Background Rural hospitals in Sichuan Province, China, face persistent challenges such as limited emergency resources, geographic isolation, and fragmented coordination with tertiary institutions. These issues undermine both emergency care quality and the sustainability of local health economies. Exploring integrated strategies that combine technology, Traditional Chinese Medicine (TCM), and institutional collaboration is essential for building resilient rural healthcare systems.

Methods A mixed-methods design was employed, using proportional stratified sampling to collect data from 252 general practitioners and administrators across 126 township hospitals in Sichuan. Quantitative data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to examine the relationships among tele-training, TCM integration, medical collaboration, and health economic sustainability.

Results Tele-training by higher-level institutions significantly improved emergency care capacity (β = 0.32, p < 0.01), bridging skill gaps in managing acute conditions such as stroke and diabetic emergencies. TCM integration also showed a positive effect (β = 0.25, p < 0.05), enhancing cost-effective treatment through acupuncture and herbal therapies. Medical collaboration mediated 45% of the total effect on health economic sustainability by optimizing resource allocation and referral efficiency between grassroots and tertiary facilities.

Conclusion The validated “sustainability flywheel” model demonstrates that combining tele-training, standardized TCM integration, and inter-hospital collaboration can enhance both healthcare equity and economic resilience in rural China. These findings provide actionable insights for policymakers and healthcare managers seeking sustainable rural health system reforms in other resource-constrained regions globally.