Terms and translation

Knowledge Transmission

The cross-cultural transmission of Chinese medicine is something of an anomaly in knowledge transmission trends in the modern world. Accounting for the bulk of cross-cultural knowledge transfer these days is scientific knowledge and technical know-how from the advanced to the less advanced countries. The transfer of such knowledge is rapid and comprehensive for the simple reason that the languages that serve as the medium of transmission are primarily those of the source culture, notably English and other Western languages, such as French, Spanish, Russian, and German. The universal learning of such languages by students, researchers, and entrepreneurs in the recipient cultures enables them not only to quickly acquire knowledge and keep abreast of new developments but also allows them to share their own findings and developments internationally. Throughout Africa and Asia, knowledge of Western languages is regarded as a primary skill because it facilitates access to a vast gamut of modern knowledge, and one or other of these languages is taut from an early age.

By contrast, Chinese medicine is hampered in its transmission by the fact that recipient communities mostly do not learn Chinese and are generally unfamiliar with Chinese culture. Few Westerners have the opportunity to learn Chinese in secondary school. Chinese medical colleges are mostly private and do not have the resources to provide Chinese-language education. Relatively few take it upon themselves to pursue language study. Hence, the transmission of Chinese medicine relies predominantly on translation by the few capable of doing it. Other European languages rely more heavily on translation from English than directly from Chinese.

Western lack of linguistic access to primary Chinese literature has been a constant drag on development. As Chinese medicine underwent a considerable growth in popularity in the West from the 1970s, students read the scant literature available at the time and took notes from East-Asian teachers whose English was often poor. The need for textbooks was first met by texts from mainland China, although within a few years, Westerners who had learned to read Chinese gradually joined the translation effort. The translated literature was sufficient to enable schools to provide a minimal education, mainly centering on acupuncture. On this basis, Chinese medicine was able to acquire the trappings of a profession, such as school accreditation and national examinations for the licensing of practitioners. Although the amount of literature has constantly grown since that time, students in the English-speaking world to this day have far less literature available to them than Chinese students do. With no knowledge of Chinese, students, teachers, and practitioners have no idea how poorly the available body of English-language literature reflects the knowledge contained in Chinese texts.

The lack of quality literature manifests in numerous ways: English-language textbooks do not cover all the topics that Chinese textbooks cover. They lack the detail of Chinese textbooks. A considerable proportion is the work of people who do not read Chinese. What we might call ideological biases have crept in. English-language texts by Chinese writers have a strong biomedical bias, while certain Western proponents of Chinese medicine have developed systems of a quasi-religious nature that bear little or no resemblance to any past or present current of thought in China. And, lastly, the translation of Chinese medical terminology has been highly variable and overly influenced by biomedicine. The lack of linguistic access to primary texts has meant that writers choose the terms they like without regard to whether they adequately reflect the original concepts, and most of their readers don’t know any better.

The development of Chinese medicine in the West is discussed in detail in Chinese Medicine: The Ideas That Shaped It (Wiseman and Wilms, Paradigm Publications, 2021). Below we focus on the problems of Chinese medical terminology and its translation.

Chinese Medical Terminology

Chinese medicine has a hist spanning more than two thousand years and has been practiced throughout the vast territory of China and increasingly beyond. Over its history, it has slowly but constantly evolved. Given the reverence for the masters of antiquity, a tendency toward renovating old ideas rather than building new ones has made Chinese medicine a complex body of knowledge composed of numerous strands and strata. Modern students have to study texts spanning two millennia, during which time the Chinese language has undergone considerable changes. Not surprisingly, therefore, Chinese medicine has a large and complex terminology. And since, until the advent of scientific thought from the West, little or no attempt at terminological management was made, the precise meaning of terms in older texts is not always clear.

The translation of Chinese medical terminology poses challenges. The number of terms is quite astounding, and many are highly susceptible to variable translation. Term translations should reflect the concepts accurately and preserve finer distinctions between concepts.

The task is not as hard as it might seem. There are time-tested translation methods of devising English terms that are accurate and that enable distinct concepts to be distinguished without conflation or confusion. The basic approach is to give a literal translation of the term that reflects the meaning in the mind of the original creator of the term. Where this fails to produce a well-motivated term, definition-based terms can be devised, and in the last resort, the source-language term can be borrowed in the form of transliteration for terms regarded as untranslatable. When close synonyms imply different nuances, they should be given distinct translations.

Source-Oriented Translation

This basic approach of close translation combined with the use of borrowing from the source language can be called source-oriented translation. This is contrasted with target-oriented translation, which refers to freer styles of translation that present the basic message of a text in easy-to-read fashion. Source-oriented translation preserves technical and cultural detail and so is more challenging for the reader, while target-oriented translation emphasizes ease of rough comprehension over preservation of detail. The two styles of translation are not totally mutually exclusive, since both may be used in the translation of any given text. However, specialized disciplines such as Chinese medicine have many special concepts that are best preserved in translation by the use of source-oriented translation.

This strategy is almost universally applied in specialist fields with large numbers of technical terms. In most disciplines undergoing cross-cultural transmission, term translation is fairly literal. Although linguists who study terminology point out that there is no intrinsic need for literality and any term is acceptable provided it is understood to reflect its stated definition, they observe that literal translation is the most widely used in most fields. There are two reasons for this. One is that terms are usually carefully chosen, or as terminologists say, well-motivated, so that literal translations tend to be equally well-motivated. The other is that people with knowledge of both languages, reading source-language information and creating target-language text naturally tend to prefer look-alike terms. The transmission of modern biomedicine from the West to China provides a typical example. A cursory survey of Chinese biomedical terminology reveals that most terms are mirror images of their English counterparts, with surprisingly few exceptions. English terms, which are largely composed of words or word roots derived from Latin and Greek, are usually matched by look-alike terms in Chinese, where each major component of the English term is matched with one or more characters in the Chinese equivalent.

The nature of Chinese medicine makes the need for especially stringent source-oriented translation particularly necessary, for three reasons:

First, Chinese medicine differs from modern disciplines in that it still considers ancient texts to be authoritative. While modern disciplines are studied through textbooks that barely mention the historical origins of their theories, Chinese medicine is learned through modern texts that liberally quote the classics and through close study of the classics themselves. Texts such as the Huáng Dì Nèi Jīng, Nàn Jīng, Shén Nóng Běn Cǎo Jīng, Shāng Hán Lùn, and Jīn Guì Yào Lüè are treasured as sacred texts that are carefully preserved and explained through annotation. No rewrite of them in modern Chinese is ever considered to be an accurate representation of their content. Translation of such texts into foreign languages requires extremely close translation to ensure maximum accuracy. Since much of the terminology of these texts is still in use today, stringent source-oriented term translation is necessary to preserve the historical perspective of Chinese medicine. Thus, to take the example of a term from the Jīn Guì Yào Lüè, some might translate 狐惑 hú huò as throat and anus syndrome, but a close translation such as fox-creeper would be a more accurate translation, since the fact that the author Zhāng Zhòng-Jǐng apparently named the disease after a mythical three-legged turtle capable of killing humans by shooting them with sand from its mouth might be of significance in understanding his thought or the thoughts of anyone who may have copied or edited the text. In modern disciplines, translation problems posed by having to bridge historical periods do not exist, but Chinese medicine they most certainly do. A translation of a modern text that reads this condition was called throat and anus syndrome in the Jīn Guì Yào Lüè would be entirely inaccurate in a discipline that fervently shuns tampering with the original text.

Second, while the modern sciences always define their concepts clearly, Chinese medicine traditionally did not always provide explicit definitions for terms. Because of this, Chinese medical dictionaries did not appear until the modern era. Traditionally, readers would deduce the meaning of a given term from its literal meaning, from the context in which it was used, from previous use of the term in the literature, and from annotations to texts by later scholars. Terms were sometimes given explicit definitions, but not systematically. In other words, communication of concepts proceeded as lay communication in any language. For this reason, it has been wrongly argued that Chinese medicine does not possess a terminology, an issue that will be discussed further ahead.

Third, unlike modern disciplines Chinese medical thinking relies heavily on analogy. It notably forms the cognitive bases for the yin-yang and five-phase systems of correspondence which grew out of a belief in resonances between the body and nature. It is so important that in the Huáng Dì Nèi Jīng it is said that medical matters cannot be understood without analogy不引比类¸ 是知不明 bù yǐn bǐ lèi, shì zhī bù míng). Accordingly, many concepts have roots in analogy, and many terms are metaphorical in nature. It therefore follows that adequate treatment of analogy is necessary for the knowledge system as a whole to be fully understood. The implications of this are discussed further ahead.

Source-oriented translation is the most widely used by Chinese medical translators for most terms. However, the widely prevalent tendency to use colloquial or biomedical terms represents a departure from source-oriented translations that creates a disturbing level of inaccuracy. Even among terms produced by source-oriented translation, there is a considerable variability. In many cases, what differs is the choice of literal translation or the frequency of resorting to definition-based English terms and to Pinyin.

Consequently, only a few English terms have been universally or widely adopted by all translators and writers, the main ones being yin, yang; qi; metal, water, wood, fire, and earth; wind, cold, summerheat, dampness, dryness, and fire; lung, kidney, liver, heart, spleen; qi stagnation; blood stasis. The vast majority of terms have no agreed translations. Distinct areas of terminology reveal different tendencies. Thus, for example, names of disease patterns are translated more or less literally by all translators despite different word choices. Disease names are rendered by many Chinese and Western translators with biomedical terms that are often not only inaccurate but also destroy the integrity of the traditional classification of diseases. Symptom terms are often translated with colloquial equivalents that fail to reflect the nuances of the Chinese terminology.

Arguably the most fundamental difference between translators concerns what expressions are considered terms requiring consistent translations and what expressions can be translated freely according to context. The following discussion deals with this last issue first before going on to discuss specific aspects of translation.

Deciding What Is a Term

Certain Western translators have argued that Chinese medicine does not have a terminology distinguishable from everyday expressions and hence does not require any consistent translation of terms. Partly as a consequence of this perception, it has been claimed that multiple translations of a single term can give readers a more rounded understanding of the concept. Some practitioners have expressed opposition to the idea of a fixed terminology on the grounds that this would be too restrictive in describing patients’ conditions and therapeutic approaches.

Terms versus words: These misgivings belie a fundamental misunderstanding as to what constitutes a term. According to Merriam-Webster, a term is a word or expression that has a precise meaning in some uses or is peculiar to a science, art, profession, or subject. In a specialized discipline, a term may be an everyday word used in the everyday sense, albeit with a specific understanding or specific connotations. Examples of this are heart, nose, and sweat in either biomedicine or Chinese medicine, where the words become terms that are conceptually understood differently from the lay words and have connotations that differ from lay ones. Alternatively, a term may be an everyday expression redefined to denote something specific, such as pulse or vessel in either biomedicine or Chinese medicine. A term may otherwise be a new expression composed of lexical items from the word stock of the language, such as clearing heat in Chinese medicine or hepatosplenomegaly (which uses everyday Greek word roots) in biomedicine.

According to this understanding of the word term, it cannot be argued that expressions seemingly derived from the everyday language have no technical significance. Thus, for instance, inability to get food down, reduced eating, and no thought of food and drink all appear to be lay expressions, but they imply nuances that may be of specialist significance. Furthermore, having multiple synonyms or partial synonyms does not make a term any less a term. Although modern disciplines tend to encourage the use of a single term for each concept, terms are still terms even when they have synonyms.

The claim that Chinese medicine does not have a terminology does not hold water when one considers that the names of acupoints, medicinals, and formulas, which denote specific things, are technical terms. No-one could possibly refute this. Chinese medicine has many other expressions designating symptoms, patterns, diseases, and methods of treatment that have been used consistently, in many cases for hundreds of years, but whose meanings, connotations, and nuances are not entirely clear to lay persons. These, too, are technical terms. The no-terminology claim stems from the fact that certain areas of terminology have been prone to considerable variation over time and space. The language of symptoms and diseases has arguably the most variable over history, and because Chinese medicine continues to revere the medical masters of the past, modern readers still encounter terms that they normally would not use themselves. To return to our examples of terms meaning poor appetite, 不食 bù shí, literally not eating or inability to eat, is a term encountered when reading traditional literature, but nowadays writers prefer to use 食少 shí shǎo, reduced eating, since not eating is considered colloquial and hyperbolic. Today, Chinese and English speakers will colloquially say that someone is not eating loosely to mean a poor appetite. Yet, a similar expression such as 食不下 shí bù xià, inability to get food down might imply a difference in meaning, which should be reflected in translation. While Chinese physicians of the past had no qualms about expressing the idea colloquially in writing, later scholars apparently decided hyperbole was best avoided. Terms vary with the intellectual climate of the age. Given the possible doubt as to whether different terms mean the same or different things, the translator’s approach should be to preserve any possible distinctions in meanings.

Context sensitivity: Words and terms can have different meanings in different contexts, which often need to be reflected in translation. A simple example is the term 滑 huá. This term can denote a tactile quality in the context of the pulse (slippery), a visual quality in the context of the tongue fur (glossy), and the phenomenon of uncontrolled loss of fluids from the body (efflux). Since no single English expression covers all these meanings, the translator must identify different senses of words and devise appropriate translations for each. The fact that a single expression in different senses can serve different technical terms is no reason for it not to be considered a term.

The term 气 qì deserves special attention in this context because it has multiple meanings and therefore tends to be translated in different ways according to context, of which the loanword qi is only one. The original meaning of the word was mist, clouds, or vapor, and this was extended to denote insubstantial forces. In early natural philosophy, the phenomena that the term originally denoted prompted the notion that the whole universe was composed of a single element in constant flux, which they naturally labeled as qi. In the lay language, the word has been used since antiquity to denote all manner of things, such as air (空气 kōng qì), breath (气息 qì xí), odor (气味 qì wèi), weather (气象 qì xiàng), (social) atmosphere (气氛 qì fēn), strength (力气 lì qì), morale (士气 shì qì), character (气质 qì zhì), and anger (生气 shēng qì). In medicine, it can denote breath, odors, flatulence, weather and environmental conditions, as well as the force that powers all movement and activity in the body. In translation, there is a natural tendency to consider 气 qì as a term with multiple meanings that can or even must be represented by different words in different contexts and therefore to restrict the loanword qi to specific senses, often mainly to the force that drives activity in the body. Thus, 嗳气酸腐 ǎi qì suān fǔ might be rendered as belching of sour putrid gas, 火气 huǒ qì (fire qi) simply as fire, and zhàng qì (distension qi) as flatulence. Yet although such translations accord with the principle of context-sensitive translation, it can prejudice students’ understanding of what qi means in its widest sense. This is because all the medical meanings of the term are all related to the use of 气 qì in Chinese lay language and in the language of ancient Chinese natural philosophy. We have already witnessed the result of treating 气 qì as a word to be translated differently according to context. When qi is reserved for the motor force of bodily activity, it becomes equated with the concept of energy or vital energy, which have been widely used by many.

Students’ difficulties in understanding of the nature of the qi that powers bodily activity can be compounded by free translations of words describing the action of qi. One of these is脱 tuō, which outside the realm of medicine is used in numerous contexts to mean molting, shedding, peeling, undressing, and escaping. In the medical context, it describes qi leaving the body, which is best represented by translations such as desertion or abandonment. This is sometimes made even more explicit by the two-word term 外脱 wài tuō, outward desertion. However, some have chosen to represent this idea in English by the word collapse, which obscures the Chinese understanding of departure of qi from the body. Presumably, the avoidance of the notion of desertion is motivated, on the one hand, by the logical expectation that if something leaves the body, it should be possible to catch and isolate it and, on the other, by the fear that failure to catch it would prove that qi didn’t exist. A similar example is the term 脚气冲心 jiǎo qì chōng xīn, which literally means leg qi surging into the heart. This could be translated as beriberi affecting the heart (giving rise to heart palpitations and deranged spirit), but such a rendering might obscure the original understanding of the condition and what qi was thought to be or able to do. It is not for the translator to change the information to suit his or her personal philosophical sensibilities.

A work-around that solves this translation problem is to translate 气 qì more systematically as qi than translators might normally do and by adding explicit clarification in key contexts, e.g., 六气 liù qì as the six qi (environmental conditions), the 四气 sì qì of medicinal substances as the four qi (four natures), 嗳气酸腐 ǎi qì suān fǔ may be rendered as belching of sour putrid qi (gas), and 失气 shī qì as fecal qi (flatus).

Minimizing equivalents: To create a streamlined terminology that is easy for others to apply, it is wise to keep the number of translations to a minimum. If a translator sometimes translates 滑脉 huá mài as slippery pulse and sometimes as smooth pulse, the reader might be left wondering if these are the same thing or two distinct things. While an individual translator may maintain consistency, different authors using different terms creates problems for readers when reading different authors. This raises the question of standardization, which will be discussed further ahead.

In the same vein as our argument about qi, when a Chinese term has distinct, but related meanings, it is advisable, though not absolutely necessary, to use the same word or word root. One example is the Chinese 络 luò, which as a noun denotes the smaller elements of the channel system, while as a verb, it means to envelop the organ that stands in exterior-interior relationship to the organ to which a main channel belongs. The word’s core literal meaning is any reticular structure (such as stringy material in a tangerine or a luffa) or to envelop as by such a structure. In channel theory, we translate the term as network vessel and to net (as in the spleen channel nets the stomach). When these concepts are expressed as collateral and linking, for example, the relationship between the two senses and the original metaphors is lost.

A similar example of this is 痹 bì, which now most commonly denotes conditions that biomedicine classes as arthritis. Yet the original meaning of the word was physical immobility, and the term later came to be used as a verb meaning to block, as reflected in its use as a verb to mean impeded flow in the channels and network vessels. Thus, we have adopted the words impediment (the disease) and impede as the verb. These two equivalents serve in most, if not all, instances of the term in Chinese literature. Of course, the disease name impediment has to be defined, at least for modern texts, as denoting a disease involving pain, stiffness, and possibly numbness of the limbs, but impediment is a convenient label for this condition that reflects the original Chinese understanding.

Literal Translation

Given that, in the Chinese intellectual tradition, words are taken at face value in their context, the aim of translation is to choose a semantically matching equivalent that can also be taken at face value in context. This is slightly more complex than it would appear at first, since words and expressions have different levels of meaning. A useful distinction can be made between everyday terms with which everyone is familiar and technical terms that have been specially devised by experts.

Everyday terms are translated by corresponding everyday terms in the target language. So 鼻 bí is translated as nose, 心 xīn, is translated as heart, etc. In such cases, the terms in either language may have literal meanings or connotations that differ. For example, 阴茎 yīn jīng literally means yīn stalk, but as an everyday term, it corresponds to penis (according to some, from the Latin pēnis, originally meaning tail; according to others, originally meaning penis in Latin and related to Greek peos and Sanskrit pasas-). However, 阴茎 yīn jīng and penis are equivalents in everyday terms.

Terms devised by experts are not necessarily new words, but are words used by experts in a special sense or new combinations of words. Take the example of 火 huǒ. The term literally means fire, but is used in several senses in Chinese medicine: one of the five phases; a heat source in the body; or the cause of conditions of heat and redness. In all its contexts, the term can be safely translated as fire, thus extending the range of meanings of fire in parallel with the Chinese. Attention has to be paid to the meaning of the terms intended in the context. As previously mentioned above, 滑 huá is variously translated according to specific contexts: as slippery, glossy, and efflux in the contexts of the pulse, tongue, and fluid loss respectively.

Everyday terms and technical terms are not always clearly differentiated. While 肝火上炎 gān huǒ shàng yán, liver fire flaming upward, may be completely unintelligible to the lay, terms such as 痄腮 zhà sāi, mumps, may often be used by the lay. (Again, here we see a difference in connotations, since while the Chinese term implies a fulminant condition of the cheeks, the English term connotes grimace.)

Accuracy: Finding an accurate translation entails awareness of the full gamut of meanings of words and understanding the meaning intended in context. Some literal translation found in English literature reveal lack of knowledge of word meanings on the part of translators. For instance, one occasionally sees 恶风 translated as evil wind, where the translator failed to realize that although 恶 can be read as è, evil, in this context it is read as wù and means aversion to. Another example is 利咽 lì yān, translated as benefiting the throat, rather than as disinhibiting it. Some mistranslations have trickled into practitioner usage, notably waist representing 腰 yāo. The Chinese term can mean waist, but in medicine, it refers to the lumbar region of the back. Fortunately, mistakes of this kind are pretty rare.

Good translations require sensitivity to precise meanings. Anyone surveying the various English translations of the nomenclature of disease patterns will discern an overall similarity. This is because most translations are fairly literal. However, literal translations can vary, and some translations are more accurate than others. For instance, while some choose to translate 肝气郁 gān qì yù as constrained liver qi, we render it as depressed liver qi. Here, constrained is less accurate than depressed, since it implies an external obstructive force, which is not most commonly the case. This becomes obvious when the differences of general usage of the two words is understood: while the word constrained is very often followed by by X, the word depressed cannot be. Constrained is a past participle that can be used as an adjective, while depressed is simply an adjective derived from a past participle.

The Chinese term 洪脉 hóng mài is sometimes translated as a flooding pulse. Flooding in the environment sometimes corresponds to 洪 hóng, but Chinese has two words for flooding: 淹水 yān shuǐ, which implies the abnormal extensive covering of the land by water; and 洪水 hóng shuǐ, which specifically describes the surge of water that causes swelling of a river above its banks. The latter is the image that describes the pulse in question, since it is the idea of a swollen river that is mapped onto the pulse by analogy. The English flooding can mean this, but it also describes the extensive covering of the land, and hence is ambiguous. The pulse is more accurately described as a surging pulse, suggesting an analogy to a swollen river rather than to a broad expanse of land covered with water.

The concept of 劳 láo refers to damage to the body by continual imbalances of activity and inactivity. The term is rendered by some as overstrain, which is acceptable for certain causes like excessive physical exercise, but it is potentially confusing for the damage caused by inactivity. We use the word taxation instead. The slightly unusual use of this English expression alerts the reader that this is a specific concept. Source-oriented translation emphasizes accuracy and precision, while target-oriented translation tends to use familiar expressions that may not be so accurate.

Preserving analogy and metaphor: Analogy is the comparison of two or more unlike things based on resemblance of a particular aspect. Metaphor is naming or describing one thing by analogy. Biomedicine, like the modern sciences in general, has little use of analogy beyond the initial formulation of hypotheses and makes limited use of metaphor in naming or description. In Chinese medicine, by contrast, analogy has played a major role in the development of knowledge; it notably lies at the root of the yin-yang and five-phase systems of correspondence and manifests in numerous metaphors. Biomedical metaphors in naming tend to be restricted to chance physical similarities, while Chinese medical metaphors describe functions and relationships. The difference between the two can be seen in descriptions of the internal organs. Biomedicine labels the chambers of the heart as atrium and ventricle. The literal meanings of these terms are internal court and little belly respectively. Here, the metaphors, based on chance similarity of physical appearance, are used merely to provide names out of want of better words, and the fact that these related body parts are labeled with mixed metaphors does not matter. What’s more, the literal meanings of the terms barely figure in the minds of users. Chinese medicine also makes use of metaphor in this way, as is seen in the terms 玉门 yù mén, the jade gates (vaginal meatus), 五轮 wǔ lún, the five wheels (five concentric regions of the eye), and 洋须疮 yáng xū chuāng, goat’s whiskers sore. However, Chinese medicine also has a vast gamut of metaphors that indicate functions. These include names for entities such as 三焦 sān jiāo, triple burner, 血海 xuè hǎi, sea of blood (the liver), 髓海 suǐ hǎi, sea of marrow (the brain), 命门 mìng mén, life gate. They also include descriptions like 上焦如雾 shàng jiāo rú wù, the upper burner is like a mist; 中焦如沤 zhōng jiāo rú ōu, the center burner is like foam; 下焦如渎 xià jiāo rú dú, the lower burner is like a sluice.

The greater depth of Chinese medical metaphor exemplified by names describing two or more entities in similar terms that indicate function and relationship. The terms 君火 jūn huǒ, sovereign fire, and 相火 xiàng huǒ, ministerial fire, denote sources of warmth in the body and relative importance. The terms正气 zhèng qì, right qi, and 邪气 xié qì, evil qi, denote the health-maintaining forces of the body and pathogenic forces that threaten it.

Similarly forming a couplet are the terms 卫 wèi and 营 yíng. These are often translated as defensive and nutritive (qi). The terms literally mean defense and camp. They are military metaphors describing the forces that resist invading evils and the logistical supply chain that supports their efforts. The choice of nourishment is out of place. One obvious reason why translators would have adopted it is because in modern Chinese 营养 yíng yǎng means nutrition. However, proper analysis of this term shows that 营 yíng means supply and 养 yǎng means nourishment, so that the two words combined mean supply of nourishment. We originally adopted Manfred Porkert’s translation of construction, which does not adequately reflect the original military metaphor. We have now replaced this with provisioning, which placed in juxtaposition to defense better evokes the military image originally intended. Of course, nourishment, for the most part, works fine and causes no confusion. Nevertheless, in a discipline that has its roots in antiquity, accurate translation helps to create a more faithful picture of ancient medical thought. The example of 卫 wèi and 营 yíng shows that when insufficient attention is paid to the meaning of terms, perceptions of Chinese medicine deriving from expectations of modern alternative health-care modalities can creep in. One may suspect that military connotations of Chinese terms have been neglected because they do not conform to the Western perception of Chinese medicine as being a medicine that seeks peace and harmony rather than military and political power play.

The naming of two major vessels, the 督 dū and the 任 rèn, is another case in point. While these are often translated as the governing and conception vessels, the names were originally derived from administrative titles, hence we translate them as governing and controlling vessels. The translation of 任 rèn as conception vessel derives from 妊 rèn, which means pregnancy. While this translation is valid insofar as the vessel is associated with pregnancy, this translation forsakes the original metaphor and thus obscures the mindset of the originators. The principle of making things clear for the reader seems laudable on the surface of it, but it can lead to dumbing down and to the introduction of ideas from the target-language culture, both of which are ultimately not helpful to students.

The tendency to play down metaphor and analogy in translation is understandable. Metaphors are avoided in the modern sciences because the act of describing something in terms of another is considered as suspect because no two things or phenomena are ever identical. However, in Chinese medicine they are highly conspicuous and even extravagant. Though translators may wish to avoid replicating metaphors in English, in Chinese medicine knowledge derived by analytical thinking is often poorly distinguishable from knowledge derived from analogical thinking. One case in point is the Chinese concept of 风 fēng, wind. The effects of external wind on the body are derived by analytical thinking insofar as winds and drafts can cause common colds. But other associations are derived by analogy: wind is said to affect the yang regions (upper body) just as wind affects the upper branches of trees more than their trunks; wind is mobile and changeable, meaning that diseases attributable to wind are of sudden onset and can affect different parts of the body at different times.

Some metaphors are even simply omitted altogether in translation. Among these are an important set of epithets for the bowels and viscera based on analogies of the organs to positions of government. Surprisingly, these epithets do not appear in every basic textbook. They are noticeably absent from the basic textbooks of Chinese authorship that were widely used in schools in the 1980’s and 1990’s and from many works of Western authorship that followed them. They include the following:

• 心者，君主之官也，神明出焉 xīn zhě jūn zhǔ zhī guān yě shén míng chū yān: heart holds the office of Sovereign; the bright spirit arises from it
• 肺者，相傅之官也，治节出焉 fèi zhě xiāng fù zhī guān yě, zhì jié chū yān: lung holds the office of Minister-Mentor; management and regulation arise from it
• 肝者，将军之官，谋虑出焉 gān zhě, jiāng jūn zhī guān, mǒu lǜ chū yān: liver holds the office of General; strategies arise from it
• 脾胃者，仓廪之官，五味出焉 pí wèi zhě, cāng lǐn zhī guān, wǔ wèi chū yān: spleen and stomach hold the office of the Granaries; the five flavors arise from them
• 肾者，作强之官，伎巧出焉 shèn zhě, zuò qiáng zhī guān, jì qiǎo chū yān: kidney holds office of Forceful Action; dexterity and ingenuity arise from it

These metaphors are complex and deep. The notion of the liver as the army general encapsulates not only the liver’s being the seat of the capacity to strategize but also reflects the liver’s connection with the sinews and nails/claws (the military power of the nation), the spreading of qi (expansion of the nation’s power), the eyes (reconnaissance and mapping of territory), anger (national indignation against foes). The idea of the heart as sovereign embodies the heart’s storing of the spirit (the leadership and guidance of the nation) and its association with fire (the power and glory of the nation and the social unity created by the campfire). The omission of these ideas from textbooks precludes deeper understanding of the original conception of the Chinese medical model. For those interested, the role of analogy in Chinese medical theory is discussed at length in Chinese Medicine: The Ideas That Shaped It, Wiseman and Wilms, Paradigm Publications, 2121.

Replication of such metaphors in translation is necessary if the historical dimension of Chinese medicine is to be preserved in transmission. When views the government epithets above with those of right qi, evil qi, defense, and provisioning, it becomes obvious that the originators of the theory of Chinese medicine viewed the whole body as being analogous to a vast empire, whose government under the leadership of an imperial sovereign ensured the supply of vital commodities, the maintenance of labor power, and the protection of its borders. The absence in English-language textbooks of this important conception of the body highlights a problem in the transmission of Chinese medicine, namely the omission of key elements in the selection of information transmitted. It is not surprising that the space left by the omission of this overall conception has been filled by some proponents of Chinese medicine with visions of cosmic spiritual peace and harmony, which violently distort the true philosophical underpinnings of the discipline.

Preserving distinctions: One purpose of accuracy is to ensure that terms distinguish distinct concepts. Terms that are completely or partially synonymous abound in almost every aspect of Chinese medicine, whether it be symptom names, disease names, pattern names, acupoint names, and medicinal names. Only the terminology of the functions and attributes of the bowels and viscera and the names of formulas are largely spared of this problem.

Translations should reflect the literal meaning of the term, so that it can be distinguished from terms of similar but not identical meaning. Actions of medicinals provide examples: 补阳 bǔ yáng, 助阳 zhù yáng, 温阳 wen1 yáng, 回阳 huí yáng, and 壮阳 zhuàng yáng can be distinguished as supplementing yang, assisting yang, warming yang, returning yang, and invigorating yang. Some may consider these to be complete synonyms and hence may make no distinction in translation, but the apparent similarity of meanings belies differences, because the terms imply different aspects of yang or different actions. While supplementing yang is a general term, warming yang is used to describe the actions of medicinals that warm the center and disperse cold, while invigorating yang means supplementing yang to enhance the male sexual function.

The terms 虚 xū and实 shí, which describe the relative strength of right qi and evil qi, have been variously rendered as deficiency/excess, emptiness/fullness, vacuity/repletion, depletion/repletion, sthenia/asthenia, and probably now most commonly by deficiency/excess. The Chinese terms literally mean emptiness/fullness or insubstantiality/substantiality. They have been translated as emptiness/fullness by some, although these terms are best reserved for 空 kōng and 满 man3, which are used in symptomatology to denote physical sensations. Deficiency/excess does not permit any distinction from insufficiency/superabundance (不足/有餘 bù zú / yǒu yú) or from 不及 / 太过 bù jí / taì guò, which is often made in modern texts. We chose vacuity/repletion to remain literal and to avoid confusion with 空 kōng and 满 man3 (emptiness/fullness). We reserve deficient/excessive for 不及 bù jí and 太过 taì guò in the context of the free coursing function of the liver. Deficient free coursing (疏泄不及 shū xiè bù jí) is a major cause of qi stagnation, which is a repletion pattern. When it is said that qi stagnation is a pattern of excess, it is difficult to see how this can be caused by a deficient function.

Over the ages, numerous Chinese terms synonymous or partially synonymous with loss of appetite have been used: 不食 bù shí, 食不下 shí bù xià, 不思饮食 bù sī yǐn shí, 饮食少思 yǐn shí shǎo sī, 不思食 bù sī shí, 食少 shí shǎo, 纳呆 nà daī, 纳谷不香 nà gǔ bù xiāng: The degree of synonymy in these terms is open to question. The translator faces the temptation of rendering all of these terms with a single English expression such as poor appetite. In source-oriented translation, wherever two or more terms are suspected of not being wholly synonymous, they should be translated in such a way as to reflect the possible difference between them. Hence, for these terms we give distinct translations:

• 不食 bù shí, inability to eat;
• 食不下 shí bù xià, inability to get food down;
• 不思饮食 bù sī yǐn shí, no thought of food and drink;
• 饮食少思 yǐn shí shǎo sī, little thought of food and drink;
• 不思食 bù sī shí, no thought of food;
• 食少 shí shǎo, reduced eating;
• 纳呆 nà daī, torpid intake;
• 纳谷不香 nà gǔ bù xiāng, no pleasure in eating.

In the absence of any clarification in traditional texts, the translator should give faithful translations and leave readers to judge the degree of synonymy for themselves. In modern Chinese texts, whose authors are more aware of the need for consistent terminology, reduced eating (simple loss of appetite) and torpid intake (reduced eating due to feelings of fullness after eating) are the most commonly, but not the only, terms used. However, if we are to reflect the tradition of Chinese medicine faithfully, it is essential to reproduce the variability in the original terminology accurately.

Preserving structure? One universally recognized principle of translation is the need for any translation to conform to the normal rules of the target-language grammar. However, translated literature naturally tends to reflect the structural forms and discourse patterns of the source language while conforming to the grammar of the target language. A classic example of this is bipartite description of medicinal actions, such as clearing heat and transforming dampness, fortifying the spleen and boosting qi. English does not normally have phrases conforming to the pattern of verb + noun–verb + noun. Yet accurate translation of Chinese medicine inevitably entails allowing English to conform to this pattern. Any restructuring in the translation process is bound to lead to loss of information in some cases.

The Chinese language was originally highly monosyllabic. But as phonological distinctions were lost, the need for one idea to be represented by two syllables (two characters) increased. The combination of close synonyms gave rise to an immense richness in vocabulary that is barely matched by European languages. In Chinese medicine, many words can be used singly or in combination. Although combinations might be seen to call for one-word translations, the fact that their components are also stand-alone terms, accurate translations requires that combinations be replicated in the target language to reflect the modularity of the Chinese terms. Examples of this include 痞闷 pǐ mèn (glomus and oppression), 胀满 zhàng man3 (distention and fullness), 涩痛 sè tong4 (rough and painful), 癫狂 diān kuáng (mania and withdrawal).

Literary style (文言文 wén yan2 wén) shows a marked preference for symmetry that often leads to redundancies such as 肝肾亏虚 gān shèn kuī xū, literally liver-kidney depletion-vacuity. Here the last two characters entail redundancy that does not require replication in translation, since it has no technical significance. Since 亏 kuī is the more specific term, the 虚 xū can be dropped in translation.

Concept-Based Translation and Borrowing

Concept-based translation: Although close translation according to the intended sense of words works for most Chinese terms, it does not work for all. Where it does not work, a translation based on the concept (definition) can be used. The classical example is 证 zhèng, which means to demonstrate, prove, or determine on the basis of evidence or facts. In Chinese medicine, it was first used to mean symptom or now more commonly an a pathological state indicated by an array of symptoms. No literal translation, such as proof, demonstration, or determination, would make much sense, so the term has to be translated on the basis of the concept. In practice, it is variously translated as pattern, meaning a meaningful array, as syndrome borrowed from modern medicine, or as presentation, possibly from the use of this term in biomedicine as a symptom or group of symptoms observed or detected upon initial examination or disclosed by a patient to the physician or loosely in the sense of the way something appears (at first sight).

Another example where literal translation is difficult is the set of terms commonly used for classifying abdominal masses, 癥瘕积聚 zhēng jia3 jī jù. 癥 zhēng and 瘕 jia3 are masses in the lower burner, while 积 jī and 聚 jù are masses in the center burner. The terms 癥 zhēng and 积 jī refer to solid masses due to static blood or phlegm, while瘕 jia3 and 聚 jù are diffuse masses due to qi stagnation. 积 jī and 聚 jù can easily be literally translated as accumulations and gatherings to reflect the hardness and softness respectively. But the other two terms are harder to translate. The character 癥 zhēng is composed of the illness radical with the character 徵 zhēng, among whose many meaning is the idea of collection. 瘕 jia3 is composed of the illness radical with the character叚 jia3, a variant form of 假 meaning false. Since in their medical usage, these two terms again reflect hardness and softness respectively, a concept-based translation approach allows us to render these as concretions and conglomerations respectively.

Borrowing: When literal and concept-based translation fails to provide adequate equivalents, borrowing the source-language term is the last resort. In Chinese-English translation, this takes the form of transcription, now almost universally by the Pinyin system, also called Hanyu Pinyin. English has no equivalents of 阴 yīn and 阳 yáng, which originally denoted sunny south-facing and shady north-facing mountain slopes, respectively. Few attempts have been made to translate these terms and transcriptions have been used in English for centuries.

In the practice of translation, Pinyin is arguably more commonly used than needs to be. 精 jing1 and 神 shén in particular are preferred by many translators, although solid arguments against the obvious equivalents essence and spirit have not been put forward.

In the present dictionary, very few English equivalents are borrowings. Here are the most commonly used.

• 便 bian4 in 便毒 bian4 dú, bian toxin [sore], a bubo sore prior to rupture (contrasted with 鱼口 yú kǒu, fish mouth, a ruptured bubo). The core meaning of 便 bian4 is convenient. It is not known why this should be used to label a lesion.
• 疳 gān in 疳积 gān jī, gan accumulation and in terms denoting ulcerative conditions 眼疳 yan3 gān, eye gan and 牙疳 ya2 gān. Although gan accumulation is understood to be due to malnutrition and hence is often translated as such, why ulcerative diseases should bear the same name is unclear. The character 疳 is composed of with the illness radical 疒 and contains the phonetic 甘 gān, which means sweet. It is not clear how the composition relates to either category of disease.
• 癞 laì in癞病 laì bìng, lai / repudiation. The character is composed of the illness radical 疒 with 赖 laì as a phonetic or meaning component. Paul Unschuld has suggested repudiation as a translation, presumably on the grounds that 赖 can mean to disclaim, disavow, disown, or reject.

Target-Oriented Tendencies

A cursory glance over the works of multiple translators gives the impression that there is a great similarity in the overall approach. Nevertheless, there are two tendencies that can be considered as target-oriented: the use of colloquial terms and the use of biomedical terms.

Use of Colloquial Terms

The tendency not to recognize expressions as technical terms deserves a little more attention. Giovanni Maciocia, among others, have asserted that terminology should conform as far as possible to terms that patients use. Of course, this idea seems empowering for patients and hence accords with the desiderata of New Age healing practices. Nevertheless, it is problematic for two reasons. The first is that such a guideline can only relate to terms used in the interface between practitioner and patient, not as a general translation guideline. The practitioner has a whole understanding of the workings of the body and the influences affecting it that cannot be explained in lay terms. The second reason is that even in the realm of the practitioner-patient interface, the practitioner sees things in ways completely different from the way the patient does. While patients may understand and describe their symptoms in numerous different ways, the symptoms discussed in Chinese medicine are diagnostically meaningful and useful categories that provide, as it were, a standard grid onto which the patient’s descriptions are mapped. While some symptom names naturally come from colloquial speech, a considerable portion have been devised by physicians to capture the information they want. For example, 小便清长 xiǎo biàn qīng cháng, literally, urine/urination clear long, that is, long voidings of clear urine, encapsulates a condition that would not spontaneously be described as such by any patient, in English or even in Chinese, and would be identified only after asking the patient several questions. Symptom names represent technical categories established for the purpose of diagnosis.

Pulses in Chinese medicine are represented by words from colloquial speech, which are given clear definitions that allow them to be consistently identified. To view pulse terms as simply colloquial descriptions suggests that they can be translated by seemingly equivalent English colloquial terms without heed to their technical content. This naturally leads to a variability in English terms that causes confusion. A thready pulse (细脉 xì mài) can easily be confused with a stringlike pulse (弦脉 xián mài), even though they represent two distinct conditions. Given the present lack of terminological rigor, it is doubtful whether most students have words to distinguish between weak (弱 ruò), vacuous (虚 xū) or forceless (无力 wú lì). The loose use of colloquial terms encourages them to be taken at face value and underestimate their degree of technicality, especially when writers use different terms to represent a given concept and fail to clarify their usage or refer readers to a term list they apply.

The preference for colloquial terms has been fostered by the anti-intellectual atmosphere pervading many quarters of the Western Chinese medical community. Given the general unfamiliarity with the Chinese language and lack of access to primary texts, any attempt to convey Chinese concepts accurately in their historical perspective tends to be viewed as obscurantist. This is detrimental to the successful cross-cultural transmission of Chinese medicine.

Use of Biomedical Terms

Finally, it is important to discuss the use of biomedical terminology in Chinese medicine. In China, a widely held view is that any concept that has a biomedical equivalent should be translated with the corresponding biomedical term, since medical terms are more familiar to Westerners. This practice is shunned by many Western translators on the grounds that the conceptual framework is different from that of biomedicine. Unfortunately, Western students and practitioners without a knowledge of Chinese cannot judge this issue, and hence many are quite happy with the use of biomedical terms, even though these are often inaccurate and compromise the integrity Chinese medicine’s conceptual framework.

The use of biomedical terms to represent traditional Chinese medical concepts is acceptable provided they imply no specialist knowledge specific to biomedicine. Everyday terms such as liver, kidney, small intestine, eye, ears, rib, cough, vomiting, headache, which are used in biomedicine, are perfectly acceptable and indeed the only terms that can possibly represent the concepts they denote in Chinese medicine. Certain not-so-everyday biomedical terms may also be used. Strangury (from the Greek meaning dripping) is a perfect match to 淋 lìn, which also literally means drippingand is more efficient than other than wordier translations such as painful urinary syndrome. Dysentery, which literally simply means a poor state of the intestines, is also a perfect match for 痢疾 lì jí.

Nevertheless, when a biomedical term whose definition is based on knowledge specific to biomedicine is used to represent a traditional Chinese medical concept, this is target-oriented translation that sacrifices culture-specific information to the goal of effortless comprehension for the target-language reader. A classic example of this is acute conjunctivitis as the translation of the traditional concept of 风火眼 fēng huǒ yǎn, which is literally rendered wind-fire eye. Needless to say, acute conjunctivitis is the term most familiar to most people. Nevertheless, even those who propose it translate 风 fēng as wind and 火 huǒ as fire in the context of external evils. While the translation wind-fire eye describes the disease in terms of traditional etiology, the term acute conjunctivitis gives a false impression that the Chinese doctors were acquainted with the notions of conjunctiva and inflammation (-itis) before the introduction of biomedicine. The table below (Biomedicalized Translations of Disease Names) provides further examples from The Chinese-English Medical Dictionary (CEMD, People’s Medical Publishing House, 2004) and Practical Dictionary of Chinese Medicine (PDCM, Paradigm Publications, 1997).

The prevalent tendency to use biomedical terms for disease names has had the result of giving the impression that Chinese medicine has virtually no disease categories other than patterns. Nothing could be farther from the truth.

Target-oriented translation causes even greater loss when it destroys the classification framework of diseases. The Chinese terms 痈 (yōng) and 疽 (jū) refer to yang- and yin-type abscesses, respectively. This binary framework is destroyed when each kind of abscess is labeled with the biomedical name of the closest corresponding condition identified, as the WHO’s 2007 International Standard Terminology shows (See table Traditional Classification Destroyed by Biomedicalized Translation).

Biomedicalized translations are not limited to disease names. Other examples include 治未病 zhì weì bing4 (lit. treating disease before it arises) translated as preventive medicine, 梅核气 meí he2 qì (lit. plum-pit qi) as globus hystericus, 痹 bì (lit. impediment) as arthralgia, 活血 huo2 xue4 (lit. quicken/enliven the blood) as promoting blood circulation, 利水 lì shui3 (lit. free [the flow of] water) as diuresis.

Probably the worst translation has been the choice of sedate as the rendering of one of the two basic acupuncture stimuli 补 bu3 and 泻 xie4 (rendered in this book as supplement and drain). The term sedate was introduced by MD Felix Mann, who believed that the effects of needling could be explained in neurological terms, without the need for traditional concepts such as qi and the channels. The term sedate violently distorts the traditional concept. Suggesting a reduction in movement, it has the opposite meaning of the Chinese term, which is to promote flow. A mistranslation of this kind could affect treatment strategies and expected outcomes.

The preference for biomedical terms for traditional concepts is particularly prevalent among the Chinese. Even though one might expect the Chinese to be particularly sensitive to the differences in the meaning of the source-language terms, they apparently consider questions of accuracy secondary to the practical advantage of using terms familiar to the foreign readership. That advantage is perceived to be all the greater given that MDs and the biomedical community are for them the most important targets within the potential readership. For a Chinese translator, the use of an existing familiar term has the further advantage of being much easier than devising a new term that fits the concept precisely and that is intelligible and acceptable to target-language recipients. It is very much more difficult for a native speaker of Chinese to come up with translations such as sudden turmoil, dispersion-thirst, or plum-pit qi.

One might expect that Western students and practitioners of Chinese medicine would prefer English terms that accurately represent traditional concepts over biomedicalized terms that do not. The problem here is that too few people can read Chinese and hence cannot judge whether a chosen English term is accurate or not, so that a familiar biomedical term is perceived as being as good as a made-up term that some scholarly intellectual considers more accurate. It is likely that some even feel that having biomedical terms in their daily vocabulary elevates their social status.

The history of Chinese medical translation is enlightening. In the 1980’s and 1990s, there were scholars in China who claimed that the internal organs could not be translated by their natural English equivalents liver, heart, spleen, lung, and kidney on the grounds that these were biomedical terms that could only be used according to biomedical definitions. They were apparently unaware that the terms had a much longer history than biomedicine or even any medicine at all. Most terms for heart in European languages, for example, are cognate and can be traced to a proto-Indo-European root. Instead of natural equivalents, the Chinese scholars proposed the use of Pinyin: gan, xin, pi, fei, shen. The proposal was never adopted in China or beyond, but it is an interesting example of translation problems. The proponents probably never thought how these terms would be perceived by native English speakers: Chinese medicine tells us we have a gan, a xin, a pi, a fei, and a shen, but what does it say of the liver, heart, spleen, lung and kidney?

One unique form of biomedicalization was the creation by a notable Chinese scholar of terms based on Greek roots in the manner of biomedical terms. Thus, he translated 肾气虚 shen4 qì xū as nephroqipenia and 中风 as anemobatia. Again, this style of translation was not adopted because no-one saw any advantages over the use of ordinary English words, especially since certain word roots such as anem- meaning wind would not even be familiar to biomedical doctors.

Gradually, over the years, a growing consensus has emerged over the translation of basic terms. People no longer question the qi, liver, heart, spleen, lung and kidney, or imagine the need for inventing Greek-flavored terms.

Term Standardization

Modern scientific disciplines dealing with many detailed concepts have developed the notion that, for the sake of unequivocal communication, each concept should ideally be represented in every instance by a single term. Hence, there are now many technical dictionaries that list and define the terms of specific fields. This kind of terminological management did not develop in Chinese medicine before the introduction of the Western knowledge systems into China over the past 200 years. The transmission of Chinese medicine was traditionally based on study of the early classics and the work of famous latter-day medical scholars. Given the terse nature of classical expression, study was based on a traditional of careful reading and even memorization, very much as Westerners traditionally studied the Bible. This ensured that students expressed themselves in the language of the texts they read and hence the continuity of terminology over generations. The locus of knowledge was in revered texts, rather than in concepts as it is in the modern sciences. Yet this ensured some continuity in the use of terminology.

Term standardization is a natural process in any field of knowledge. People tend to pick the terms that they know will be understood most clearly by others. The process can be sped up by formal discussion and agreement on the terms recommended for universal use, but it tends to happen anyway in the absence of such efforts. In Chinese medicine, although before the modern era no committees were ever set up to standardize terminology, a standardization to a considerable degree did occur. As can be seen from the selection of terms included in this book, Chinese medicine evinces a high degree of synonymy. Although at least 1,000 names have been used to denote the 360 odd channel point names over the centuries, the nomenclature has long been completely standardized, except for a few commonly used synonyms. The same thing has happened with the names of the widely used range of medicinals used in classical medicinal therapy.

Term standardization in most specialized fields is an important issue. When everyone always refers to any given concept by the same term, confusion is avoided. In Chinese medicine, however, the need for standardization of English terminology, while widely recognized in China, is less widely felt in the West. For any terminology to be used by multiple translators or become the standard for the entire field, it must be available in a published terms list. Any terminology competing for adoption as the standard terminology cannot even be considered unless it is available in list form for comparison with rival terminologies. While translators in China have produced numerous Chinese-English term lists, Western translators have been reluctant to do so, which suggests that they do not consider relating English terms to the original Chinese terms to have any utility and that standardization of any kind is unnecessary. Some Western translators have said as much expressly.

Multiple equivalence is only tenable within certain limits. If the various equivalents of a given term are well-known or the concept is easily identifiable, no communication problems arise. However, even among familiar concepts, lack of term standardization can create confusion. One has only to survey differences in pulse term translations to grasp the severity of the problem (see table below). Chinese pulses are difficult enough for students to identify in their patients. When they are referred to by different terms among different authors, it is hard to imagine how they cannot be confused. See table Renderings of Pulse Terms by Different Writers.

Some translators have suggested that multiple translations of the same term give readers a more rounded understanding of the concept. This would be acceptable only if the equivalence of two or more of the same term is expressly stated. Yet if the equivalence is not explicitly stated, readers will not be able to identify the two terms as synonyms. Synonymy between multiple translations may be obvious in the case of key concepts such as vital energy / qi or deficiency / vacuity, but it becomes much less obvious in the case of less prominent terms if not stated. The problem is exacerbated when translators fail to clarify terms by the addition of Chinese and Pinyin. Terms are simply convenient labels and best used consistently. Definitions of terms are the place to ensure that the understanding of the concept is complete.

Despite the tendency of translators to adopt different translations, a process of standardization of terms occurs to some extent naturally. Translators will come up with different translations under the influence of their particular understanding of the concept and of their own world view. Thus, for example, the Chinese 气 qì has been variously translated as spiritus, pneuma, vital energy, influences, and qi over the centuries. Nevertheless, it is interesting to note that older translations fall into disuse with the appearance of new translations that, for whatever reason, are perceived to be more satisfying. In the case of 气 qì, nearly all translators now use the word qi. There is a natural tendency for people to a single term for a given concept, even though this might take time.

The standardization of terminology has to occur naturally and by organic consensus. Standard terminologies decided by terminology committees are only legitimate if the deliberating committees include major opinion leaders in the discipline. The WHO’s efforts to standardize the terminology of East-Asian medicine have had little influence on translation practice because they excluded all but token representatives from the community of translators.

Twenty years ago, the suggestion that terminological standardization would be beneficial was interpreted by many Westerners to mean some authoritarian imposition of a fixed terminology on clinicians. Yet, with a expanding range of English-language literature on the subject and a growing number of people who have learned Chinese, attitudes toward terminology have changed. While clinicians and translators are free to use whatever terms they like, the goal of translating Chinese literature must be to give accurate renderings of terms and ensure all possibly meaningful distinctions in Chinese texts so that Chinese authors of any period can speak clearly in English translation. That is the goal the present work aims to promote.