How ancient texts saved millions: A scientist-historian’s discovery of the cure for Malaria

Reading time: 7 minutes

One of Earth’s oldest, and deadliest diseases. Malaria has been around since the dawn of civilisation, with evidence of Malaria antigens recently being discovered in Egyptian remains from 3200 BC. In the 20^th Century alone, up to 300 million people died from Malaria – even in an era of advancing modern medicine and a vaccine explosion following WW2.

For such a deadly, longstanding disease, you might think the only way to win is with more innovation, more futuristic medicine. But one Chinese scientist took a different approach.

In 2015, Tu Youyou won the Nobel Peace Prize in Physiology or Medicine 2015 for her work developing one of the world’s first effective anti-malaria drug. Yet she didn’t do so with a doctorate, nor even a medical degree.

Instead, she used a combination of ancient Chinese texts, and determination. Here’s how she did it.

Project 523

Coming out of the Long March, WW2 and the Chinese civil war, communist China was a renewed player on the world stage, eager to rebuild and re-establish itself as a major world power.

As the Vietnam War raged on in 1967, both the forces of North Vietnam and the Chinese troops present in the country supporting the war effort were being ravaged by Malaria. At the request of Ho Chi Minh (Prime Minister of North Vietnam), Mao Zedong ordered the initiation of Project 523, named after its starting date on the 23^rd of May.

US soldiers during the Vietnam War. Picryl.

Tasked with finding the next superweapon in the fight, over 500 Chinese scientists from across the country were recruited to the secretive Project 523, taken from all manner of institutions and backgrounds. Amongst them: Tu Youyou.

China’s Malaria Problem

In the 1940s, around 30 million cases of Malaria were reported annually in China. Not just a military obstacle in the conflict in Vietnam, Malaria was a serious contagion for the civilian population of China, and had been for much of its history.

Though sparked by a desire to increase military effectiveness, finding a way to fight back against Malaria would prove a crucial element of industrialising and modernising China.

If a cure or effective anti-malarial drug could be found, it would drastically increase the health of the average Chinese citizen, improving living standards and in turn helping increase productivity – a core aim for Mao’s new China.

Despite continued efforts, a new strain of Malaria had become resistant to the popular treatment of Chloroquine, and chloroquine-resistant Malaria continued to ravage the country as well as much of the wider world.

Ancient China’s Answer to Malaria

Given China’s long history of combating Malaria, a significant number of scientists under Project 523 were dedicated to studying and testing ancient remedies to help develop a new, more effective treatment.

At the heart of this research was Tu Youyou.

Having been a medical student in the 1950s during China’s initial push to grow its native scientific community, she quickly rose through the system and was appointed as head of the project in 1969, just two years after its initiation.

Leaving her family and children behind for several years, Tu Youyou and a wider team of scientists travelled to highly infected areas in China to study the disease, before returning to Beijing to begin laboratory research.

Sweet Wormwood

Upon returning, 240,000 compounds and variations of drug treatments had been tested by the Project 523 teams, and none had worked.

The team began their reading. Though it took some time, Tu Youyou and her team meticulously trawled through Ancient Chinese medical texts such as Ge Hong’s A handbook of prescriptions for emergencies, identifying ingredients, isolating compounds, and testing for effectiveness against malaria.

In their search, a reference from ~400 AD to sweet wormwood, a widespread plant native to Asia, which in the distant past had been used to treat “intermittent fevers” as described in the text, which was a common symptom of malaria.

Applying the Scientific Method

In 1971, as they had done many times before, Tu Youyou and her team began to test the plant. They quickly identified an active compound in sweet wormwood as artemisinin, which seemed to battle malaria-friendly bacteria. Before long, scientific tests of the compound began. Unfortunately, success was nowhere to be found.

Any extract of the compound had little to no effect, and initially it seemed like another failed compound of the 240,000 already tested. But Tu Youyou persisted. After rereading the ancient sources, she hypothesised that by boiling down wormwood to create the extract for testing, the team of scientists were in fact damaging the parts of artemisinin that made it effective.

Switching to a different solvent with a lower boiling point, Tu Youyou was able to boil down the sweet wormwood to an extract without damaging it, and the results were astounding. Swiftly testing the new compound on mice and monkeys, a 100% success-rate was achieved. Through the combination of historical research and the scientific method, China’s, and soon the world’s, new anti-malarial superweapon was about to be unleashed.

Dedication and Success

Curing a monkey is great, but ultimately the drug needed to be safe for humans – and there was only one way to find out if it was. Alongside two of her colleagues, Tu Youyou tested the drug on herself.

Once again, a 100% effectiveness rate was achieved. With the first human trial complete, the team was eager to test out on a larger sample size, and used the new anti-malarial drug to treat 21 patients infected with malaria in the Hainan Province – all recovered.

Malaria Parasite Connecting to Human Red Blood Cell. Wikimedia.

After hundreds of thousands of compounds tested by the wider Project 523 groups, and hundreds tested by Tu Youyou’s team alone, they had finally found what they were looking for. Just a year later in 1972, Tu Youyou presented her findings to the Chinese government, and the treatment was quickly rolled out across the country, marking the beginning of the end of Malaria in China – which has been officially malaria-free since 2021.

How History Shapes our Future

Today, artemisinin-based combination therapies (ACTs) are the World Health Organization’s first-line treatment for malaria, and to date the drug has saved millions of lives, particularly in Africa and Southeast Asia where malaria remains endemic. Meanwhile, Tu Youyou would eventually get credit for her research, winning the 2015 Nobel Prize for Physiology or Medicine, and joining a long list of pivotal scientists who saved millions.

It is often said that we must learn from our history, to avoid the mistakes of the past. Yet what is often overlooked are the positives – across thousands of years humanity has discovered, forgotten, and discovered again thousands of things. By looking back and re-assessing our perceptions of the past, we can help build a new future.