A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System

Wang Shaoci

doi:doi:10.11648/j.ijll.20261401.12

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| Peer-Reviewed

A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System

Wang Shaoci^*

Published in International Journal of Language and Linguistics (Volume 14, Issue 1)

Received: 9 December 2025 Accepted: 22 December 2025 Published: 19 January 2026

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Abstract

This literature review systematically synthesizes the body of existing research on conceptual metaphors within the theoretical and practical system of Traditional Chinese Medicine (TCM). Grounded in the analytical framework of Conceptual Metaphor Theory from cognitive linguistics, the review consolidates scholarly findings to demonstrate that metaphors are not merely rhetorical expressions but are foundational cognitive constructs that organize TCM’s understanding of physiology, pathology, and therapy. By collating evidence from numerous studies, it categorizes the pervasive metaphors documented in classical texts such as Huang Di Nei Jing into four primary types identified in the literature: ontological metaphors, structural metaphors, orientational metaphors, and philosophical metaphors. The synthesis confirms that these metaphorical frameworks are central to articulating and operationalizing core TCM doctrines, including the dynamics of Yin and Yang, the process of syndrome differentiation, and the principles of herbal formulation and acupuncture. Furthermore, the review addresses the adaptation of these traditional metaphors in contemporary contexts, particularly in digital and multimodal communication aimed at TCM communication. While highlighting their didactic and popularizing potential, it also notes challenges in multimodal representation and the risk of conceptual distortion in new media forms. This synthesis underscores metaphor as a pervasive and deep-seated cognitive mechanism that bridges TCM’s classical foundations with its modern interpretation and dissemination, with this comprehensive overview establishing metaphor as a fundamental structural element that links TCM’s historical foundations to its contemporary interpretive and communicative practices.

Published in	International Journal of Language and Linguistics (Volume 14, Issue 1)
DOI	10.11648/j.ijll.20261401.12
Page(s)	9-17
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Traditional Chinese Medicine (TCM), Conceptual Metaphor, Cognitive Linguistics

1. Introduction

Traditional Chinese Medicine (TCM) is a systematic medical system and a treasure of China’s excellent traditional culture. TCM is the culmination of over 2,000 years of practical experience based on continuous development and innovation by generations of medical practitioners

[2]

. It has been making significant contributions to disease prevention, treatment, and health maintenance in China till now.

Numerous Chinese scholars have found that the TCM system is actually a metaphorical system. The TCM framework comprises a complex array of concepts and philosophical theories that are fundamentally grounded in conceptual metaphors

[3-10]

. This paper will review the metaphorical system in TCM system based on a thorough literature review and discuss: 1) the nature and theoretical basis of the TCM system; 2) the classification of conceptual metaphors used in the TCM system; and 3) the application of conceptual metaphors in illustrating TCM diagnosis and treatment.

2. Methods

This study is a systematic qualitative literature review, focusing on the role and classification of conceptual metaphors in Traditional Chinese Medicine (TCM). A comprehensive literature search was conducted using electronic databases, including PubMed, Web of Science, CNKI, and Wanfang Data. The search period spanned from January 2000 to December 2024. Key search terms were used in combination, such as “Traditional Chinese Medicine”, “conceptual metaphor”, “cognitive linguistics”, “Qi”, “Yin Yang”, “Five Elements”, “Huang Di Nei Jing”, etc.The study selection process followed PRISMA guidelines, with clear stages for identification, screening, eligibility, and inclusion of relevant studies.

3. An Overview of the TCM System

Traditional Chinese Medicine (TCM) is a discipline that studies human physiology, pathology, diseases, diagnosis, prevention, and health rehabilitation. Grounded in the philosophical concept of “correspondence between heaven and humanity”, the TCM system develops a series of interconnected theories, including Zang-Xiang Theory, Yin-Yang Theory, Five Elements Theory, Qi-Blood-Body Fluids Theory, Meridian Theory, and the concept of Syndrome Differentiation

[12]

. TCM system encompasses a variety of practices and therapies, such as herbal medicine, acupuncture, cupping therapy, Qigong, massage (Tui Na), and dietary therapy. TCM theories are deeply rooted in the philosophy of balance and harmony within the body, emphasizing the connection between individuals and the environment

[2, 13]

. Its primary goal is to restore balance, prevent illnesses, and promote holistic well-being by addressing both physical and emotional health

[14]

The understanding of human health and bodily functions within the TCM system is profoundly intertwined with nature and philosophical thought. It is based on the perceptions of the world and the understanding of the traditional Chinese philosophy that ancient Chinese practitioners utilized a conceptual metaphor system to develop the complex TCM frameworks that explain bodily functions and pathologies

[15]

. As stated in Huang Di Nei Jing (The Yellow Emperor’s Classic of Medicine), “Failure to use analogy leads to unclear knowledge”. The method of analogy and imagery, as a primary construct tool in the TCM system, has played a significant role in the formation of concepts and the construction of TCM theoretical system

[7, 16]

. It is found that conceptual metaphors are pervasive throughout the TCM system. For instance, in etiology of the TCM system, pivotal concepts like “the six excesses (六淫) ” and “the seven emotions (七情) ” are used to explain the impact of environment and emotions on physical health. Terms like “the victory of Zheng Qi (Vital energy) over Xie Qi (pathogenic factors) (正邪胜负) ” are frequently used to metaphorically illustrate the pathogenesis in the TCM system. Further, phrases such as “excess heat above and cold below (上热下寒) ” and “cold on the exterior, heat on the interior (表寒里热) ” are usually used in the discussion of the syndrome. Phrases “four natures (四气) ” and “five tastes (五味) ” are essential concepts used to describe the nature of herbal medicine, and the principles of “sovereign, minister, assistant, and envoy (君、臣、佐、使) ” are applied to illustrate how to use them in the prescription. All these expressions are fundamentally based on metaphors

[7]

4. Theoretical Basis of TCM System

Since the 1960s, numerous scholars have argued that metaphors are not merely rhetorical devices but are central to human thought and understanding. Black suggested that metaphors help establish connections between different domains, expanding our comprehension

[17]

. Ortony pointed out that metaphors are not just a linguistic phenomenon but represent a fundamental aspect of human thought. Metaphors shape how we understand and conceptualize the world, influencing our cognitive processes

[18]

. Similarly, M. J. Reddy stated that “the locus of metaphor is thought, not language, that metaphor is a major and indispensable part of our ordinary, conventional way of conceptualizing the world, and that our everyday behavior reflects our metaphorical understanding of experience”

[19]

. These ideas later were expanded by Lakoff and Johnson in 1980. In their coauthored book Metaphors, We live by Lakoff, G et al.

[20]

, they developed the Conceptual Metaphor Theory and defined a ‘conceptual metaphor’ based on the analysis of a body of daily language. Since then, the conceptual metaphor has emerged as the prevailing perspective in metaphor research.

Conceptual Metaphor Theory (CMT) proposes that metaphors are ubiquitous in our daily lives, and most human thought processes are metaphorical, thus “the essence of metaphor is understanding and experiencing one kind of thing in terms of another”

[20]

. According to CMT, metaphor is a conceptual process, referring to understand a conceptual domain by the use of another conceptual domain. Lakoff and Johnson specifies the components of conceptual metaphor, including source domain, target domain, mapping, ideal cognitive model and schematic structure. Source domain refers to the source of metaphorical metaphor and target domain refers to the ontology, and the interaction between those two domains is called mapping.

5. Categories of Conceptual Metaphors in TCM System

CMT divides metaphor into three categories basically: structural metaphor, ontological metaphor and orientation metaphor. Ontological metaphor means that human could understand the experience, emotions through the entities and substances of objects

[21]

. Ontological metaphors are most common cognitive way for understanding human experiences. Structural metaphor maps the structure of the source domain onto the target domain, allowing people to understand the target domain according to the structure of the source domain

[21]

. Orientational metaphor gives a concept a spatial orientation, making people understand the abstract concepts like feeling, emotions, experience by spatial concepts

[10]

In TCM system, metaphors are categorized more intricately based on the basic classification of conceptual metaphors. Under the guidance of traditional Chinese philosophy of “unity of heaven and humanity”, metaphors have been widely employed in the TCM system

[8]

. The human body serves as a fundamental standard for measuring and evaluating the surrounding phenomena. By relating familiar objects to unfamiliar ones, people employs the perceptions and cognition of the world to gain insights into life phenomena and the principles of diseases. Thus the metaphorical system of TCM is built on the perceptual experiences of the human body. Based on the varied sources and objects of these experiences, the types of metaphors within the TCM system can be generally categorized into four types of metaphor as following.

5.1. Ontological Metaphors in TCM System

Since people perceive the world primarily through experiential interactions, ontological metaphors are particularly abundant in the representation of TCM concepts. The representative work of the TCM system, Huang Di Nei Jing (The Yellow Emperor’s Classic of Medicine) offers extensive instances of the application of ontological metaphors.

5.1.1. Natural Phenomenon Metaphors

Natural phenomena such as water, fire, wind, rain, mist, cold, heat, humidity, dryness, etc. are widely used as source domains in metaphors in the TCM system. These metaphors are employed to articulate the body’s perceptions of the external environment and to convey metaphorical concepts related to illnesses

[8]

For example, in the phrase “Yang Qi is like the heaven and sun; when it loses its proper place, it leads to shortened life and lack of vitality” (Huang Di Nei Jing-“Suwen-On the Transmission of Vital Energy”), “heaven and sun” providing energy in the natural world are used as a metaphor for the energy required for various physiological activities in the human body. Similarly, “The spleen is earth; it governs the center” (“Suwen-On the Taiyin and Yangming”) employs “earth”, which nurtures all life in the natural world, as a metaphor for the spleen’s physiological functions in transforming food and fluid into Qi and blood, nourishing the entire body. In another example, the observation “Wind is agile and ever-changing” (“Suwen-On Wind”) likens the invisible and fluid nature of “wind” in the natural world to pathogenic factors that induce symptoms in the human body, such as fever, sweating, aversion to wind, and fluctuating conditions. A similar analogy can be detected in the phrase “The upper burner is like mist” (“Lingshu-On the Regulation of Nutritional Essence”). The term “upper burner” here refers to the heart and lungs, which is responsible for distributing water and clear Qi (essential substances and oxygen) throughout the body. This metaphor vividly relates the heart and lungs’ ventilatory functions to the way mist and drew spreads, highlighting the role of upper burner in nourishing the skin, muscles, hair, and other tissues

[8]

These metaphors effectively draw parallels between natural phenomena and physiological functions, enhancing the understanding of TCM concepts through vivid and relatable imagery.

5.1.2. Entity Metaphors

This category involves metaphors that depict abstract TCM concepts as tangible substances. For instance, emotions or diseases may be described as having a physical presence, allowing readers to comprehend these abstract notions in a more concrete manner.

The statement “The five organs are like bells and drums, and the six bowels are like carriages and horses” (“Lingshu-On the Separation of the Five Organs”) illustrates the significance and functions of the five organs (heart, liver, spleen, lungs, kidneys) and the six bowels (gallbladder, small intestine, large intestine, stomach, bladder, sanjiao) in the human body. The analogy of the five organs to bells and drums underscores their vital role in the body’s internal functions, akin to the primary instruments within a musical ensemble. By comparing the six bowels to carriages and horses, the statement highlights their essential function in transporting and delivering substances, such as food and Qi (vital energy), throughout the body. Another apt example is the saying, “The stomach is the sea of food and drink” (“Suwen-On the Separation of the Five Organs”). Here, the stomach is likened to the “sea”, a powerful force in nature capable of holding vast amounts of substance, metaphorically reflecting the stomach’s capacity to receive and contain food and drink

[10]

These metaphors collectively convey the TCM understanding of the coordinated functions and overall operation of various organs in maintaining health, emphasizing the interconnectedness of bodily systems in ensuring well-being.

5.1.3. Container Metaphors

Container metaphor involves defining a boundary for an intangible concept, making the abstract idea appear less abstract. In the TCM system, critical concepts such as “Jing” (essence), “Qi” (vital energy), and “Yin and Yang” (inner balance) exist dynamically within the body, thus, container metaphors are widely utilized in illustrating how these intangible substances exist and operate within the body or specific organs

[10]

For example, the statement “The five organs are the foundation of Qi and blood, and the vessels for their transformation and transportation” (“Lingshu - Jing Mai”) metaphorically equates the five organs to channels that facilitate the transformation and transport of Qi. This imagery underscores the critical role of the five organs in the processes of conveying and transforming Qi and blood, while also giving form to “Qi”, a vital substance. In a similar vein, the phrase “The kidney is the place where true essence is stored, and the sea of Qi (vital energy)” (“Suwen - Discussion on Ancient Heavenly Truths”) illustrates how Qi exist and operate within the kidney. The kidneys are regarded as the source of life, responsible for storing and regulating Qi (vital energy) throughout the body. The metaphor of the “sea” vividly illustrates that the kidneys serve as a reservoir of vital energy, highlighting their central role in the circulation of Qi and blood, as well as the operational range of Qi within the human body

[1]

5.1.4. Personification Metaphors

Personification metaphors involves attributing human characteristics or qualities to non-human entities or concepts. For instance, organs or bodily functions may be described as having intentions or behaviors akin to those of human being, thereby creating a more relatable and dynamic understanding of their roles. A typical example can be found in the phrase “When a person’s symptom is as fierce as an agile fighter, it should be calmed or controlled through immediate treatment” (“Suwen- The Great Treatise on Yin and Yang Correspondence”). Here, the symptom is personified as a fighter, emphasizing the need for prompt action. In the phrase “external causes (like guests) affect the five internal organs of the human body, leading to rheumatism-related diseases” (“Suwen-The Treatise on Bi”), The term “guest” is used to metaphorically represent external pathogenic factors invading the human body

[1]

Personification metaphors are frequently used to describe “pathogenic factors” in the TCM system. It can be best exemplified by the following expressions such as “When the body is harmed by ‘Xie (evil) Qi’ (six exogenous pathogenic factors: wind, cold, summer-heat, dampness, dryness, and fire), it may lead to internal pathological changes such as phlegm-fluid retention, blood stasis, and food stagnation.” (“Suwen-On the Comprehensive Analysis of Deficiency and Excess”) and “When the ‘Xie (evil) Qi’ (pathogenic wind) arrives, it is as violent as wind and rain” (“Suwen-On the Correspondence of Yin and Yang”), as well as “pathogenic factors exploiting deficiency and stealthy climatic pathogens” (“Suwen-On the Primordial True Nature of Antiquity”). Terms like “evil”, “exploit” and “stealthy” are likened to undesirable or hostile entities in human society and serve as metaphors for external factors that contribute to disease in the human body

[8]

Further examples of personification can be found in expressions such as “Spring should not assault the liver, and winter should not disturb the kidneys” (“Suwen-On the Correspondence of Yin and Yang”). “Assault” refers to attacking, suppressing, or over-consuming. In spring, if one goes against the liver’s nature of growth and expansion, such as by repressing emotions (as the liver governs the flow of emotions), overworking, excessively using harsh and drying herbs, or over-purging liver fire, it can damage Qi in liver, leading to liver stagnation or liver deficiency. The term “disturb” refers to causing turbulence or depletion. In winter, if one excessively sweats (such as through intense exercise), engages in excessive sexual activity, stays up late, or improperly uses cold and cooling herbs that damage Qi in kidney, it can lead to the leakage of kidney essence and instability of Yang Qi. The use of these personified actions promote a better understanding of the key points of seasonal health preservation

[1]

In summary, ontological metaphors play a vital role in articulating and understanding concepts within the TCM system, making the complex interplay between physical and emotional health more accessible and engaging.

5.2. Structural Metaphors in TCM System

Structural metaphors in the TCM system often draw on various structural relationships that exist within human society, such as those between men and women, parents and children, rulers and subjects, hosts and guests, and warfare, to elucidate TCM concepts and theories

[8, 10]

. For instance, the phrase “Cold and heat are the mother of all things” uses the relation between mother and kids to symbolically illustrates that the balance and changes between these two forces are the root causes of growth and decline in various phenomena

[9]

There are many structural metaphors in Huang Di Nei Jing. In the chapter of “Suwen” particularly, there are many discussions of the occurrence, development, and outcomes of diseases through the lens of the offensive and defensive dynamics of righteousness and evil, as well as their gains and losses, victories and defeats, and survival and demise

[9, 10]

. Diseases and enemies, as well as treatment and warfare, belong to different domains yet, they share structural and relational similarities. Both diseases and enemies can inflict suffering and death, while treatment and warfare represent struggles involving opposing forces. For instance, the phrases like “When Yin predominates, Yang suffers; when Yang predominates, Yin suffers” (“Suwen-On the Correspondence and Manifestation of Yin and Yang”) and “Yin contends within, Yang disturbs outside” (“Suwen-On the Differentiation of Yin and Yang”) use warfare-related descriptors such as “predominate”, “contend”, and “disturb” to portray the rivalry between Yin and Yang, relating it to the internal imbalance that leads to illness

[8, 11]

Moreover, social hierarchy is also a common type of structural metaphors used to describe the relation of human organs. This can be best exemplified by the following discussion “the heart is the ruler’s organ, and spirit emerges from it. The lungs are the minister’s organ, responsible for regulating and harmonizing. The liver is the general’s organ, associated with strategizing and planning. The gallbladder is the organ of central justice, responsible for decision-making. The diaphragm is the official of joy, where happiness and delight emerge...Therefore, when the ruler is clear, the subordinates are at peace; by nurturing life in this way, one can achieve longevity and avoid calamity in life, ensuring prosperity for the world. When the ruler is unclear, the twelve organs become endangered, and the pathways of vitality are blocked and inaccessible.” (“Suwen-The Secret Collection of Linglan”). A clear ruler leads to harmony among subordinates, while an unclear ruler endangers the organs and obstructs vitality in society. This excerpt serves as a typical structural metaphor using terms describing social status and value, such as “nobility”, “official”, and “ruler” to metaphorically explain the physiological functions and the interrelationships of the organs

[8]

In summary, TCM system employs structural metaphors that vividly link concepts of warfare, social hierarchy, etc. with health, providing a rich understanding of the interplay between body and environment.

5.3. Orientation Metaphors in TCM System

Orientation metaphor is a cognitive process that maps spatial concepts as a source domain to other non-spatial concepts as a target domain. For instance, the expression “I’m feeling up today” illustrates how the spatial concept “up” serves as the source domain to represent the non-spatial concept of “happiness”

[20]

. Orientation metaphors such as “up and down”, “inside and outside”, and “front and back” are particularly used to demonstrate the relation between “Yin” and “Yang”, two critical concepts in TCM system and their representation within human body.

The statement “Yang Qi floats outside, thus it disperses; Yin Qi is stored within, thus it gathers” (“Suwen-Pulse Essentials”) is a prime example. This metaphor uses the spatial term “outside” to indicate that the characteristic of Yang Qi is to radiate and disperse, manifesting on the surface of the body and in the external environment. Yang Qi is associated with warmth and activity, typically linked to the body’s metabolism, movement, and physiological functions. Yang Qi can dissipate heat from the body through sweat on the skin, helping to maintain temperature balance. By contrast, the use of the term “inside” indicates that Yin Qi has internal and static characteristics, primarily operating within the body. It is related to nourishing and protective functions inside the body, such as the storage of fluids and nutrients. Similarly, the phrase “Yin deficiency results in external cold, while Yang deficiency leads to internal heat; on the other hand, Yang excess causes external heat, and Yin excess results in internal cold” (“Suwen-On the Regulation of the Menstrual Cycle”) further illustrates the use of orientation metaphors in the TCM theories. The directional terms “internal ”and “external” are applied to show the different states exhibited by Yin and Yang in terms of their abundance or deficiency, thereby explaining the onset of diseases and pathological changes in the human body

[11]

5.4. Philosophical Metaphors in TCM System

Philosophy is the rational reflection and abstract generalization made by humanity based on the perceptual experiences of the natural world and human society. As a worldview, value system, and methodology, philosophy not only guides social, economic, and political activities but also directs scientific research and influences people's understanding and study of the body, health, and life, thereby supporting and promoting the development of medicine. TCM theory in its formation, has also drawn a great deal of nourishment from ancient philosophical thoughts. Some core concepts and theoretical models in the TCM system are derived from philosophical notions or categories such as Yin-Yang, the Five Elements, etc.

[5, 6, 8, 22-25]

The Five Elements:Water, Fire, Wood, Metal, and Earth have been extensively mapped to physiological and pathological aspects of the body in TCM system. The following excerpt from “Suwen-The Golden Coffer’s Maxims” exemplifies how the Five Elements correspond to the organs within the human body.

“East (Green): Corresponds to the liver, connects to the eyes, stores essence in the liver. Disorders are manifested as fright or shock, its flavor is sour, and it relates to Wood.

South (Red): Corresponds to the heart, connects to the ears, stores essence in the heart, hence disorders are found in the five organs. Its flavor is bitter, and it relates to Fire.

Center (Yellow): Corresponds to the spleen, connects to the mouth, stores essence in the spleen, hence disorders are found at the root of the tongue. Its flavor is sweet, and it relates to Earth.

West (White): Corresponds to the lungs, connects to the nose, stores essence in the lungs, hence disorders are found in the back. Its flavor is pungent, and it relates to Metal.

North (Black): Corresponds to the kidneys, connects to the two lower orifices, stores essence in the kidneys, hence disorders are found in the valleys. Its flavor is salty, and it relates to Water.”

The analogy between the five organs and the five elements suggests that the interactions and pathological changes of the organs can be understood through the relationships of generation and restriction among the five elements. For example, wood generates fire, indicating that the liver’s function of regulation and smooth flow promotes the activities of the heart; conversely, if heart fire is overly abundant, it may adversely affect the liver’s regulatory functions.

Table 1. Classification of Conceptual Metaphors in TCM.

Primary Metaphor Type	Subtypes	Examples
Ontological Metaphor	Natural Phenomenon Metaphor	“Yang Qi is like the heaven and su” (Huang Di Nei Jing, Suwen)
	Entity Metaphor	“The stomach is the sea of food and drink.” (Huang Di Nei Jing, Suwen)
	Container Metaphor	“The kidney is the sea of Qi.” (Huang Di Nei Jing, Suwen)
	Personification Metaphor	“When a person’s symptom is as fierce as an agile fighter…” (Huang Di Nei Jing, Suwen)
Structural Metaphor	-	“The heart is the ruler’s organ; the lungs are the minister’s orga.” (Huang Di Nei Jing, Suwen)
Orientational Metaphor	-	“Yang Qi floats outside, thus it disperses; Yin Qi is stored within, thus it gathers.”(Huang Di Nei Jing, Suwen)
Philosophical Metaphor	-	“The Liver corresponds to Wood.” (Huang Di Nei Jing, Suwen)

6. Application of Metaphors in TCM Diagnosis and Treatment

The use of numerous metaphors in the TCM system not only aids in describing and explaining the normal physiological functions of the human body but also elucidates the patterns of disease onset and progression and guides treatment.

6.1. Application of Metaphors in TCM Diagnosis and Syndrome Differentiation

As the fundamental principle of TCM diagnosis, syndrome differentiation is a basic method for understanding and treating diseases

[26-28]

. Syndrome differentiation embodies the creative thinking of dialectical reasoning and demonstrates that the diagnostic methods of TCM are based on logical inference. This process relies on the medical history and current symptoms collected through the four diagnostic approaches: inspection, auscultation, inquiry, and palpation. It involves the analysis and synthesis of relevant TCM theories, aiming to elucidate the underlying causes and mechanisms of the individual’s condition, while summarizing specific types of syndromes as a result

[26, 29]

. It is found that conceptual metaphors have been widely applied in TCM diagnosis and syndrome differentiation

[8, 30]

In terms of the inspection, conceptual metaphors have been used to describe the normal or pathological physical conditions. The following discussion in “Suwen-Pulse Essentials” stands as a best instance for how conceptual metaphors used to portray the representation of Qi (vital energy) in the body of a healthy person.

“The Qi is manifested by the brightness of the five colors presented by different parts of body:

Red should resemble the brightness of a white object wrapped in vermilion, not like ochre.

White should resemble the feathers of a goose, not like salt.

Green should resemble the sheen of a dark jade, not like blue.

Yellow should resemble the bright yellow of orpiment, not like yellow earth.

Black should resemble the color of deep lacquer, not like the color of damp earth.”

Moreover, it is discovered that conceptual metaphors also contribute much to the auscultation, one of important diagnostic methods in the TCM system. The excerpt “Phlegm is like the foam of crabs, the sound is like that of a male duck.” in The Origin of Medicine describes the nature of phlegm and the corresponding sounds produced by a patient. This case serve as a clear illustration of how metaphors applied in auscultation to help practitioner to make diagnoses based on the corresponding symptoms

[30]

In addition, conceptual metaphors have also been used in the palpation. In “Suwen-Pulse Essentials”, the seasonal pulse characteristics are discussed as following, “In spring, the pulse is floating, like a fish swimming in the waves; in winter, the pulse is deep, as hibernating insects are well-hidden.” These metaphors enable practitioners to accurately grasp the features of the pulse and assess the rise and fall of Qi and blood, so as to determine the location of illness—whether it is superficial or deep. For instance, an overly floating pulse in spring may indicate an exterior syndrome due to pathogen invasion, while a pulse that is not deep in winter may suggest a deficiency of Yang Qi leading to external symptoms

[8]

6.2. Application of Metaphors in Treatment

First of all, conceptual metaphors can be widely found in the introduction and the use of herbal medicine. Compendium of Material Medica applies plenty of metaphors to introduce the nature of various Chinese herbal medicines. “Gypsum is like the white tiger, and its energy is as crisp and deadly as that of the autumn season.” is notable example to demonstrate the nature and efficacy of Gypsum, a herbal medicine

[31]

. The application of metaphors in introducing how to use herbal medicine can also be often detected in the various TCM ancient codes and records.

“Just like lifting the kettle and removing the lid, when the upper orifice is opened, the lower orifice will naturally be connected.” The research by Wang et al.

[32]

is a typical example to illustrate how herbal medicine function in the treatment. For the purpose of showing how herbal medicine promotes lung function and facilitates water metabolism, the act of “lifting the kettle and removing the lid” is used as a metaphor to state when the specific medicinal herbs help unblock the upper focal point (lungs), the lower focal point (urinary function) will naturally become unobstructed, allowing for urinating. The metaphor indicates the interconnectedness of the body’s systems and the importance of unblocking pathways for overall health.

In Wen Bing Tiao Bian (Differentiation of Warm Diseases), an another classical ancient TCM work, offer many examples of the application of conceptual metaphors in TCM treatment. In “Increasing water to keep the boat sail: method of moistening Yin to relieve constipation”, the analogy compares intestinal dryness and constipation to a dry river where boats struggle to navigate, particularly after a febrile illness leads to Yin deficiency. Increasing the water level symbolizes using medicinal decoctions to nourish Yin, allowing feces to descend naturally. The discussion “Treating the upper burner as light as a feather: using ‘Light and Lifting’ Approach”; treating the middle burner as balanced as a scale: using ‘Harmonizing’ Approach; Treating the lower burner as heavy as a weight: using ‘Heavy and Descending’ Approach.” stands as a group of definitive examples of the use of metaphors in TCM treatment. Treating diseases of the upper burner (heart and lungs) should be as light and agile as using a feather. Medications should be light and uplifting (such as mint and mulberry leaves) and should not be heavy or turbid. Treating diseases of the middle burner (spleen and stomach) should resemble the use of a balance scale. Medications must therefore balance ascending and descending actions (tonifying the spleen Yang while down-regulating the stomach Qi), focusing on harmony. Treating diseases of the lower burner (liver and kidneys) should be like using a heavy weight, directly reaching the depth of the problem. Medications are often dense and heavy (such as prepared Rehmannia and tortoise shell)

[33]

The use of metaphors in TCM treatment are also common in Shang Han Lun (Treatise on Cold Damage), a famous ancient TCM work. For instance, in “Removing the Fire from the bottom of cauldron: method of clearing heat and draining fire”, the act of withdrawing fuel from the bottom of a boiling cauldron is used to illustrate employing purgatives like Rhubarb and Gypsum to drain heat in cases of excess heat syndromes (such as high fever, constipation, and red eyes), effectively extinguishing the fire

[34]

. The similar instance can also be found in Jing Yue Quan Shu, an important ancient TCM work. In “Guiding fire back to its source: method of leading deficient fire downward”, the analogy uses a flame flickering upwards to represent deficient fire rising. By adding oil to the lamp and guiding the flame back to the wick, it symbolizes the use of medications to tonify the kidneys and nourish Yin. This vivid metaphor explains the treatment for conditions presenting with excess heat above and cold below (such as sores in the mouth and cold pain in the lower back and knees)

[35]

What’s more, conceptual metaphors are also used in the illustration of acupuncture. The following excerpt exemplifies a typical case.

“...The invasion of wind and cold from all directions can enter the body’s meridians, leading to stubborn diseases. To treat such persistent ailments, the 'sharp needle’ was developed. Its body is as long and straight as a cylinder, with a sharp tip, suitable for dispelling pathogenic heat, needling to release blood, and thereby alleviating chronic conditions.

If Yin and Yang in the body are separated, and cold and heat clash, causing the two forces to aggregate, qi and blood may stagnate, resulting in abscesses and localized infections. To address these symptoms, the 'beryllium needle’ was invented. Its tip is as flat and sharp as a sword, designed to puncture abscesses and drain pus and blood.

When the body is attacked by the malicious wind, sudden symptoms of numbness and stiffness can arise. To treat these acute conditions, the 'round and sharp needle’ was created. Its tip resembles a cow’s tail, being both rounded and pointed, with a slightly thicker body, suitable for addressing acute ailments.” (“Lingshu-The Discussion of Nine Needles”)

[1]

This excerpt employs metaphors to illustrate the characteristics of various needle types, which are designed based on the human body’s acupuncture points, meridians, and the flow of Qi and blood. The use of analogy empowers practitioners to accurately utilize needles in accordance with different pathological conditions. Additionally, it highlights the adaptable treatment methods of TCM through syndrome differentiation.

7. Conclusion and Prospect

This review synthesizes how conceptual metaphors are foundational to structuring the knowledge system of Traditional Chinese Medicine (TCM). By systematically categorizing these metaphors—ontological, structural, orientational, and philosophical—we illustrate their central role in theorizing physiology, pathology, diagnosis, and treatment. Metaphors not only render abstract TCM concepts accessible but also actively guide clinical reasoning and therapeutic strategies.

The growing popularity of TCM short videos on social media underscores the potential of multimodal communication to enhance public understanding of TCM knowledge

[36-39]

. Through the integrated use of subtitles, visual symbols, and audio elements, metaphorical concepts in TCM can be expressed more intuitively, thereby facilitating audience comprehension. However, the current landscape also reveals significant challenges in the accurate and consistent multimodal presentation of TCM metaphors, which may lead to misconceptions

[12, 40, 41]

. This highlights an urgent need for research to evaluate the effectiveness of multimodal metaphors in conveying TCM knowledge. Future studies could, for instance, examine whether videos that align visual and auditory metaphors with classical TCM mappings improve viewer comprehension, whether such multimodal reinforcement enhances diagnostic reasoning among learners, and whether consistency across media elements strengthens conceptual clarity. By grounding metaphorical analysis in such empirically testable directions, future work can refine the digital communication of TCM, support more accurate health guidance, and contribute to the broader intersection of cognitive linguistics, health education, and media studies.

Abbreviations

TCM	Traditional Chinese Medicine
PRISMA	Perferred Peporting Items for Systematic Reviews and Meta-Analyses

Author Contributions

Wang Shaoci is the sole author. The author read and approved the final manuscript.

Conflicts of Interest

The author declares no conflicts of interest.

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Shaoci, W. (2026). A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System. International Journal of Language and Linguistics, 14(1), 9-17. https://doi.org/10.11648/j.ijll.20261401.12

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Shaoci, W. A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System. Int. J. Lang. Linguist. 2026, 14(1), 9-17. doi: 10.11648/j.ijll.20261401.12

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Shaoci W. A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System. Int J Lang Linguist. 2026;14(1):9-17. doi: 10.11648/j.ijll.20261401.12

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@article{10.11648/j.ijll.20261401.12,
  author = {Wang Shaoci},
  title = {A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System},
  journal = {International Journal of Language and Linguistics},
  volume = {14},
  number = {1},
  pages = {9-17},
  doi = {10.11648/j.ijll.20261401.12},
  url = {https://doi.org/10.11648/j.ijll.20261401.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijll.20261401.12},
  abstract = {This literature review systematically synthesizes the body of existing research on conceptual metaphors within the theoretical and practical system of Traditional Chinese Medicine (TCM). Grounded in the analytical framework of Conceptual Metaphor Theory from cognitive linguistics, the review consolidates scholarly findings to demonstrate that metaphors are not merely rhetorical expressions but are foundational cognitive constructs that organize TCM’s understanding of physiology, pathology, and therapy. By collating evidence from numerous studies, it categorizes the pervasive metaphors documented in classical texts such as Huang Di Nei Jing into four primary types identified in the literature: ontological metaphors, structural metaphors, orientational metaphors, and philosophical metaphors. The synthesis confirms that these metaphorical frameworks are central to articulating and operationalizing core TCM doctrines, including the dynamics of Yin and Yang, the process of syndrome differentiation, and the principles of herbal formulation and acupuncture. Furthermore, the review addresses the adaptation of these traditional metaphors in contemporary contexts, particularly in digital and multimodal communication aimed at TCM communication. While highlighting their didactic and popularizing potential, it also notes challenges in multimodal representation and the risk of conceptual distortion in new media forms. This synthesis underscores metaphor as a pervasive and deep-seated cognitive mechanism that bridges TCM’s classical foundations with its modern interpretation and dissemination, with this comprehensive overview establishing metaphor as a fundamental structural element that links TCM’s historical foundations to its contemporary interpretive and communicative practices.},
 year = {2026}
}

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TY  - JOUR
T1  - A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System
AU  - Wang Shaoci
Y1  - 2026/01/19
PY  - 2026
N1  - https://doi.org/10.11648/j.ijll.20261401.12
DO  - 10.11648/j.ijll.20261401.12
T2  - International Journal of Language and Linguistics
JF  - International Journal of Language and Linguistics
JO  - International Journal of Language and Linguistics
SP  - 9
EP  - 17
PB  - Science Publishing Group
SN  - 2330-0221
UR  - https://doi.org/10.11648/j.ijll.20261401.12
AB  - This literature review systematically synthesizes the body of existing research on conceptual metaphors within the theoretical and practical system of Traditional Chinese Medicine (TCM). Grounded in the analytical framework of Conceptual Metaphor Theory from cognitive linguistics, the review consolidates scholarly findings to demonstrate that metaphors are not merely rhetorical expressions but are foundational cognitive constructs that organize TCM’s understanding of physiology, pathology, and therapy. By collating evidence from numerous studies, it categorizes the pervasive metaphors documented in classical texts such as Huang Di Nei Jing into four primary types identified in the literature: ontological metaphors, structural metaphors, orientational metaphors, and philosophical metaphors. The synthesis confirms that these metaphorical frameworks are central to articulating and operationalizing core TCM doctrines, including the dynamics of Yin and Yang, the process of syndrome differentiation, and the principles of herbal formulation and acupuncture. Furthermore, the review addresses the adaptation of these traditional metaphors in contemporary contexts, particularly in digital and multimodal communication aimed at TCM communication. While highlighting their didactic and popularizing potential, it also notes challenges in multimodal representation and the risk of conceptual distortion in new media forms. This synthesis underscores metaphor as a pervasive and deep-seated cognitive mechanism that bridges TCM’s classical foundations with its modern interpretation and dissemination, with this comprehensive overview establishing metaphor as a fundamental structural element that links TCM’s historical foundations to its contemporary interpretive and communicative practices.
VL  - 14
IS  - 1
ER  -

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Author Information

Wang Shaoci

The Foreign Language Department, Cangzhou Jiaotong College, Huanghua, China;The Centre for Research in Language and Linguistics, The National University of Malaysia, Selangor, Malaysia

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http://orcid.org/0009-0002-0869-808X

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Table 1

Table 1. Classification of Conceptual Metaphors in TCM.

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APA Style

Shaoci, W. (2026). A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System. International Journal of Language and Linguistics, 14(1), 9-17. https://doi.org/10.11648/j.ijll.20261401.12

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Shaoci, W. A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System. Int. J. Lang. Linguist. 2026, 14(1), 9-17. doi: 10.11648/j.ijll.20261401.12

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Shaoci W. A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System. Int J Lang Linguist. 2026;14(1):9-17. doi: 10.11648/j.ijll.20261401.12

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@article{10.11648/j.ijll.20261401.12,
  author = {Wang Shaoci},
  title = {A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System},
  journal = {International Journal of Language and Linguistics},
  volume = {14},
  number = {1},
  pages = {9-17},
  doi = {10.11648/j.ijll.20261401.12},
  url = {https://doi.org/10.11648/j.ijll.20261401.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijll.20261401.12},
  abstract = {This literature review systematically synthesizes the body of existing research on conceptual metaphors within the theoretical and practical system of Traditional Chinese Medicine (TCM). Grounded in the analytical framework of Conceptual Metaphor Theory from cognitive linguistics, the review consolidates scholarly findings to demonstrate that metaphors are not merely rhetorical expressions but are foundational cognitive constructs that organize TCM’s understanding of physiology, pathology, and therapy. By collating evidence from numerous studies, it categorizes the pervasive metaphors documented in classical texts such as Huang Di Nei Jing into four primary types identified in the literature: ontological metaphors, structural metaphors, orientational metaphors, and philosophical metaphors. The synthesis confirms that these metaphorical frameworks are central to articulating and operationalizing core TCM doctrines, including the dynamics of Yin and Yang, the process of syndrome differentiation, and the principles of herbal formulation and acupuncture. Furthermore, the review addresses the adaptation of these traditional metaphors in contemporary contexts, particularly in digital and multimodal communication aimed at TCM communication. While highlighting their didactic and popularizing potential, it also notes challenges in multimodal representation and the risk of conceptual distortion in new media forms. This synthesis underscores metaphor as a pervasive and deep-seated cognitive mechanism that bridges TCM’s classical foundations with its modern interpretation and dissemination, with this comprehensive overview establishing metaphor as a fundamental structural element that links TCM’s historical foundations to its contemporary interpretive and communicative practices.},
 year = {2026}
}

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TY  - JOUR
T1  - A Literature Review of Conceptual Metaphors in the Traditional Chinese Medicine System
AU  - Wang Shaoci
Y1  - 2026/01/19
PY  - 2026
N1  - https://doi.org/10.11648/j.ijll.20261401.12
DO  - 10.11648/j.ijll.20261401.12
T2  - International Journal of Language and Linguistics
JF  - International Journal of Language and Linguistics
JO  - International Journal of Language and Linguistics
SP  - 9
EP  - 17
PB  - Science Publishing Group
SN  - 2330-0221
UR  - https://doi.org/10.11648/j.ijll.20261401.12
AB  - This literature review systematically synthesizes the body of existing research on conceptual metaphors within the theoretical and practical system of Traditional Chinese Medicine (TCM). Grounded in the analytical framework of Conceptual Metaphor Theory from cognitive linguistics, the review consolidates scholarly findings to demonstrate that metaphors are not merely rhetorical expressions but are foundational cognitive constructs that organize TCM’s understanding of physiology, pathology, and therapy. By collating evidence from numerous studies, it categorizes the pervasive metaphors documented in classical texts such as Huang Di Nei Jing into four primary types identified in the literature: ontological metaphors, structural metaphors, orientational metaphors, and philosophical metaphors. The synthesis confirms that these metaphorical frameworks are central to articulating and operationalizing core TCM doctrines, including the dynamics of Yin and Yang, the process of syndrome differentiation, and the principles of herbal formulation and acupuncture. Furthermore, the review addresses the adaptation of these traditional metaphors in contemporary contexts, particularly in digital and multimodal communication aimed at TCM communication. While highlighting their didactic and popularizing potential, it also notes challenges in multimodal representation and the risk of conceptual distortion in new media forms. This synthesis underscores metaphor as a pervasive and deep-seated cognitive mechanism that bridges TCM’s classical foundations with its modern interpretation and dissemination, with this comprehensive overview establishing metaphor as a fundamental structural element that links TCM’s historical foundations to its contemporary interpretive and communicative practices.
VL  - 14
IS  - 1
ER  -

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