The evolution of traditional Chinese medicine education policies in China: themes, characteristics, and experiences—a historical institutionalism analysis based on 197 policy texts

Background: This study examines the historical evolution of Chinese TCM education policies since 1949, analyzing the characteristics of each developmental stage, their underlying driving mechanisms, and their implications for modernizing traditional medical education. Methods: A mixed-methods approach was employed, combining quantitative content analysis (using NVivo) of 197 policy documents with qualitative analysis grounded in historical institutionalism. Results: The evolution is categorized into four distinct stages: 1949-1977, 1978-1999, 2000-2011, and 2012-present. This progression follows a trajectory from "standardization" to "distinctiveness," then to "systematization," and finally toward "internationalization." Key driving mechanisms include path dependence and responses to critical junctures. Conclusion: Changes in TCM education policy arise from the interplay of national strategic needs, cultural heritage preservation, and global competition. Future reforms should prioritize strengthening clinical practice education, enhancing cultural protection within the curriculum, and fostering cross-disciplinary collaboration. This study offers an institutional paradigm for modernizing traditional knowledge systems.