Cognitive Bricolage: Reconciling Fecal-Based TCM with Gut Microbiota Science Through Bidirectional Legitimation

This study explores the evolving cognitive legitimacy of fecal-based traditional Chinese medicine (TCM) and its interaction with modern microbiome science through historical analysis, policy review, and discourse research. Applying the cognitive bricolage framework, we argue that TCM is not passively validated by modern science but actively co-constructs knowledge through bidirectional adaptation. A longitudinal analysis of the Pharmacopoeia of the People’s Republic of China (1953–2020) reveals that fecal-based medicines were partially excluded in the late 20th century due to the absence of clear chemical mechanisms. However, the rise of microbiome research in the 21st century enabled their reintegration under the paradigm of ecological regulation. Analysis of scientific texts shows that gut microbiota research has linked TCM’s “eliminating accumulation” concept to fecal microbiota transplantation (FMT), fostering cross-paradigmatic knowledge reproduction. Meanwhile the language of microbiome science has provided a new conceptual foundation for TCM-based interventions, including fecal-based medicines. Social discourse analysis reveals that while microbiome science has influenced public discussions of gut health, its integration into traditional medicine remains incomplete and selective. An epistemic disconnect between feces and gut microbiota is found, which implies a selective discursive sanitization of the microbial concept. This study highlights the tension between the reconstruction of TCM’s legitimacy and its practical marginalization, and offers a new perspective on how to bring together the reductionism of microbiome research with the systems thinking of TCM.