In the process of the internationalization of traditional Chinese medicine (TCM), English-language journals serve as a crucial platform for integrating TCM knowledge into the global academic system and building its international academic discourse power. At present, China hosts more than 20 English-language journals focusing on TCM, representing a pivotal force in journal publishing within the global traditional medicine community. However, the development of English-language TCM journals remains deeply embedded within the paradigm and evaluation framework of natural science research. Consequently, research on the humanities and cultural dimensions of TCM has been significantly marginalized, while the historical experience, philosophical foundations, and cultural logic inherent in the TCM knowledge system are increasingly confronted with the dual challenges of discursive voicelessness and value obscuration in international scholarly communication. Drawing on the theory of local knowledge, this study examines the operational logic of the international academic publishing system and systematically analyzes the major challenges facing international TCM publishing from four interrelated dimensions: disciplinary positioning, research evaluation, knowledge representation, and cross-cultural communication. Based on this analysis, the paper proposes a set of practical strategies, including strengthening knowledge system development as the guiding principle, advancing strategic agenda setting, establishing a multidimensional evaluation framework, optimizing international academic expression, and deepening collaborative publishing mechanisms. Meanwhile, using Chinese Medicine and Culture, the world's only English-language journal focusing on humanities research related to TCM, as a case study, the paper explores how English-language TCM journals can uphold the epistemic subjectivity of TCM while adhering to international publishing standards. Through the cultivation of academic communities and innovation in cross-cultural scholarly discourse, these journals can facilitate the effective transformation of TCM as local knowledge into global academic discourse. This study aims to provide both a practical model and theoretical support for advancing China's initiatives to build world-class sci-tech journals and promote the "dual return" strategy within the field of TCM.