Duan Chengshi’s 段成式 Tang dynasty work Youyang zazu 酉陽雜俎 (Miscellaneous Morsels from Youyang), records a foreign botanical medicine called aboshen 阿勃參 (balm of Gilead or Mecca balsam) originating from Fulin 拂菻 (Byzantine Empire). This balsam (resin, spice, or oil) was mainly produced on the banks of the Dead Sea in western Asia. Although never widely used in medieval China and only enjoying brief popularity there, in the medieval Islamic world it was regarded as a panacea with a wide range of uses. After the Age of Discovery, balm of Gilead was gradually replaced by balsam of Peru from South America. Jesuit missionaries introduced balsam of Peru to China in the late Ming and early Qing dynasties, where it was known as baersamo 巴爾撒摩 (balsam), baersamu you 巴爾撒木油 (balsam oil) and baersamu xiang 巴 爾 撒 木 香 (balsam spice). There was a gradual increase in the number of records of this medicine and its uses in Chinese Materia Medica, dispensatories, and jottings literature, mainly relating to its use in the treatment of traumas. It appeared numerous times in exchanges between the Qing court, the Jesuits and foreign countries. In Japan during the period when the study of Western medicine was promoted, this balsam even came to be referred to as “sacred medicine.” This article traces the journey of Mecca balsam and balsam of Peru over a long historical period across different regions of ancient China, focusing on transmission of knowledge, methods of use, and trade routes. The author attempts to sketch the routes of its transmission through ancient Greece, Rome, Syria, Persia, Arabia, pre- and post-Renaissance Europe, South America, India, and Southeast Asia to China and Japan. This article also explores how, in the process of botanical medicine exchange from the medieval period to modern period, the role and status of Chinese medicine in world medicine changed. This case study will also help us understand changes in Chinese society from the pre-modern period to the late Qing dynasty.