This article compares the cognitive differences and influencing factors of traditional Chinese medicine culture among rural residents in Guigang, Guangxi, and Jinhua, Zhejiang, providing a reference for balanced development. A stratified sampling method was used to conduct a questionnaire survey in three townships in each region, and data were analyzed using SPSS 25.0 and chi-square test. The survey shows that residents in Guigang rely more on personal experience for their understanding, resulting in fragmented cognition, with their needs concentrated on disease treatment. On the other hand, residents in Jinhua rely on rational trust and digital communication, leading to deeper cognition, and their needs tend to focus on preventive health care. Occupational factors significantly affect the cognitive level in Jinhua, while in Guigang, it is closely related to trust and cultural atmosphere. The interaction of regional economy, occupational background, and cultural tradition affects cognitive differences. It is suggested that Guigang should build a community traditional Chinese medicine cultural experience matrix, develop digital content for ethnic medical resources, and strengthen the “experience-identification-dissemination” closed loop. Jinhua should deepen the construction of digital IP and promote the integration of industry and education. The two regions should jointly build a cross-regional cultural corridor, cultivate inheritors, and use new media to expand the coverage of dissemination.