look at it again with fresh eyes.
That, perhaps, is the most interesting lesson of Tu Youyou’s remarkable story.
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