Blended teaching has been widely adopted in health sciences education, yet the mechanisms through which it influences academic achievement remain unclear, particularly in culturally distinctive fields like Traditional Chinese Medicine (TCM) pharmacy. This study examines autonomous learning ability as a mediator in the relationship between blended teaching and academic achievement, and further tests whether cultural adaptation moderates this mediated pathway. A quantitative cross?sectional design was employed, using Structural Equation Modeling (SEM) to analyse survey data and academic records from 600 undergraduate TCM pharmacy students across eight institutions in Shaanxi Province, China. Instruments included an adapted Autonomous Learning Ability Scale (ALAS) and the Blended Teaching Efficacy Survey (BTES), administered via online (DingTalk) and paper?based questionnaires. Data were analysed using SPSS 28 and AMOS 28 through confirmatory factor analysis, path analysis, and bias?corrected bootstrapping. The results confirmed a significant indirect effect of blended teaching on achievement via autonomous learning (indirect effect = 0.42, 95% CI [0.35, 0.49]), accounting for 62% of the total effect. Cultural adaptation significantly moderated the mediation, with a stronger indirect effect in high?alignment environments (0.51 versus 0.31). These findings underscore that blended teaching improves academic outcomes primarily by cultivating self?regulated learning capabilities, and that culturally responsive design amplifies this benefit. The study offers practical implications for developing adaptive blended learning frameworks that respect Confucian?heritage values while promoting learner autonomy.
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