Conveying Imagistic Thinking in Traditional Chinese Medicine Translation: A Prompt Engineering and LLM-Based Evaluation Framework

TL;DR

This paper presents a novel prompt engineering framework using large language models to improve the translation of imagistic Chinese medical texts, enhancing conceptual clarity for clinical application.

Contribution

It introduces a human-in-the-loop approach with prompt-based cognitive scaffolding to better convey metaphor and metonymy in TCM translation using LLMs.

Findings

Prompt-adjusted LLM translations outperform baseline and human translations

Simulated reader evaluations show higher cognitive dimension scores for prompt-adjusted translations

The framework offers a replicable method for translating concept-dense ancient texts.

Abstract

Traditional Chinese Medicine (TCM) theory is built on imagistic thinking, in which medical principles and diagnostic and therapeutic logic are structured through metaphor and metonymy. However, existing English translations largely rely on literal rendering, making it difficult for target-language readers to reconstruct the underlying conceptual networks and apply them in clinical practice. This study adopted a human-in-the-loop (HITL) framework and selected four passages from the medical canon Huangdi Neijing that are fundamental in theory. Through prompt-based cognitive scaffolding, DeepSeek V3.1 was guided to identify metaphor and metonymy in the source text and convey the theory in translation. In the evaluation stage, ChatGPT 5 Pro and Gemini 2.5 Pro were instructed by prompts to simulate three types of real-world readers. Human translations, baseline model translations, and prompt-adjusted translations were scored by the simulated readers across five cognitive dimensions, followed by structured interviews and Interpretative Phenomenological Analysis (IPA). Results show that the prompt-adjusted LLM translations perform best across all five dimensions, with high cross-model and cross-role consistency. The interview themes reveal differences between human and machine translation, effective strategies for metaphor and metonymy transfer, and readers' cognitive preferences. This study provides a cognitive, efficient, and replicable HITL methodological pathway for the translation of ancient, concept-dense texts such as TCM.