How metaphors facilitate intercultural health communication: insights from traditional Chinese medicine doctors in UK clinics

2.1 Metaphor theory in health communication

Since the publication of Metaphors We Live By (Lakoff and Johnson 1980), Conceptual Metaphor Theory (CMT) has gained significant influence, demonstrating how metaphors shape human cognition by mapping familiar, concrete concepts (source domains) onto more abstract or complex ones (target domains) (Landau et al. 2018). In the context of healthcare, such metaphorical mappings are especially powerful. For instance, describing cancer treatment as a “battle” evokes notions of conflict, courage, and endurance, thereby framing how patients interpret and cope with their experiences. Metaphors play a vital role in facilitating communication between patients and clinicians, particularly when addressing emotionally sensitive or subjective aspects of illness and health – whether physical or psychological (Demjén and Semino 2017, 2020).

Metaphors also serve as a strategic tool in clinical communication, reducing barriers between practitioners and patients. Notably, patients themselves employ metaphors to express otherwise ineffable aspects of their illness, sometimes using contradictory analogies to reconcile disrupted identities (Gibbs and Franks 2002).

Beyond verbal metaphors, visual metaphors – defined as image-based analogies that communicate meaning non-verbally – play a significant role in enhancing comprehension in healthcare contexts by conveying complex ideas through imagery rather than words (Forceville 1996, 2008). For instance, diagrams depicting “blocked energy” in pain management leverage visual analogies to improve patient engagement (Forceville 2008). While Western medicine frequently employs metaphors like the “war on cancer” (Sontag 1978), culturally specific metaphors, such as those in TCM, remain underexplored. TCM’s theoretical framework is inherently metaphorical, relying on analogies like Qi (气, ‘energy flow’) and Yin-Yang (阴-阳) balance, which align with its holistic epistemology (Fang and Jia 2015; Jiang and Zhang 2015).

2.2 Metaphors in TCM

TCM’s theoretical foundation is deeply metaphorical, employing analogies like “Qi stagnation” (blocked energy) to explain health and disease (Jiang and Zhang 2015). Shi and Yue (2024) insightfully pointed out that TCM uses a thinking pattern of figuring out the interior by observing the exterior or learning one thing through the knowledge of another thing. In terms of Yin and Yang in the human body, the external is Yang, and the internal is Yin, the back is Yang, and the abdomen is Yin. In terms of Yin and Yang concerning the Zangfu-organs, the Zang-organs pertain to Yin, and the Fu-organs to Yang. Therefore, the liver, heart, spleen, lung, and kidney are all Yin, while the gallbladder, stomach, large intestine, small intestine, bladder, and Sanjiao (Triple-Energizer) are all Yang.

These metaphors are rooted in natural phenomena and reflect the process-oriented worldview of TCM (Fang and Jia 2015; Shi and Yue 2024). For instance, orientations toward the sun are associated with Yang, while those away from it signify Yin. Consequently, “fire” is used to represent inflammation, and “dampness” denotes sluggish metabolism. Emotional distress is metaphorically framed as Qi stagnation – an obstruction of energy flow analogous to a blocked river – while illness is often conceptualized as a Yin-Yang imbalance, indicating a disruption in the dynamic interplay of complementary forces (Li 2016).

Despite extensive research on metaphors in Western medicine, few studies examine their use in TCM clinical communication, particularly in intercultural settings like the UK. Existing work (e.g. Huang et al. 2025; Liu 2022; Shi and Yue 2024; Wang et al. 2011; Zhao and Mao 2025) focuses on intracultural contexts (e.g. China), neglecting how TCM metaphor’s function where patients lack familiarity with TCM concepts. This gap is critical, as metaphors that resonate in one culture may confuse or alienate in another (Ma and Jia 2012; Wang 2006).

2.3 Metaphors and intercultural health communication

Intercultural communication refers to the exchange of information between individuals with differing cultural norms, values, and linguistic frameworks (Piller 2017). In healthcare, metaphors act as double-edged swords: while they can clarify complex ideas (e.g. “immune defence as an army”), they may also perpetuate cultural misunderstandings if sources (e.g. Qi) are unfamiliar (Lazard et al. 2016).

Research on the intercultural communication of TCM in the UK has largely centred on two areas: (1) the translation of TCM classical texts and (2) the development of communication strategies. From a metaphorical perspective, studies on TCM text translation can be divided into two approaches of general metaphor translation strategies and text-specific metaphor analysis.

For general metaphor translation strategies, scholars have categorized TCM culture-loaded words into orientational, ontological, and structural metaphors, proposing strategies such as retaining, substituting, or omitting figurative images. Key principles include preserving TCM’s metaphorical characteristics through literal translation, explanatory annotations, or metaphor transformation. For text-specific metaphor analysis, studies on works like Huangdi Neijing (黄帝内经, ‘Inner Canon of the Yellow Emperor’) examine translation strategies (e.g. equivalence, transformation, alienation) and methods (e.g. literal translation, free translation, transliteration with annotation). These works classify metaphors into orientational, ontological, structural, and social relationship types, comparing different English versions to assess translation styles and effectiveness.

With Python, Jiang and Zhang (2015) put forward the constructive communication strategies such as strengthening the research on the evaluation methods of acupuncture efficacy, increasing the research on the safety of TCM, actively responding to the concerns of the public about animal medicine, learning from the communication experience of Chinese Kung Fu, and making good use of the communication platform of Confucius Institutes, so as to solve the current communication problems and difficulties.

The intercultural communication of acupuncture of TCM in the UK mainly puts forward the relevant suggestions on the intercultural communication path of acupuncture culture of TCM. The article points out that in order to effectively improve the communication effect of acupuncture culture of TCM in the UK, the intercultural communication practice of acupuncture of TCM should make good use of the common parts of Chinese and Western cultures, and remove the cultural discount of TCM culture; As for the theory, it shall promote the standardization of acupuncture terminology translation; As for the education, it shall carry out the practice of “TCM + language” for the localized talent cultivation. However, previous research on TCM’s intercultural communication in the UK primarily focus on development contexts, strategy analyses, and text translations, with less attention to topics like the current metaphorical status of TCM’s diagnosis and communication language, and the characteristics of metaphor use in contemporary UK.

2.4 Research gaps

The gap in the literature is the lack of empirical study to investigate the actual example of metaphor of TCM clinical health communication in the UK context. This study hope to fill this gap to enhance patience’ understanding of complex medical concepts to patients in a more comprehensible way with TCM metaphors such as “Qi stagnation”, “Yin-Yang imbalance”. The understanding of TCM metaphors in health communication will also facilitate intercultural communication, enabling General Practitioners to better understand and respect the beliefs and customs of patients from different cultural background. TCM emphasize the interconnection and balance among the body’s systems, which can encourage Western practitioners to adopt a more comprehensive approach to treatment, focusing on the patients’ overall health. The use of easily understandable metaphors can enhance patients’ understanding of and participation in the treatment process, thereby improving treatment efficacy and patient satisfaction.

Metaphors in TCM are sometimes used to express emotional and psychological states, which are crucial for providing comprehensive patient care, including emotional and psychological support. In summary, metaphors in TCM can provide new perspectives and tools for Western medicine, helping practitioners to communicate, understand, and care for patients better in their treatment practices. For TCM practitioners in the UK, metaphors serve as tools to translate TCM concepts for Western patients, e.g. explaining “dampness” as “fluid buildup”; negotiate meaning when cultural frameworks clash, e.g. reconciling “Yin-Yang” with biomedical diagnoses; and empower patients by validating culturally rooted health beliefs (Hansen 2018). However, empirical studies on TCM metaphors in intercultural settings remain scarce. Most research prioritizes Western biomedical contexts (e.g. cancer, mental health), neglecting how TCM’s metaphorical language impacts patient understanding, trust, or adherence in multicultural societies like the UK.

This study addresses three key gaps: lack of empirical data: Prior works (e.g. Shi and Yue 2024) analyse TCM metaphors theoretically but omit real-world examples from UK clinics; intercultural focus: no studies systematically compare how TCM metaphors are interpreted by patients of diverse cultural backgrounds in the UK, and practical implications: The literature offers few guidelines for clinicians using TCM metaphors cross-culturally. By analyzing authentic TCM consultations in the UK, this paper identifies common TCM metaphors and their communicative functions, examines how patients with varying cultural fluency interpret these metaphors, and proposes evidence-based strategies for optimizing metaphor use in intercultural TCM practice.

3.1 Data collection

Participants were recruited via purposive sampling through professional Chinese medicine practitioner networks. Recruitment emails briefly introduced the research topic and invited participation. Of the 21 practitioners initially contacted, 11 responded affirmatively and were interviewed, resulting in a response rate of approximately 52 %. All participants met the inclusion criteria: being ethnically Chinese, aged over 30, and having more than three years of TCM clinical experience in the UK.

Eight of them were female, and three were male, ages 39–67. The researchers used a semi-structured interview protocol that allowed the participants to tell their stories about their experiences and understandings of the metaphors and intercultural health communication. After the participants signed the Institutional Review Board (IRB) consent forms, they talked about their understandings of the differences between the China and UK medical systems, intercultural health communication and metaphors they use in their daily communication with patients. Then the researchers moved to ask two central questions: (1) how do participants deal with Chinese medical terms in communication with their patients, when there is no equivalent concept of these terms in the Western medical system; (2) how do participants describe their communication strategy (i.e. use of metaphors) based on their medical practices. We used semi-structured interviews to elicit both structured data and spontaneous metaphorical language in clinical narratives. This format allowed for open-ended responses while ensuring consistency across interviews. Interviews were conducted between February and April 2023, either face-to-face or via Zoom, depending on participant availability and pandemic-related constraints. Each interview lasted approximately 50 min on average, ranging from 30 to 65 min. All interviews were audio-recorded with participant consent, and subsequently transcribed verbatim in the original Chinese language with some code-switching. The study received Ethical Approval from Lancaster University’s Research Ethics Committee (grant number: FASSLUMS-2025-5235-RECR-2). Informed consent was obtained from all participants prior to data collection. Participants were assured of confidentiality, and pseudonyms were used in all reporting.

3.2 Data analysis

In order to identify and analyse metaphors in the transcribed case rounds, the researchers followed the inductive steps connected to metaphor-led discourse analysis (Cameron et al. 2009). A bottom-up approach was used, and the analysis consisted of multiple phases, going from identification, over coding to investigating patterns, in accordance with the steps laid out in the methodological framework. After transcription, the researchers began identifying instances of metaphorically used language and indicating vehicle terms, namely the words or phrases that can be justified as somehow anomalous, incongruent, or “alien” in the ongoing discourse, when they have some other meaning that is more basic in some way and that contributes to the meaning in context through comparison (Cameron et al. 2009). In connection with this initial stage, all authors discussed criteria for inclusion and exclusion. To ensure reliability, the investigator triangulation (Creswell 2014) was followed, and the researchers first independently coded the whole transcript for the first case round before discussing any differences and cases of doubt, and criteria for inclusion and exclusion. For the subsequent transcripts, each transcript was coded by two researchers individually. For any discrepancies, all authors of this paper discussed thoroughly until an agreement was reached. We acknowledge that metaphor identification can be interpretively complex and potentially subjective. To mitigate this, we employed investigator triangulation (Creswell 2014), where two researchers independently coded each transcript for metaphorical language and then met to reconcile differences. Cases of ambiguity were discussed collaboratively until consensus was reached. We also relied on Cameron et al.’s (2009) framework to guide consistent application of inclusion criteria. Challenges included distinguishing between idiomatic and metaphorical expressions, and interpreting culture-specific analogies unfamiliar to non-native speakers.

4.1 Pain metaphors in health communication

In Western medicine, the pain metaphor often utilizes the “sharp” and “fire” metaphors, emphasizing the intensity and subjective experience of pain. Words such as “sharp”, “fire”, and “burning” are used to depict the sharpness and impact of pain. On the other hand, in TCM, the pain metaphor tends to use milder vocabulary such as “裹” (guo, ‘wrapped’), “隐” (yin, ‘hidden’), and “绞” (jiao, ‘twisted’), focusing on conveying the objective sensations and external manifestations of pain (see Table 1).

4.2 Emotion metaphors in health communication

In Western medicine, the emotion metaphor is primarily used to describe depressive emotions. On one hand, the pressure metaphor is often employed, using words such as “pressure”, “weight”, and “burden” to reflect the heaviness of depressive emotions. On the other hand, directional metaphors are frequently utilized, with words and phrases like “at the bottom of”, “under”, and “sink into” to convey a sense of downward orientation, highlighting the negative nature and detrimental effects of depressive emotions. Container metaphors are also used, with phrases like “all doors are closed”, “was safe in this bubble”, and “be trapped in a ‘container of depression’” to convey the characteristics of depression, such as internal confinement and self-isolation (see Table 2).

In contrast, in TCM, emotion metaphors are mainly reflected in the descriptions of depression and anxiety. In the description of depression, TCM also likes to use spatial metaphors, such as “One’s will sinking like falling into an abyss” using spatial words like “坠” (zhui, ‘falling’) to convey the experience of depression as being low and negative. The sentence “Emotions, like stocks, decline after reaching their peak.” applies the law of motion in Chinese philosophy, “物极必反 ” (wuji bifan, ‘what goes up must come down’), to emotions by comparing them to stocks. It metaphorically suggests that emotions, like stocks, rise to their peak to symbolize excitement and exhilaration, and decline like stocks to signify depression and despondency. On the other hand, when describing anxiety disorders, TCM tends to use fire metaphors more frequently, using terms related to “自然之火” (ziran zhihuo, ‘wildfire’) such as “太阳” (taiyang, ‘sun’), “火山” (huoshan, ‘volcano’), and “火山岩浆” (huoshan yanjiang, ‘volcanic magma’) to depict the restless and agitated experience of anxiety. By associating anxiety disorders with natural phenomena, such as wildfire, it is hoped to break down people’s inherent biases towards anxiety disorders and encourage them to embrace and address anxiety with a more positive attitude, seeing it as a more natural and common symptom.

4.3 Infertility metaphors in health communication

In Western medicine, metaphors for infertility often focus on describing the symptoms and frequently use nature metaphors. For instance, phrases like “Because a tree has shadows and fruits. People gather and pick the fruits. We are constantly excluded since we are fruitless […]” use the metaphor of being fruitless to describe the experience of infertility. Another example is “You know, you buy a ticket if you won. Infertility is also something like that.” which metaphorically represents the cure for infertility by comparing it to winning a lottery ticket (see Table 3).

The use of metaphors in TCM to describe infertility primarily focuses on the analysis of causes and treatments, with a predominant use of nature metaphors. For example, the use of the metaphor “The method of nourishing the kidney Yang to treat infertility is like the spring breeze that brings rain, nourishing all things. It is often referred to as ‘the blending of heaven and earth, the transformation of all things into essence’” metaphorically describes the infertility treatment of warming and nourishing kidney Yang as the nurturing spring wind and rain that nourishes all things. However, there are currently no documented cases of using gambling metaphors in TCM to describe infertility.

4.4 Cancer metaphors in health communication

The metaphorical expressions commonly used in Western medicine to describe cancer include the war metaphor and the journey metaphor. In the war metaphor, cancer is often seen as an invading enemy, and the process of the body’s immune system fighting against it and chemotherapy is likened to military actions to combat and eliminate the enemy, thus highlighting the strong harm of cancer to the human body. In the journey metaphor, cancer treatment is often portrayed as a long journey, emphasizing the stubbornness of cancer (see Table 4).

In TCM, the metaphorical expressions used to describe cancer mainly involve the use of nature metaphors and social relationship metaphors. In the nature metaphor, symptoms related to neurological tumors, such as tremors, are often seen as movements of wind, while tumors located on the surface or connected to the external environment are compared to natural fires. The use of social relationship metaphors in this context often involves representing the interconnection between two organs through a specific social relationship and the allocation of responsibilities. For example, “膀胱经和肾经的关系就像一对东家和掌柜, 相辅相成” (‘The relationship between the bladder meridian and the kidney meridian is likened to that of a master and a steward, complementing each other’). In this sentence, by using the social relationship and the allocation of rights and responsibilities between a master and a steward, it reflects the connection between the bladder meridian and the kidney meridian.

4.5 Obesity metaphors in health communication

In Western medicine, the metaphorical use of war, addiction, and religious metaphors is prevalent when discussing obesity. In the war metaphor, Western medicine either views obesity as a military opponent or portrays the food industry as a military opponent. Strategies for weight loss, such as sugar tax, are seen as weapons in this battle. As for the addiction metaphor, Western medicine mainly considers unhealthy diets, such as junk food, as addictive drugs. In the religious metaphor, obesity is viewed as a sin, and foods that are likely to cause weight gain are demonized (see Table 5).

The obesity metaphor in TCM is similar to that in Western medicine, as it primarily utilizes the metaphors of war and addiction. An example of the war metaphor is the analogy of seafood being compared to deep-sea bombs. The corresponding example sentence is: Seafood is compared to a “deep-water bomb”. Prior to the explosion, it is completely “cold in nature”, but once it reaches a certain depth within the water, and reaches its explosive threshold, it will explode, generating heat”. The addiction metaphor is mainly reflected in the description of uncontrolled eating habits, viewing it as an addictive behaviour.

It can be seen from the results above that the analytical emphasis on metaphor unveils a unique aspect of intercultural health communication that extends beyond the typical categorization of challenging doctor-patient interactions, including delivering difficult news, fostering behavioral changes, and navigating emotional exchanges. While these scenarios are present in our data, the qualitative and linguistic insights offered by this research bring a nuanced understanding of the micro-dynamics inherent in intercultural communication challenges. This approach not only deepens our comprehension of culturally significant medical terms like Yin-Yang but also enriches our perspective on broader intercultural communication issues.

The above analysis also illustrates that metaphorical language can be recognized as a potent tool for expressing emotions and facilitating sense-making in complex emotional situations, such as infertility and miscarriage. Unlike prior studies that primarily focus on patients and their families, the investigation of this research highlights how TCM doctors utilize metaphors to clarify health conditions and enhance doctor-patient interactions. This metaphorical perspective allows us to access underlying emotions that may otherwise not explicitly articulated, revealing how metaphors shape the healthcare dialogue.

5.1 Power distance

Power distance can be defined as the extent to which the weaker members of institutions and organizations within a country (or region) expect and accept unequal distribution of power. In Western medicine, to represent power distance, disease metaphors mainly focus on the use of verbs that reflect power relationships. Metaphors in TCM not only use relevant verbs and adjectives to directly reflect power consciousness but also convey power relationships indirectly through different responsibilities allocation.

In Example (1), the metaphor delicately reflects the unequal power relationship between the stomach and the spleen through the different responsibilities allocated to the canteen and the distributor.

Direct expressions of power can create a sense of being enslaved and generate resistance from patients. Therefore, for better communication, Western medicine can also consider using indirect ways to express unequal power dynamics by explaining specific role assignments, rather than directly indicating power distance. This approach not only facilitates effective transmission of metaphorical information, but also helps to avoid the sense of distance and oppression that power distance may bring to patients.

5.2 Individualism versus collectivism

Individualistic society is a social form where individual interests outweigh collective interests, while in collectivist societies, collective interests take precedence over individual ones. Individualism emphasizes personal time, freedom, and challenges, whereas collectivism places greater value on training, material conditions, and the application of skills. Based on our analysis, the number of Chinese medical disease metaphors reflecting collectivist tendencies (22 cases) is much higher than that of Western medical disease metaphors (10 cases), highlighting a stronger emphasis on collectivist concepts in TCM discourse (Semino 2021).

According to Hofstede’s three dimensions for measuring collectivism – training, material conditions, and skill utilization – the most common representation of collectivism in Western medicine is the utilization of skills. For example, the sentence “It feels like an ice-cream headache – the sharp deep freeze of eating or drinking too much of a cold substance too quickly.” conveys the skill of triggering an ice-cream headache – the sharp deep freeze – by explicitly pointing out the act of eating or drinking too much of a cold substance too quickly, thus embodying a collective consciousness. Another sentence, “But again, coming back to the sugar tax I think sugar tax is a great idea because you know, like, especially combating obesity”. This sentence emphasizes that the sugar tax possesses the skill and function to combat obesity, which also reflects collectivist ideals through the application of skills. The specific implementation of the sugar tax involves raising taxes and prices on sugary products, creating a higher price barrier to suppress people’s desire to purchase and limit consumption. As a result, the purchase of sugary products, which is one of the causes of obesity, decreases, leading to a reduction in the occurrence of obesity.

On the contrary, in the disease metaphors of TCM, the primary manifestation of collectivism is focused on the utilization of material conditions and skills. Example (2) reflects a strong collectivist ideology by suggesting that the spleen and stomach are interdependent on each other as material conditions. Example (3) illustrates that Qi and blood serve as the material conditions for the energetic potential of the heart-mind, highlighting a collectivist orientation.

Example (4), which reflects the concept of collectivism through the application of the skill of blood nourishment and activation via Xuehai (‘sea of blood’), conveys a positive affirmation of collectivism.

The use of material conditions to convey a collectivist tendency is a paradigm that TCM offers for Western medicine to draw inspiration from in disease metaphors. In practical terms, Western medicine can pay more attention to the connection between relevant symptoms and the external environment, as well as the interdependence between different organs and cells. By doing so, Western medicine can explore the material environmental basis that causes or treats related diseases, as well as the material conditions for the survival and development of a particular organ or cell. These findings can then be reflected in the discourse of disease metaphors as introductory background material, enhancing the collective consciousness and information capacity within the discourse of disease metaphors.

5.3 Masculinity versus femininity

Masculinity is characterized by a strong and assertive temperament, emphasizing income, recognition, competition, and challenges. Femininity, on the other hand, is characterized by a soft and nurturing temperament, with a focus on relationships, cooperation, community, and job security. According to my analysis and compilation, it can be observed that the number of cases in which Chinese and Western medical disease metaphors exhibit masculine qualities is similar, with 13 cases and 15 cases respectively. Therefore, the representation of masculine qualities in Western and Chinese medical disease metaphors is generally consistent. Specifically speaking, in representing masculine traits, disease metaphors in Western medicine often use war metaphors to represent masculine traits. Terms like “invaders”, “enemy”, “war”, “bullet”, and “military opponent” are all source domains used in war metaphors to depict masculine features. Verbs like “defeat”, “destroy”, “beat”, and “combat” are also commonly used in war metaphors to convey masculine qualities. In contrast, disease metaphors in TCM mainly use source domains that have masculine qualities and proactive characteristics, such as “sun” (太阳, taiyang), “volcanic magma” (火山岩浆, huoshan yanjiang), “stocks” (股票, gupiao), and “fire” (火, huo).

War is characterized by aggression and destruction, and it is associated with memories of disasters and suffering for people around the world. Therefore, it is not advisable to use war metaphors excessively in disease metaphors. Too many war metaphors can burden patients with heavy and negative experiences. Semino criticized the excessive use of war metaphors in describing COVID-19, pointing out that war metaphors inappropriately portray the virus and disease as malicious enemies. This implies that those who died from the disease did not try hard enough in their “battle” against the virus, leading to excessive anxiety among people. Furthermore, it may also legitimize the implementation of authoritarian policies (Semino 2021). To avoid excessive use of war metaphors while representing masculine traits, Western medicine disease metaphors can learn from traditional Chinese medicine’s use of source domains that have proactive characteristics. This approach will not trigger stereotypical impressions of war in patients and can effectively reflect masculine qualities. It can also provide patients with positive motivation to actively accept treatment and overcome obstacles.

The term “uncertainty avoidance” was first introduced by Cyert and March (1963) in The Behavioural Theory of the Firm. Subsequently, Hofstede (2010) defined it as the extent to which members of a culture feel threatened by uncertain or unknown situations. This feeling is expressed through a sense of tension and a need for predictability – a demand for both written and unwritten rules. Based on our analysis, the acceptance level of uncertainty in the metaphorical representation of diseases in Chinese medicine (8 cases) is significantly higher than in Western medicine (3 cases). Therefore, Western medical metaphors tend to demonstrate a stronger tendency to avoid uncertainty.

In specific terms, to convey an accepting attitude towards uncertainty, Western medicine disease metaphors often convey an attitude of accepting uncertainty through the use of vocabulary that indicates possibility. For example, in the phrase “You could possibly describe the pain as swords on fire”, the word “possibly” highlights the potential for different interpretations. Similarly, in the statement “This attack may eventually lead to defeating the disease although it also involves”, the word “may” acknowledges the uncertainty of the outcome. In the phrase “junk food could be addictive ‘like heroin’”, the phrase “could be” suggests that there is a possibility of addiction but does not assert it as an absolute fact.

In this aspect, Chinese medicine disease metaphors employ various approaches. The use of questioning tone, omission of words, comparative terms, or words indicating possibility are all ways in which it reflects an attitude of inclusiveness towards uncertainty.

5.4 Long-term versus short-term

Long-term orientation means cultivating and encouraging virtues that are oriented towards future rewards, such as perseverance and frugality. In contrast, short-term orientation means cultivating and encouraging virtues that are focused on the past and present, such as respecting tradition, maintaining face, and fulfilling social obligations. TCM metaphors demonstrated more significant long-term orientation (7 cases) in comparison to short-term orientation. On the other hand, Western medicine disease metaphors tend to prioritize short-term orientation and rarely exhibit clear long-term orientation (3 cases).

In Western medicine, the long-term in disease metaphors is mainly reflected in the metaphors of emotion and cancer. Moreover, most of the metaphors that demonstrate long-term belong to the journey metaphor, such as “Understanding cancer in the context of a longer life journey” and “This is not a short road”. These metaphors use the concept of a journey or road to represent the long-term. By contrast, in terms of the dimension of long-term and short-term, TCM often uses continuous verbs or phrases such as “accumulate” (积累, jilei), “gather” (积聚, jiju), and “as age increases” (随着年龄的增长, suizhe nianling de zengzhang) to convey the long-term in various metaphorical descriptions of diseases.

In Example (5), the use of the verb “accumulate” (积累, jilei) reflects the long-term in the development of “damp-heat” (湿热, shire) and the onset of obesity.

It is evident that Western medicine disease metaphors need to expand the range of expressions for long-term and draw from the characteristics of TCM disease metaphors, which often use continuous verbs and phrases. This is important in order to demonstrate long-term in a wider range of disease metaphors. Particularly when explaining the pathogenesis to patients, the use of continuous verbs and phrases can make the explanation more vivid, realistic, and improve the patient’s trust in the physician, thereby enhancing the effectiveness of diagnosis and treatment.

5.5 Indulgence versus restraint

Indulgence is characterized by the freedom to act, consume, socialize with friends, or engage in leisure and entertainment activities according to one’s own desires. On the opposite end, restraint manifests as the constraints imposed on one’s behaviour by various social norms and prohibitions. According to my analysis and compilation, it is evident that the number of cases with distinct tendencies towards constraint in Chinese and Western medical disease metaphors is nearly equal, with 4 cases and 5 cases respectively. Therefore, it can be concluded that Western and Chinese medical disease metaphors exhibit homogeneity in terms of their expression of constraint.

People tend to desire freedom more than constraints. Therefore, using excessively restrictive modal verbs and imperative verbs may give patients a negative experience of feeling suppressed, confined, and losing their autonomy. As a result, when expressing constraint in Western medical metaphors, it is necessary to learn from TCM and use more gentle modal verbs, such as “should”, “ought to”, “could”, etc., to soften the inherent constraint in metaphorical discourse and give patients a greater sense of freedom and agency, thereby improving the effectiveness of diagnosis and treatment communication.