The work aims to explore the cultural connotations and theoretical logic of traditional Chinese medical instruments from the perspective of local knowledge and reveal the local knowledge contained in them as material carriers of medical practice. Based on Clifford Geertz's theory of "local knowledge", the historical evolution of traditional Chinese medical instruments is systematically sorted out through archaeological evidence and document analysis, the theoretical connections of medical instruments with the theories of vital qi, yin-yang, and the five elements are analyzed, and the generative logic and cultural connotations of local knowledge in medical instruments are revealed. It is found that the material selection, shape design, and usage methods of traditional medical instruments are all rooted in the natural environment, philosophical thoughts, and social traditions of specific regions, representing the material transformation of medical practice in local knowledge.