Terms and translation

Introduction

Chinese medical translation, specifically the translation of terminology, has been a matter of debate for decades, resulting in much agreement. Discussions have center around translation of individual terms, with little attention being paid to underlying issues such as the nature of Chinese medicine, the bases of its knowledge, the goals of translation, or the guiding principles of translation suited to achievement of goals.

In what follows, we tackle the problem of term translation with these wider issues in mind and emphasize the need for a source-oriented translation strategy that is accurate and that preserves the historical and cultural perspectives indispensable for a deeper understanding of the subject.

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 German, French, Russian, and Spanish. 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. This also facilitates the development of a unified technical vocabulary in target languages that mirrors that of the source language.

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 of non-Chinese understanding and practice. As Chinese medicine underwent 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.

This poor reflection manifests both quantitatively and qualitatively. China has a vast library of literature spanning 2,000 years of medical thought, only a fraction of which has been translated into English or other languages. Of course, many of the main classical and latter-day texts have been translated, but not all of those still considered of value today. The translation effort has centered on the production of basic English-language textbooks. These 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. Many English-language texts, especially those 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.

Chinese Medical Knowledge

Chinese medicine has a history 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.

Two features of Chinese medicine are crucial to the question of transmission of knowledge. One is the reverence for founding works of antiquity and a tendency toward renovating old ideas rather than building new ones, which has made Chinese medicine a complex body of knowledge composed of numerous strands and strata. Students in modern China are required to study texts spanning two millennia, during which time Chinese medicine as well as the Chinese language it is expressed in have undergone considerable changes. The other feature is the importance of analogy as a cognitive basis for the development of Chinese medical knowledge. This principle is of such great importance that the authors of the Nèi Jīng, who otherwise provided little evidence of their reasoning, said that analogy was the key to understanding Chinese medical theories.

These two features are highly problematic for people of the modern age who are imbued with the scientific understanding of the world. On the one hand, the modern sciences, including biomedicine, have little need to consider theories of the past unless certain discoveries of the past prove to have been overlooked. On the other, analogy as a basis for knowledge is completely shunned; even though it might prompt a hypothesis, it is considered useless without analytical proof.

In China, Chinese medicine has been preserved for its practical utility, its importance in the country’s cultural heritage, and its popularity among its people. However, the influence of scientific thinking and modern biomedicine has led the Chinese medical community to be selective about what should be preserved, to modernize knowledge and practice, and even to attempt to integrate Chinese medicine with modern biomedicine. And of course, these tendencies also exist outside China for the same reasons.

In China, the push toward greater selectivity, modernization, and integration has the support of teachers and practitioners to varying degrees. Different schools of thought are very much in evidence. There are traditionalists who emphasize the importance of the classics and modernizers who use Chinese medical treatments demonstrated to have some basis in modern science to deal with conditions recognized by biomedicine, with the result that there are considerable differences in styles of practice. Generally agreed, however, is that the core theories that have endured through the ages should be preserved and expressed in the traditional terminology.

Approaches to Term Translation

The translation of Chinese medicine into foreign languages has been highly influenced by the conflicting tendencies in what elements of the subject are to be preserved or discarded. The traditionalist and modernizing tendencies in the practice of Chinese medicine are reflected in similar trends in translation.

The push toward modernization fosters the tendency in foreign-language texts to use readily understood terms likely to appeal to non-Chinese readers, notably the liberal use of biomedical terms and general-language expressions. This strategy avoids the need to devise new terms that reflect the traditional concepts. At the same time, it makes for easier readability and reduces the need to explain terms. Nevertheless, it often fails to adequately reflect the understanding that the original Chinese term creators had in mind.

Chinese translators in particular avoid inventing new terms because they have difficulty gauging acceptability among non-Chinese readers and because they fear that literal translations might suggest a certain unscientific quality of Chinese medical concepts. Since many in the PRC who have been engaged in Chinese medical translation have a biomedical background, it is not surprising that the use of biomedical terms or at least neutral terms is the safest option. And, as previously mentioned, Chinese translators were influential in the period from the 1960s through to the 1980s through the publication of basic foreign-language texts.

More traditionalist approaches to translation are mainly seen in the works of Westerners who have a solid knowledge of the Chinese language. They translate texts to reflect as completely as possible the ideas of their authors, whatever the period the texts were produced in. These approaches mainly use literal translation to create terms that preserve all the analogies and metaphors that abound in Chinese medicine, so that non-Chinese readers gain access to the history and culture in which Chinese medicine is rooted. However, it must be re-emphasized that among influential Chinese medical writers in the West, those who have a sound mastery of Chinese are in the minority, sources listed in bibliographies usually attesting to this. In an environment where non-Chinese students, teachers, and practitioners have little or more commonly no knowledge of the Chinese language, and are not even expected to, few of them understand the issues surrounding different choices of term translations and base their term preferences without reference to accuracy in reflecting the Chinese concepts. Term translation would be very different if all students could read Chinese because they would expect a look-alike terminology in English.

These two poles in translation approaches are by no means limited to Chinese medicine. Translation theorists have been aware of these tendencies for centuries. Notably, Friedrich Schleiermacher in Über die verschiedenen Methoden des Übersetzens (On the different Methods of Translating) published in 1813 insightfully summed these approaches as follows: Either the translator leaves the author in peace, as much as is possible, and moves the reader towards him: or he leaves the reader in peace, as much as possible, and moves the author towards him. Leaving the author in peace means faithfully representing what the author said, even if this makes the reader work a little harder to understand him, while leaving the foreign reader in peace means reducing the work of the reader at the expense of accuracy in the transmission of the original author’s thoughts.

Schleiermacher’s statement concisely sums up the choices of Chinese medical translation strategy. Either we accurately reflect the concepts, which can make things harder for the reader. Or we make things easier for the reader by using familiar but less accurate target-language terms.

If, as one would hope, the aim is to transmit Chinese medicine to non-Chinese students intact and respecting its integrity, then the only choice is to leave the original authors in peace by faithful, largely literal translation or the original concepts. The alternative strategy, that of making things easier for the reader results in inaccuracy. Accurate translation provides access to the entirety of Chinese medical thought, yet does not preclude the possibility of relating Chinese medical knowledge to modern biomedicine. Restricting target-language terminology to familiar terms makes a full understanding of Chinese medicine impossible; it provides a modernized version of Chinese medicine severed from its historical and cultural roots.

The mutually opposed translation approaches can usefully be labeled as the source-oriented translation, which accurately relays the original content, and target-oriented translation, which makes things easier for the reader, at the expense of accuracy.

Source-Oriented Translation

Source-oriented translation mainly uses context-sensitive literal equivalents to accurately represent concepts, but applies freer translations and borrowing (transliteration) where literal translations fail to reflect the concepts adequately. 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 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.

The source-oriented translation 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 specialist 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 a 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 represented by one or more characters in the Chinese equivalent.

Chinese medical translation faces a double challenge in this regard. On the one hand, given the lack of knowledge of the Chinese language outside China, the preference for look-alike target-language terms is generally lacking. On the other, the dominance of the scientific worldview and biomedicine discourages source-oriented translation to give Chinese medicine a veneer of modernity.

The necessity for source-oriented translation in Chinese medicine

The argument presented here is that 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 in 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. 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. The notion of systematically and comprehensively listing all terms in a single dictionary did not appear until the modern era. For this reason, it has been wrongly argued that Chinese medicine does not possess a terminology so that rigor in translation is unnecessary, 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 yīn-yáng 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 clearly understood without drawing analogies (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 ahead under Analogy and Metaphor.

Source-oriented translation is the most widely used by translators for most terms, even though the words they choose often differ. A small range of English terms are well-established. These include literal translations such as metal, water, wood, fire, and earth; wind, cold, summerheat, dampness, dryness, and fire; lung, kidney, liver, heart, spleen; qì stagnation; blood stasis, and the transliterations yīn, yáng, and qì. Most translators apply source-oriented translation for pathomechanisms, disease patterns, and methods of treatment because the concepts are unique to Chinese medicine. Nevertheless, many simplify the terminology of symptoms tends by using inaccurate colloquial expressions or biomedical terms. Many translators substitute biomedical terms for the disease entities recognized in Chinese medicine. Many metaphors and analogies of basic physiology are diluted or erased.

Strict adherence to source-oriented translation is the only accurate approach to translation. Deviation from it is not helpful. For example, 風火眼 fēng-huǒ-yǎn, may be roughly equivalent to acute conjunctivitis, but for a translator who translates 風 fēng as wind, 火 huǒ as fire, and 眼 yǎn as eye, as indeed most do, to adopt acute conjunctivitis as the equivalent English term is unnecessary and misleading, since it neither reflects the Chinese medical etiology and suggests that Chinese physicians of the past had identified the conjunctiva as a distinct part of the eye. Similarly, translating 活血 huó xuè as promoting blood circulation, may suggest that Chinese medical scholars understood blood circulation in the way that William Harvey described it in 1628.

Below we present an overview of source-oriented translation principles, showing what methods are prioritarily used for what kind of terms. This is followed by a detailed discussion.

What is a term as opposed to a word?

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 because this would be too restrictive in describing patients’ conditions and therapeutic approaches.

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 ancient 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. Nobody 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, rather as today Chinese will say 不吃 bù chī, and English speakers will say not eating to mean poor appetite. However, nowadays writers prefer to use 食少 shí shǎo, reduced eating, since not eating is considered colloquial and hyperbolic. Yet, a similar expression such as 食不下 shí bù xià, inability to get food down may 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.

Literal Translation

In Chinese medicine, words were traditionale taken at face value, but their meanings are derived from their context. Given this, 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.

Source-oriented translation is largely based on literal translation. The term literal translation has two meanings that can usefully be distinguished: denotative and lexical. For example, the non-medical term 小便 xiǎo biàn, is denotatively equivalent to urine in English since the two terms denote the same thing (the same referent). However, we can also say that the Chinese terms literally translates as lesser convenience, since that is what the two component characters means. Thus, lesser convenience is the literal translation as regards the lexical components of the Chinese term. (Note that the term 小便 xiǎo biàn is a euphemism synonymous with 尿 niào, standing in opposition to 大便 dà biàn, stool. While the latter completely replaced 屎 shǐ, shit (now considered vulgar), 小便 xiǎo biàn did not.)

In the translation of terms, we distinguish between literal equivalents of lay terms and literal equivalents of exclusively specialist terms. Lay terms are those used in the everyday language by non-medical speakers, while exclusively specialist terms are those whose significance is only fully understood by people with a medical background. Lay-term translations are denotative equivalents, while speciliast-term translations are lexical / etymological equivalents.

In source-oriented translation, everyday terms are rendered by corresponding everyday terms in the target language. So, 鼻 bí is translated as nose; 心 xīn, is translated as heart, 胃 wèi, as stomach. 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 (lexical equivalent), but as an everyday term, it corresponds to penis, which has a different etymological meaning since, according to some, it comes from the Latin penis, 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. Although the translator might wish to highlight the literal meaning of the term in certain contexts, it would be normal to associate it expressly with penis.

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, i.e., combustion. However, in Chinese medicine, it is mostly used in several metaphorical senses: 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 must 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. Context sensitivity is discussed in greater detail further ahead.

Note that the superficial familiarity of lay speakers with specialist terms blurs the distinction between lay and specialist terms somewhat. For this reason, we class lumbus as a lay equivalent of 腰 yāo, because, though a biomedical term, is familiar to lay speakers, and does not convey any strictly biomedical knowledge. The more colloquial term low back is awkward in translation because it is two words.

A lay term in one language may or may not have a lay equivalent in another language. Chinese people may speak of 上火 shàng huǒ, fire rising, a concept of Chinese medical origin denoting heat that develops in the body causing sore throat, red eyes, acne, dry stool, and irascibility. In contrast, English has no equivalent lay term. The idea of fire rising might help Chinese people to understand 肝火上炎 gān huǒ shàng yán, liver fire flaming upward, though lay people do not usually use this terms. Conversely, the English term mumps, is intelligible to all native speakers, and many parents will recognize the disease in their children. The Chinese medical equivalent 痄腮 zhà sāi, on the other hand, is not a lay term, since it is now referred to by a biomedical term (流行性腮腺炎 liú xíng xìng sāi xiàn yán, epidemic parotitis). (Interestingly, the connotations of the traditional terms in both languages are comparable since the Chinese term implies a fulminant condition,of the cheeks, as suggested by the乍 zhà of 痄), while the English term suggests a grimace the disease causes.)

Although the line between lay and specialist knowledge may be blurred in some cases, a good rule of thumb for translators of Chinese medicine is that any English biomedical term, familiar or not to the lay, that implies biomedical knowledge alien to Chinese medicine should not be used to translate lay terms or even any Chinese medical terms at all.

In the vast majority of cases, it takes the single character as the basis for translation. There are dimorphemic terms, notably 膀胱 páng guāng, bladder; combinations of close synonyms such as 虛虧 xū kuī, depletion; 泄泻 xiè xiè, diarrrhea. Nevertheless, the vast majority of characters used in the terminology of Chinese medicine contribute a meaning to the term in which they appear or are even kernel terms in themselves; hence they require individual translations. In only a few cases does English have a single term that corresponds to two or more characters, e.g., 大便 / 屎 dà biàn / shǐ, stool; 便秘 biàn mì, constipation.

The Terms section of this database includes single characters constituting the kernel terms out of which most of the commonly terminology is formed, together with their English translation(s). This list is useful for anyone wishing to study our proposed terminology.

On a final note, the common practice among Western writers of using initial capital letters for organ names and certain other entities (Heart, Liver, Blood, etc.), notably to differentiate the Chinese medical meanings and connotations of these terms from their biomedical meanings is to be avoided since may be suggestive of depreciation or disparagement.

Literal Equivalents of Lay Terms

Any everyday Chinese term, i.e., any term used in lay speech or writing (at the time of text production) that has a natural correspondence in English is translated with that English term.

Physiology

• 肝 gān, liver
• 心 xīn, heart
• 脾 pí, spleen
• 肺 fèi, lung
• 肾 shèn, kidney
• 胃 wèi, stomach
• 小肠 xiǎo cháng, small intestine
• 大肠 dà cháng, large intestine
• 膀胱 páng guāng, bladder
• 胆 dǎn, gallbladder
• 眼/目 yǎn/mù, eye
• 舌 shé, tongue
• 口 kǒu, mouth
• 鼻 bí, nose
• 耳 ěr, ear
• 鼻 bí, nose
• 筋 jīn, sinew
• 肉 ròu, flesh
• 皮 pí, skin
• 骨 gǔ, bone
• 泪 lèi, tears
• 汗 hàn, sweat
• 涎 xián, drool
• 涕 tì, snivel
• 唾 tuò, spittle
• 胸 xiōng, chest
• 腹 fù, abdomen
• 背 bèi, back
• 手 shǒu, hand
• 足 / 脚 zú / jiǎo, foot
• 肩 jiān, shoulder
• 头 tǒu, head
• 颧 quán, cheek (upper part)
• 唇 chún, lips
• 颈 jǐng, neck
• 项 xiàng, nape
• 腕 wàn, wrist
• 肘 zhǒu, elbow
• 指 zhǐ, finger
• 趾 zhǐ, toe
• 膝 xī, knee
• 腰 yāo, lumbus
• 肛 gāng, anus
• 尿 / 小便 niào / xiǎo biàn, urine
• 大便 / 屎 dà biàn / shǐ, stool
• 脐 qí, umbilicus, navel (umbilicus works better since it has the adjectival form umbilical
• 涎 xián, drool
• 唾 tuò, spittle

Causes of disease

• 风 fēng, wind
• 寒 hán, cold
• 暑 shǔ, summerheat
• 湿 shī, dampness
• 燥 zào, dryness
• 火 huǒ, fire
• 热 rè, heat
• 痰 tán, phlegm
• 毒 dú, toxin

Symptoms

• 咳/咳嗽 ké/ké sòu, cough
• 痛/疼 tòng/téng, pain
• 头痛 tóu tòng, headache
• 胸痛 xiōng tòng, chest pain
• 便秘 biàn mì, constipation
• 泄泻 xiè xiè, diarrrhea
• 遗尿 yí niào, enuresis
• 崩漏 bēng lòu, flooding and spotting
• 小便失禁 xiǎo biàn shī jìn, urinary incontinence
• 癢 yǎng, itch
• 麻木 má mù, (tingling and) numbness

Literal Translation of Specialist Terms

Any Chinese term that implies a distinctly Chinese medical understanding should prioritarily be rendered by a more or less lexically literal translation to reflect the idea within the Chinese medical context. Terms in this category notably include Chinese medicine’s many metaphorical terms. Literal translation is by far the most productive principle of translation, seen in all realms.

Physiology

• 神 shé, spirit
• 精 jīng, essence
• 津液 jīn yè, liquid and humor
• 水谷 shuǐ gǔ, grain and water: food.
• 营卫 yíng wèi, provisioning and defense
• 母子 mǔ zǐ, mother and child
• 标本 biāo běn, tip and root
• 血海 xuè hǎi, sea of blood
• 三焦 sān jiāo, triple burner
• 命门 míng mén, life gate
• 表里 biǎo lǐ, exterior and interior
• 精关 jīng guān, essence gate
• 腐熟 fǔ shú, ripening and rotting: decomposition of food in the stomach.
• 水液蒸腾 shuǐ yè zhēng téng, water-humor steams upward
• 中焦如沤 zhōng jiāo rú ōu, the center burner is like foam
• 心开窍于舌 xīn kāi qiào yú shé, the heart opens at the tongue
• 肝生于左 gān shēng yú zuǒ, the liver lives on the left
• 肝者，将军之官 gān zhě, jiāng jūn zhī guān, the liver holds the office of general
• 肺主通调水道 fèi zhǔ tōng tiáo shuǐ dào, the lung governs regulation of the waterways
• 肺者，相傅之官 fèi zhě, xiàng fù zhī guān, the lung holds the office of minister-mentor
• 肾主骨生髓 shèn zhǔ gǔ shēng suǐ, the kidney governs the bones and engenders marrow
• 脾统血 pí tǒng xuè, the spleen controls the blood
• 相生 xiāng shēng, engendering
• 相克 xiāng kè, restraining

Symptoms

• 痞 pǐ, glomus
• 满 mǎn, fullness
• 喘 chuǎn, panting
• 闷 mèn, oppression
• 眼花 yǎn huā, flowery vision
• 恶风 wù fēng, aversion to wind
• 弦脉 xián mài, stringlike pulse
• 革脉 gé mài, drumskin pulse
• 梅核气 méi hé qì, plum-pit qì
• 骨蒸潮热 gǔ zhēng cháo rè, steaming bone tidal heat
• 头重脚轻 tóu zhòng jiǎo qīng, heavy head and light feet
• 语声重浊 yǔ shēng zhòng zhuó, heavy turbid voice
• 胸脅苦滿 xiōng xié kǔ mǎn, fullness in the chest and rib-side
• 小便清长 xiǎo biàn qīng cháng, long voidings of clear urine
• 五心烦热 wǔ xīn fán rè, vexing heat in the five hearts
• 腹痛拒按 fù tòng jù àn, abdominal pain that refuses pressure
• 大便如羊屎 dà biàn sè zhì, stool like sheep’s droppings
• 喉中有水鸡声 hóu zhōng yǒu shuǐ jī shēng, frog rale in the throat
• 懒言 lǎn yán, laziness to speak

Diseases

• 痿 wěi,(derived from 萎), wilting
• 痃 xián, (弦 xián), string (a type of abdminal mass)
• 痹 bì, impediment
• 痈 yōng, welling-abscess
• 疽 jū, flat-abscess.
• 疔dīng, clove sore
• 疖 jié, boil.
• 疥 jiè, scab²
• 癣 xiǎn, lichen
• 结胸 jié xiōng, chest bind
• 脑漏 nǎo lòu, brain leak
• 嘈杂 cáo zá, clamoring stomach
• 疔疮 dīng chuāng, clove sore
• 滑泄 huá xiè, efflux diarrhea
• 阳痿 yáng wěi, yáng wilt (impotence)
• 积聚 jī jù, accumulations and gatherings
• 惊风 jīng fēng, fright wind
• 水肿 shuǐ zhǒng, water swelling
• 狐惑 hú huò, (狐蜮 hú yù), fox-creeper
• 喉蛾 hóu é, throat moth
• 喉痹 hóu bì, throat impediment
• 臌胀 gǔ zhàng, drum distension
• 头风 tóu fēng, head wind
• 脐风 qí fēng, umbilical wind
• 雷头风 léi tóu fèng, thunder head wind
• 历节风 lì jié fēng, joint-running wind
• 鹤膝风 hè xī fēng, crane’s-knee wind
• 白秃疮 bái tū chuāng, white scalp sore

Pathomechanisms and patterns

• 火 huǒ, fire (in the metaphorical sense most common in Chinese medicine)
• 相乘 xiāng chéng, overwhelming
• 相侮 xiāng wǔ, rebellion
• 正邪 zhèng xié, right and evil
• 虚实 xū shí, vacuity and repletion
• 气滞 qì zhì, qì stagnation
• 气陷 qì xiàn, qì fall
• 气脱 qì tuō, qì desertion
• 热结 rè jié, heat bind
• 湿毒带下 shī dú dài xià, damp toxin vaginal discharge
• 炼液为痰 liàn yè wéi tán, condense humor into phlegm
• 心肾不交 xīn shén bù jiāo, noninteraction of the heart and kidney
• 肝火上炎 gān huǒ shàng yán, liver fire flaming upward
• 肝风内动 gān fēng nèi dòng, liver wind stirring internally
• 肝气犯胃 gān qì fàn wèi, liver qì invading the stomach
• 熱入心包 rè rù xīn bāo, heat entering the pericardium
• 邪热入营 xié rè rù yíng, evil heat entering provisioning
• 肾气不固 shèn qì bù gù, insecurity of kidney qì
• 脾为湿困 pí wèi shī kùn, spleen encumbered by dampness
• 湿热下注 shī rè xià zhù, damp-heat pouring downward
• 胃气不和 gān qì fàn wèi, disharmony of stomach qì
• 外感寒邪 wài gǎn hán xié, external contraction of cold evil
• 风寒束表 fēng hán shù biǎo, wind-cold fettering the exterior
• 外邪袭表 wài xié xí biǎo, external evils assailing the exterior
• 风寒犯肺 fēng hán fàn fèi, wind-cold invading the lung
• 毒火攻唇 dú huǒ fàn ěr, toxic fire attacking the lips
• 风火相煽 fēng huǒ xiāng shān, wind and fire fanning each other
• 风湿相搏 fēng shī xiāng bó, wind and dampness contending with each other
• 湿热下注大肠 shī rè xià zhù dà cháng, damp-heat pouring down into the large intestine

Treatment

• 针灸 zhēn jiǔ, acumoxatherapy
• 补泻 bǔ xiè, supplementation and draining
• 敛汗 liǎn hàn, constrain sweat
• 补阳 bǔ xiè, supplementing yáng
• 壮阳 zhuàng yáng, invigorating yáng (to treat yáng wilt, impotence)
• 养阴 yǎng yīn, nourishing yīn
• 滋阴 zī yīn, enriching yīn
• 坚阴 jiān yīn, consolidating yīn
• 健脾 jiàn pí, fortifying the spleen
• 升阳举陷 shēng yáng jǔ xiàn, upbearing yáng and raising the fall
• 辛凉解表 xīn liáng jiě biǎo, resolving the exterior with coolness and acridity
• 疏风泄热 shū fēng xiè rè, coursing wind and discharging heat
• 滋阴解表 zī yīn jiě biǎo, enriching yīn and resolving the exterior
• 清热解毒 qīng rè jiě dú, clearing heat and resolving toxin
• 活血化瘀 huǒ xuè huà yū, quickening the blood and transforming stasis
• 破瘀散结 pò yū sàn jié, breaking stasis and dispersing binds
• 破血逐瘀 pò xuè zhū yù, breaking blood and expelling stasis
• 理气化痰 lǐ qì huà tán, rectifying qì and transforming phlegm
• 潜阳熄风 qián yáng xī fēng, subduing yáng and extinguishing wind
• 温补命门 wēn bǔ mìng mén, warming and supplementing the life gate
• 开阖补泻 kāi hé bǔ xiè, open and closed supplementation and draining
• 提壶揭盖 tí hú jiē gài, lifting the pot and removing the lid
• 釜底抽薪 fǔ dǐ chōu xīn, raking the firewood from beneath the cauldron
• 闭门留蔻 bì mén liú kòu, shutting the gate and keeping the intruder inside
• 白虎汤 bái hǔ tāng, White Tiger Decoction
• 五虎追风汤 wǔ hǔ tāng, Five Tigers Decoction
• 清宮汤 qīng gōng tāng, Palace-Clearing Decoction Decoction
• 水陆二仙丹 shuǐ lù èr xiān dān, Land and Water Two Immortals Elixir
• 行军散 xíng jūn sǎn, Troop-Marching Powder

Concept-Based Translations

A concept-based translation reflects the concept (or definition) of the Chinese term, rather than its literal meaning. This is used when a literal translation when a literal translation would be unclear or confusing.

• 五行 wǔ xíng, literally five movements/actions, translated as five phases
• 脏腑 zàng gǔ, derived from 藏府 zàng fǔ, literally meaning stores/treasuries and official exchange houses, translated as as bowels and viscera (in some contexts also storehouses and dispatch houses to reflect the original metaphors).
• 州都之官 zhōu dū zhī guān, lit., island capital, translated as regional rectifier
• 穴 xué, literally cave, translated as point or acupoint
• 饮 yǐn, literally drink, translated as rheum
• 证 zhèng, (literally, testimony, evidence) translated as pattern
• 瘀 yū, presumably derived from 淤 yū, “sedimentation,” translated as stasis
• 癥瘕 zhēng jiǎ, concretions and conglomerations
• 鼻渊 bí yuān, literally, nose abyss, translated as deep-source nasal congestion
• 怔忡 zhēng chōng, lit., fearful, terrified, translated as fearful throbbing

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 is 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).

The term 瘀 yū, almost universally translated as, stasis presumably derived from its homophone 淤 meaning to settle or sedimentation, a water metaphor that complements the concept of 气滞 qì zhì, qì stagnation. When the water of rivers and streams stagnates, sediment settles on the bed. Similarly, qì stagnation is a major cause of stasis. Unfortunately, any literal translation 瘀 (淤) would be not only clumsy but also potentially confusing, since for example sediment/sedimentation, unlike stagnation, is not normally used in any metaphorical sense; hence the choice of stasis.

The term 五行 wǔ xíng refers to wood, fire, earth, metal water, representing activities in nature in five corresponding seasons (spring, summer, late summer, autumn, and winter). 行 xíng means to walk, practice, or act. We refer to them as the five phases, reflecting the seasonal activities as phases of a cycle, although five agents,latterly adopted by P.U. Unschuld, is closer to the Chinese terms. The common translation five elements falsifies the concept, as is discussed further ahead.

Another example where literal translation is difficult is the set of terms commonly used for classifying abdominal masses, 癥瘕积聚 zhēng jiǎ jī jù. 癥 and 瘕 jiǎ 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 jiǎ and 聚 jù are diffuse masses due to qì 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 meanings is the idea of collection. The character瘕 jiǎ is composed of the illness radical with the character 叚 jiǎ, 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.

The term 鼻淵 bí yuān, lit., nose abyss, is a metaphor that becomes clearer when rendered as deep-source nasal congestion.

Finding adequate translations for terms presents many challenges, as is often the case when the vehicle of a metaphor is unclear. One example is the phrase 州都之官 zhōu dū zhī guān as an epithet of the bladder. In Huang Di nei jing su wen (University of California Press, 2011), Paul U. Unschuld and Hermann Tessenow adopt the translation regional rectifier, but note that other translations have been offered: This identification follows Hucker 1346 (p.179). Accordingly, the title 州都 was introduced during the North-South Division as a variant of the term Rectifier (see above) applied to the regional level. The Regional Rectifier was responsible for identifying and classifying all males considered qualified for government office. In contrast, one may also interpret this passage as is the official functioning as provincial capital. Hence, Wang Shaozeng/175 identifies 州都 as 都會, city. Gu dian yi zhu xuan bianxiezu/11 identifies 州都 as an administrative region. Zhen Lifen et al./77: 州都: The Shuo wen states: A place amidst water where one can dwell is called 州. 都 is a dike keeping water off. This indicates that the urinary bladder is the organ responsible for gathering liquids.

Concept-based translation can be combined with literal translation to help relate the term to the referent. This has been a common practice in the Chinese translation opelvis as 骨盆 gǔ pén or incus as 砧骨 zhēn gǔ, where in both cases the word for bone is added. A similar approach can be applied in Chinese medicine: 怔忡 zhēng chōng, lit., fearful, terrified, can be adjusted to imply a heart condition by the addition of the word throbbing to make fearful throbbing. Loose transations such as severe palpitation do not capture the point of the Chinese term, namely that it is palpitation that causes the panic rather than, as with 惊悸 jīng jì, fright palpitation, where the fright or panic causes the palpitation.

Transliteration (Pīnyīn)

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 transliteration, now almost universally by the Pīnyīn system, also called Hànyǔ Pīnyīn. 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 transliterations have been used in English for centuries.

Pinyīn is opaque to people who have not learned Chinese. It can be very useful to add Pīnyīn (and Chinese) parenthetically after a good translation, but as a substitute for translation, it should be the last resort. (See Special Cases below).

Pīnyīn is meaningless to any non-Chinese person who has not studied Chinese. It provides a label, but one that is empty of meaning unless adequately explained. Because of its opaqueness, Pīnyīn transliteration should be used sparingly, as a last resort, and is best accompanied by a true translation. In the practice of translation, Pīnyīn is arguably more commonly used than needs to be. 精 jīng and 神 shén in particular are preferred by many translators. Solid arguments against the obvious equivalents essence and spirit have never been put forward. One suspects that the use of Pīnyīn in such cases adds a little “mystery” for those in search of the ineffable wisdom of the Orient.

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

• 气 qì, qì.
• 阴阳 yīn yáng, yīn and yáng, yīn-yáng.
• 便 biàn in 便毒 biàn 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 biàn 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 yǎn gān, eye gān and 牙疳 yá 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 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 lài in 癞病 lài bìng, lài / repudiation. The character is composed of the illness radical 疒 with 赖 lài as a phonetic or meaning component. Paul U. Unschuld has suggested repudiation as a translation, presumably because 赖 can mean to disclaim, disavow, disown, or reject.

One final example is 抵当汤 dǐ dàng tāng, Dead-On Decoction, where the origin of 抵当 dǐ dàng is not clear (said either to be a corruption of 抵掌 dǐ zhǎng, an alternate name of the chief ingredient 水蛭 shuǐ-zhì, leech (Hirudo), or to mean 抵擋 dǐ dǎng, somehow interpreted to suggest that without drastic agents it is impossible to fight heat bind and blood amassment). We opted for an English name that mimicks the Chinese sound and reflects the strength of the formula.

Special Cases: Acupoints, Medicinals, and Formulas

Acupuncture points have for years been commonly represented by alphanumeric codes, such as LU-1, LI-4, ST-36 for 中府 zhōng fǔ; 合骨 hé gǔ; 足三里 zú sān lǐ, respectively. They are sometimes also referred to by their Pīnyīn names.

Medicinals are often referred to by their Pīnyīn names, Latin pharmacognostic names, or common English names. Thus, 红枣 hóng zǎo, as Jujubae Fructus (or Fructus Jujubae), or as jujube.

Formulas are often referred to by their Pīnyīn names or by English translations, e.g., 麻黄汤 má huáng tāng or Ephedra Decoction.

Our practice is a multiple naming system that ensures that all readers can identify such items, however they refer to them in their personal usage. Thus, we usually write LU-1 (中府 zhōng fǔ, Central Treasury); hóng zǎo, as (红枣, Jujubae Fructus, jujube); and má huáng tāng (麻黄汤, Ephedra Decoction), at least at first mention in a given context.

Note that we refer to 藥 yào in the Chinese medical context as medicinals. The popular term herbs is rejected because it only refers to plant products and does not include the many animal and mineral products used.

Further Considerations

Accuracy: Finding an accurate translation entails awareness of the full gamut of meanings of words and understanding the meaning intended in context. Some literal translations found in English literature reveal a 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, lumbus. 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 qì, we render it as depressed liver qì. 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 in 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. We don’t normally describe something as being depressed by something.

The Chinese term 洪脉 hóng mài is sometimes rendered 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 term 崩漏 bēng lòu is a couplet used to mean heavy and light bleeding via the vagina unassociated with normal menstruation. We use the colloquial terms flooding and spotting for these. The Chinese 喘 chuǎn, meaning difficult breathing, is understood by comparison with the breathing that results from strenuous exercise. While the biomedical term dyspnea is not incorrect, we prefer panting.

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.

The term 下 xià has numerous meanings in Chinese medicine: below, down, descend, cause to descend. As a verb denoting a method of treatment, it has the meaning causing evils and stool to pass down and out of the body. This is commonly rendered as purgation, a term that connotes getting rid of something. We render this as precipitation, to capture the meaning of causing downward movement. 下 xià is also often combined with 泻 xiè, which literally conveys the notion of causing to flow away. We translated this as drain and the combined term as draining-preciptiation. The term 导 dǎo literall means to guide or conduct. In 消食导滞 xiǎo shí dǎo zhì, disperse food and abduct stagation (abduct meaning to carry away).

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, or 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 wēn yáng, 回阳 huí yáng, and 壮阳 zhuàng yáng can be distinguished as supplementing yáng, assisting yáng, warming yáng, returning yáng, and invigorating yáng. 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 yáng or different actions. While supplementing yáng is a general term meaning to increase the power of yáng qì, assisting yáng means to enhance the flow of yáng qì, and invigorating yáng means supplementing yáng to specifically enhance male sexual function.

The terms 虚 xū and实 shí, which describe the relative strength of right qì and evil qì, 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 rendered as emptiness/fullness by some, although these terms are best reserved for 空 kōng and 满 mǎn, 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 / tài guò, which is often made in modern texts. We chose vacuity/repletion to remain literal and to avoid confusion with 空 kōng and 满 mǎn (emptiness/fullness). We reserve deficient/excessive for 不及 bù jí and 太过 tài 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 qì stagnation, which is a repletion pattern. When it is said that qì stagnation is a pattern of excess, it is difficult to see how this can be caused by a deficient function. In addition, consideration must also be given to preserving different degrees of 虛 xū, vacuity, e.g., 竭 jié, exhaustion: Severe insufficiency. 虧 kuī, depletion.

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 dāi, 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 rendered 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 dāi, 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 due to a breakdown of the stomach’s 主納 zhǔ nà, intake function) 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.

纳谷不香 nà gǔ bù xiāng, literally translates as taken in food not fragrant, whereby lack of appetite is expressed as projection onto the food itself. The translation no pleasure in eating, takes a liberty but is clearer.

Below are more distinctions that should be preserved in translation.

Cold symptoms

• 恶寒 wù hán, aversion to cold: Sensation of cold unrelieved by heat or additional clothing. A sign of external evils in the exterior, especially cold.
• 恶风 wù fēng, aversion to wind: Mild aversion to cold felt on exposure to wind or drafts.
• 畏寒 wèi hán, 怕冷 pà lěng, fear of cold: Chronic sensation of cold that is relieved by heat or additional clothing. Attributed to yáng vacuity.
• 形寒 xíng hán, physical cold: Sensations of cold and visible signs of cold. Cause: yáng vacuity.
• 憎寒 zēng hán, abhorrence of cold: Violent aversion to cold.
• 肢冷 zhī lěng, cold limbs: general term for cold in the extremities.
• 四肢不温 sì zhī bù wēn, lack of warmth in the limbs: mild form of cold limbs.
• 四肢逆冷 sì zhī nì lěng, counterflow cold of the limbs: severe cold in the extremities reaching to the knees and elbows.
• 四肢厥冷 sì zhī jué lěng, reversal cold of the limbs: same as counterflow cold of the limbs.

Heat symptoms

• 壯热 zhuàng rè, tidal heat effusion (fever): Fever or heat sensation felt at specific times of the day. Usually denotes next.
• 潮热 cháo rè, tidal heat effusion (fever): Fever or heat sensation felt at specific times of the day. Usually denotes next.
• 午后潮热 wǔ hòu cháo rè, postmeridian tidal heat effusion (fever): Tidal heat effusion felt sometime after midday, often during nighttime (yīn vacuity).
• 日晡潮热 ri bū cháò re, late afternoon tidal heat effusion (fever): Tidal heat effusion at 3-5 pm. Associated with yáng brightness disease.

Breathing symptoms

• 气少 qì shǎo , qì scantness: Mild shallow breathing, a sign of qì vacuity; also means qì vacuity.
• 少气 shǎo qì, scantness of breath: Mild breathing difficulty, but without discontinuity.
• 气短 qì duǎn, shortness of breath: Breathing difficulty with discontinuity. Causes: severe qì vacuity; phlegm-rheum, qì stagnation, blood stasis.
• 喘 chuǎn, panting: Severe breathing difficulty, with discontinuity of breathing (inability to catch one’s breath), and in the severest cases raised shoulders and flaring of the nostrils. Causes: heat, phlegm-heat, phlegm-rheum, wind-cold; lung- kidney depletion (kidney failing to absorb qì).
• 哮 xiào, wheezing: Phlegm rale. A sound that often accompanies panting. Wheezing and panting is equivalent to asthma.

Acid reflux symptoms

• 泛酸 fàn suān, acid upwelling: Welling up of acid fluid into the throat. (Mild)
• 吞酸 tūn suān, acid swallowing: Welling up of acid fluid into the throat that is swallowed before it can be ejected. (More severe)
• 吐酸 tù suān, vomiting of acid: Ejection from the stomach of acid matter. (Most severe).

Involuntary loss of semen

• 遗精 yí jīng, seminal emission: Involuntary loss of semen during sleep. Distinctions are made between emission with or without dreaming. Due to various kidney and heart problems. There is usually dreaming when the heart is affected.
• 滑精 huá jīng, seminal efflux: Involuntary loss of semen at any time, when a asleep or awake, without dreaming. Mostly due to insecurity of kidney qì.

Spasm

• 瘈瘲 chì zōng, tugging and slackening: Alternating contraction and relaxation. Convulsions.
• 筋脉拘挛 jīn mài jū luán, hypertonicity of the sinews: Persistent tension in the limbs.
• 手足蠕动 shǒu zú rú dòng, wriggling of the extremities: Slight movement of the extremities.
• 筋惕肉瞬 jīn tì ròu shùn, jerking sinews and twitching flesh: Movement of the flesh without necessarily causing a whole body part to move. Notably includes “tics”.

Urinary symptoms

• 尿赤 niào chì, reddish urine: urine that is a dark tea color.
• 尿黄 niào huáng, yellow urine: urine that is yellower than normal.
• 小便短赤 xiǎo biàn duǎn chì, short voidings of reddish urine: reddish urine that comes in voidings that are of short duration.

Pulses

• 脉虚 mài xū, vacuous pulse: a pulse that is forceless, soft, usually large and that feels empty.
• 脉弱 mai ruò, weak pulse: sunken and forceless.
• 脉无力 mài wú lì, forceless pulse: a pulse that has no strength.

Blood stasis

• 血瘀 xuè yū, blood stasis: Non-movement of blood.
• 血滞 xuè zhì, blood stagnation: Mild blood stasis (as treated by 四物汤 sì wu4 tāng, Four Agents Decoction)

Treatments for blood stasis

• 活血 huó xuè, quickening the blood: To enhance the movement of blood.
• 和血 hé xuè, harmonizing the blood: To treat mild blood stasis as resulting from blood vacuity
• 化瘀 huà yū, transforming stasis: To treat blood stasis.
• 破血 pò xuè, breaking blood: To forcefully treat blood stasis.

Treatments to dispel dampness

• 祛湿 qū shī, dispelling dampness: To eliminate dampness in any way.
• 化湿 huà shī, transforming dampness: (1) dispel dampness. (2) Dispel dampness in the upper burner using aromatic medicinals that promote sweating.
• 燥湿 zào shī, drying dampness: Dispel dampness, especially in middle burner, without inducing sweating or increasing urination.
• 利湿 lì shī, disinhibiting dampness: encourage dampness in the lower burner to pass out with urine.
• 胜湿 shèng shī, overcoming dampness. Dispelling dampness especially when wind medicinals are used, reflecting the axiom 风能胜湿 fēng néng shèng shī, wind can overcome dampness.
• 收湿 shōu shī, absorbing dampness: Remove dampness from the skin using externally applied medicinals.

External medicine diseases

• 痈 yōng, welling-abscess: Large elevated suppurative lesion below the skin with redness and pain. Clearly circumscribed. There are also welling-abscess of the internal organs.
• 疽 jū, flat-abscess: Diffuse suppurative lesion without elevation.
• 疔dīng, clove sore: A small hard sore with a deep root, occurring most commonly on face or ends of fingers.
• 疖 jié, boil: a small round superficial swelling that is hot and painful, suppurates within a few days, and easily bursts.
• 疥 jiè, scab: A skin disease characterized by small papules the size of a pinhead that are associated with insufferable itching that when scratched may suppurate and crust without producing exudate. WM: scabies.
• 癣 xiǎn, lichen: A skin disease characterized by elevation of the skin, serous discharge, scaling, and itching.

Explanation and definition: Source-oriented translation aims to chose target-language words that reflect the meaning of the source-language as closely as possible. As numerous examples above show, many Chinese terms have technical meanings that are more specific than the literal meaning suggests, so that terms that are seemingly synonymous may belie subtle or even major distinctions that must be explained to students. For example, 壮阳 zhuàng yáng might be taken as a synonym of 补阳 bǔ yáng, when in fact it usually refers to the action of supplementing kidney yáng to enhance sexual function. These terms can be distinguished in English perfectly as invigorating yáng and supplementing yáng, but the connotations must be signaled explicitly by additional explanation, even in Chinese.

Sometimes a greater explanatory effort is required in English translation. Of the five colors corresponding to the five phases, two a re problematic. Earth is a associated with 黃 huáng, naturally translated as yellow, but unbeknownst to most English speakers, the Chinese term has a much wider meaning than the English term, including shades of brown, which accounts for its association with earth. Wood is associated with 青 qīng, which can refer to green or to blue. While the association with wood is based on green, in diagnosis of skin coloration, it means green or blue; hence our translation green-blue.

Context sensitivity: Source-oriented translation is not word-for-word translation that ignores contextual meaning. 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, e.g., 滑脱 huá tuō, efflux desertion). 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.

Examples of the need for context-sensitive translation are too many to mention: 淡 dàn in 舌淡红 shé dàn hóng, 淡渗利水 dàn shèn lì shuǐ, disinhibit water by bland percolation; 薄 bó / báo / bò in 博苔 bó tāi, thin tongue fur; 薄厥 bó-jué, vehement reversal; 薄荷 bò hé, mint; 重言 chóng yán, stutter; 头重 tóu zhòng, heavy-headedness; 中 zhōng, center, zhòng, strike; 实 shí, replete, repletion as in 实证 shí zhèng, repletion pattern; to fill, replenish, as in 虚虚实实 xū xū shí shí, evacuate vacuity and replenish repletion; solid, as in 大便不实 dà biàn bù shí, unsolid stool.

The term 气 qì deserves special attention in this context because it has multiple meanings and therefore tends to be rendered in different ways according to context, of which the loanword qì 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 qì. 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 qì 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 qì) simply as fire, and zhàng qì (distension qì) as flatulence. Yet although such translations accord with the principle of context-sensitive translation, it can prejudice students’ understanding of what qì means in its widest sense. This is because all the medical meanings of the term are 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 qì is reserved for the motor force of bodily activity, it becomes equated with the concept of energy or vital energy, which has been widely used by many.

Students’ difficulties in understanding the nature of the qì that powers bodily activity can be compounded by free translations of words describing the action of qì. 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 qì 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 qì escaping 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 qì didn’t exist. Note here that according to the acupuncture method called 开阖补泻 kāi hé bǔ xiè, open and closed supplementation and draining, supplementation is achieved by lightly pressing and rubbing the point after needle extraction to close the hole and prevent channel qì from discharging, while draining is achieved by waggling the needle on extraction without pressing, to open the hole and allow channel qì to discharge.

A similar example is the term 脚气冲心 jiǎo qì chōng xīn, which literally means leg qì surging into the heart. This could be rendered 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 qì 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 workaround that solves this translation problem is to translate 气 qì more systematically as qì than translators might normally do and by adding explicit clarification in key contexts, e.g., 六气 liù qì as the six qì (environmental conditions), the 四气 sì qì of medicinal substances as the four qì (four natures), 嗳气酸腐 ǎi qì suān fǔ may be rendered as belching of sour putrid qì (gas) and 失气 shī qì as fecal qì (flatus).

Minimizing equivalents: To create a streamlined terminology that is easy for others to apply, it is wise to keep the number of chosen equivalents to a minimum. If a translator sometimes renders 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 in the last section of this article.

In the same vein as our argument about qì, 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 (風痹 fēng bì, wind impediment; 喉痹 hóu bì, throat impediment; 胸痹 xiōng bì, chest impediment). Of course, the disease name impediment must 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.

The kernel term 结 jié, provides an example of how a carefully chosen equivalent can be used in most compound terms in which it appears.

• 结胸 jié xiōng, chest bind
• 大肠寒结dà chǎng hán jié, large intestinal cold bind
• 热结 rè jié, heat bind
• 肝气郁结 gān qì yù jié, binding depression of liver qì
• 痰气互结 tán qì hù jié, phlegm and qi binding together
• 大便干结 dà biàn gān jié, dry bound stool
• 结脉 jié mài, bound pulse

Preserving structure? One universally recognized principle is the need for any translated text 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 a bipartite description of medicinal actions, such as clearing heat and transforming dampness, fortifying the spleen and boosting qì. 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, so that, for example, 目 mù, eye, came to be replaced by 眼睛 yǎn jīng. 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 renderings, the fact that their components are also stand-alone terms, accurate translation 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 mǎn (distention and fullness), 涩痛 sè tòng (rough and painful), 癫狂 diān kuáng (mania and withdrawal).

The literary style (文言文 wén yán wén) shows a marked preference for symmetry that often leads to redundancies. For example, 疼痛 téng tòng, literally means pain pain. This duplication often appears after body parts expressed in two characters, as in 骨节疼痛 gǔ jié téng tòng, joint pain. Another example is 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.

Of paramount importance in source-oriented translation is the preservation of metaphor. The following section is devoted to this.

Brevity: The need for brevity is a factor to be considered in translation. 活血 huó xuè, translated as promoting blood circulation, apart from introducing biomedical notions of circulation, is awkward in some contexts, such as 补肾活血汤 bǔ shèn huó xuè tāng. A literal translation with one word for one character provides a slicker rendering as Kidney-Supplementing Blood-Quickening Decoction.

Another example is that of 升 shēng (go/bring up, rise/raise) and 降 jiàng (go/bring down, descend/lower) present difficulties in this regard, since both can be used intransitively and transitively. English only has two words that fit the bill here, the slightly unusual upbear and downbear.

Brevity is a factor in stasis for 瘀 yū, mentioned above, and for bowels and viscera for 脏腑 zàng fǔ, discussed below.

Preserving Analogy and Metaphor

Analogy is a comparison of two otherwise unlike things based on resemblance of a particular aspect, usually used to explain one thing in terms of another. Metaphor is naming or describing one thing by analogy to another. Biomedicine, like the modern sciences in general, has little use of analogy beyond the initial formulation of hypotheses and but does use 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 yīn-yáng and five-phase systems of correspondence and manifests in numerous metaphors.

Biomedicine and Chinese medicine make similar use of naming metaphors based on chance similarity. Biomedical terms such as acetabulum (lit., vinegar pot), pelvis (basin), ala nasi (wing of the nose) are all based on chance similarities that provide names out of want of better words. The fact that our English anatomical terminology largely comes from Latin and Greek obscures these metaphors for many if not most speakers. Words chosen by chance similarity can lead to mixed metaphors, such as the labeling of the chambers of the heart as atrium and ventricle, literally meaning entrance hall, and little belly, respectively. The mixing of metaphors clearly did not concern the inventors of the terms, who would have been more aware of their literal meanings than people today.

Chinese medicine also makes use of metaphor merely for the purpose of naming, 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. Because these Chinese terms are Chinese in origin rather than borrowings, Chinese speakers are aware of the metaphorical nature of the terms. Yet the terms themselves provide little or no help in understanding the medical significance of these concepts.

Both biomedicine and Chinese medicine have other metaphors that reflect functional analogies of the things they represent. For example, biomedicine speaks of macrophages, literally big eaters, referring to white blood cells that devour debris or pathogens. In the ear, we have the ossicles malleus, incus, and stapes, which literally mean hammer, anvil, stirrup, respectivley, and which are often rendered as such in English to highlight the function. Chinese medicine has similar functional metaphors, but a much larger array than biomedicine. These include 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 the three descriptions of the triple burner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, which, taken together, are reminiscent of the rain cycle, which the authors of the Nèi Jīng were aware. Yet, far more important than even this the role of analogy in the systems of correspondence and the concept of qì, which involve systematic analogies over numerous phenomena.

Analogy as a Cognitive Approach

Analogies are not just seen in numerous isolated instances. Analogical thinking, the way of understanding things by likening them to others, lies at the core of the all-encompassing yīn-yáng and five-phase systems of correspondence as well as the concept of qì, which enabled ancient medical scholars to develop rudimentary analytical observations into a fully-fledged theoretical model. For this reason, the Huáng Dì Nèi Jīng states that medical matters cannot be clearly understood without drawing analogies (不引比类¸ 是知不明 bù yǐn bǐ lèi, shì zhī bù míng).

The yīn-yáng system is based on the observation that numerous things and phenomena occur in pairs, the two members of which each show similarities both in nature and in their relationship of opposition and complementarity to the other member. Thus, night is to day as winter is to summer, as cold is to heat, as light is to dark, as up is to down, as in is to out, as concentration is to diffusuion, as male is to female, and so on.

The five-phase system works in a similar way, but with groups of five, labeled as wood, fire, earth, metal, and water. This system developed from the existing notion of the five materials / utilities (五才 wǔ cái), things essential to human life, when these were seen as useful labels for the activities and qualities in nature associated with five distinct seasons of the year. Thus, wood (representing wood as substance, trees, vegetation in general) was seen to embody the qualities of strength, resilience, and forceful thrust of vegetation coming to life in springtime; fire, the growth and exuberant activity of nature in summer; earth, the qualities of late summer when crops ripened; metal (used to make scythes and knives), the slaughter of animals in autumn when the first frosts kill off plant and animal life in nature; and water (which naturally flows to low places), the season when nature, as it were, goes into cold storage mode. From this, numerous correspondences were generated: Spring is to birth, morning, the east, and the sourness of sap, as summer is to growth, noon, south, and the bitterness of burnt vegetable matter, etc. These associations are summarized in the table below. Furthermore, the relationships between members of five-phase groupings are seen to reflect the cycles of nature such as that of engendering, whereby spring gives way to summer as wood moves earth; summer gives way to late summer, as fire reduces vegetation to earth, and so forth.

Another major concept developed by the natural philosophers of antiquity was the concept of qì, a term originally denoting clouds, mist, steam, and vapor. The changing states of clouds, mist, and steam prompted thoughts about the nature of the universe. The observation that clouds and mist could gather and turn to rain or rapidly disperse and disappear, and that steam rising from a pot was the hottest and most powerful in its formless state, prompted the notion that these distinct phenomena were different manifestations of a single substance. They elaborated on this idea by positing that the whole world was made up of one substance manifesting in different shapes and forms, including forces so intangible that they could pervade all matter to power all activity. Thus, a further notion with roots in analogical thinking was born, namely that of qì as the single element. Thus, the concept of qì is rooted in an ancient Chinese world view.

When the origin of concepts is understood, blatant mistakes can be avoided. The 五行 wǔ xíng are referred to as the five elements, simply because wood, fire, earth, metal, and water are names that ring a bell with the four elements earth, fire, air, and water of Greek antiquity. The word element as a basic substance of the universe can only be applied to qì. The name 五行 wǔ xíng implies movement, action, activity, not elements. Not even the 五才 wǔ cái were ever considered elements. Suprisingly, many Chinese translators use the term five elements on the grounds that this is the mostly commonly used and easily understood translation, without being aware it replaces an Chinese worldview with a Western, albeit ancient, one.

When medical scholars of antiquity were seeking to develop a functional model of the body and the causes of its afflictions, we can assume that they realized that the body was composed of individual organs that played a role in keeping the body alive and in health, and that it was important to understand their function. Analysis of naked-sense observations would have revealed certain basic functions and attributes of the organs, e.g., the stomach’s digestive function; the lung’s respiratory function; the liver’s blood-storing function (even though this is not consistent with biomedical theory); the kidney’s urinary function; the heart’s spirit-storing function; and possibly even the differentiated location of the five minds and seven affects. With a couple of exceptions, notably the blood-storing and spirit-storing functions, these inferences are largely consistent with biomedical theory.

Analysis of direct observations was not pursued beyond these rudimentary findings. Rather, the analogical reasoning of natural philosophers set the approach for medical investigations. Medical scholars applied to concepts of yīn-yáng, the five phases, and qì in the medical realm to explain physiological and pathological phenomena.

In the realm of physiology, yīn-yáng theory was used to categorize the major internal organs according to whether they stored things (a yīn function) or discharged things (a yáng function), giving rise to the concept of the five viscera and six bowels, where the liver is paired with the gallbladder, heart with the small intestine, the spleen with the stomach, the lung with the large intestine, and the kidney with the bladder. Five-phase theory was used to categorize the five viscera according to their similarities to the qualities of wood, fire, earth, metal, and water to explain the functions of the organs in greater detail. So for example, the kidney, as the source of urine, was naturally associated with water and was presumed also to have the storage activity of water in the five phases; hence it was deemed to store essence, the seed as it were, of human life. The spleen, lying on the underside of the stomach, was presumed to store the essence of grain and water, i.e., the nutrients released from food in the digestive process, which provide the basis for the production of blood, fluids, and the yáng qì of the body. Other structures, aspects of the body, and even mental faculties and emotions were similarly classed according to the five phases, as the table below shows.

The concept of qì developed by natural philosophers was also applied in medicine. The solids and fluids of the body were classed as yīn qì, while all movement of and within the body and all the transformative processes occurring in it were attributed to a formless, invisible, and intangible yáng qì, which could flow through matter to all around the body.

The scholars who developed these theories did not explain their reasoning in great detail, so we can only deduce their rationale from the theories themselves. Some associations made appear somewhat far-fetched, notably the association between the heart and small intestine, and the lung and the small intestine.

Modern Chinese textbooks evade investigation of these connections. The associations are simply presented as facts, and students are left to understand them by their own wits. Most appear to be dimly aware of the issues. When asked why the liver is related to wood, they usually say that it is because the liver’s function of free coursing (疏泄 shū xiè) is like the orderly reaching (條達 tiáo dá) quality of wood, without wondering about the origin of the free coursing function. The reason for the poor understanding of the origins of these medical theories probably lies in the age-old Chinese didactic approach of having students memorize statements and leaving them to figure them out intuitively. Another reason why these issues are not broached in modern textbooks is that it may lead to certain uncomfortable conclusions about the nature of Chinese medical theories. Needless to say, Western students, with shorter curricula and fewer texts to read, receive even fewer promptings to think about such issues. The transmission of knowledge from a bye-gone age in China poses problems; transmission from the bye-gone age of a distant culture poses even greater difficulties.

The concept of qì, central to so many aspects of Chinese medicine, poses particular difficulties for Westerners, unlike in Chinese, it is not an everyday word in their languages. Because yīn qì is rarely seen in English literature, Westerners associated the concept exclusively with yáng qì. And since it has often been rendered as (vital) energy, they easily fail to understand it as anything but energy. The tendency of other phenomena called qì in Chinese (breath, flatulence, environmental influences) to be rendered with other words in English makes it even more difficult to gain a comprehensive grasp of the concepts.

Analogical reasoning by no means stops at yīn-yáng, the five phases, and qì. Also seen in Chinese medicine is a whole slew of metaphors that liken the human body to a vast country or empire, its economics, and its administration. The terminology of acupuncture points abounds in names derived from topographical and transportational concepts (cleft, stream, well, marsh, mountain, hubs, etc.), most of which Westerners, who use alphanumeric codes and Pīnyīn names, are unaware of.

• 外丘 wài qiū (GB-36), Outer Hill
• 阳陵泉 yáng líng quán (GB-34), Yáng Mound Spring
• 中渎 zhōng dú (GB-32), Central River
• 阳溪 yáng xī (LI-5), Yáng Ravine
• 曲池 qū chí (LI-11), Pool at the Bend
• 地仓 dì cāng (ST-4), Earth Granary
• 气冲 qì chōng (ST-30), Qì Thoroughfare
• 大都 dà dū (SP-2), Great Metropolis
• 阴陵泉 yīn líng quán (SP-9), Yīn Mound Spring
• 小海 xiǎo hǎi (SI-8), Small Sea
• 肩外俞 jiān wài shù (SI-14), Outer Shoulder Transport
• 肺俞 fèi shù (BL-13), Lung Transport
• 胃仓 wèi cāng (BL-50), Stomach Granary
• 京骨 jīng gǔ (BL-64), Capital Bone
• 水泉 shuǐ quán (KI-5), Water Spring
• 曲泽 qū zé (PC-3), Marsh at the Bend
• 中冲 zhōng chōng (PC-9), Central Hub
• 外关 wài guān (TB-5), Outer Pass
• 中都 zhōng dū (LR-6), Central Metropolis
• 石门 shí mén (CV-5), Stone Gate
• 紫宫 zǐ gōng (CV-19), Purple Palace

However, the most systematic empire metaphors are those describing the organs:

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

Surprisingly, these epithets do not appear in every basic English-language textbook. They are noticeably absent from the basic textbooks of Chinese authorship that were widely used in schools in the 1980s and 1990s and from many works of Western authorship that followed them. The reason for this is that analogies of human physiology to the administrative organization of a country or empire seem far-fetched. In contrast, yīn-yáng and the five phases appear more rational because they center around light and warmth versus darkness of cold in nature; in other words, they have a basis in physics as well as analogy.

The attributes of the viscera and their cognitive origins in direct observation and analogical frameworks so far as these can be deduced from traditional statements are summarized below. These ideas are explained in greater detail in analogy and elaborated at greater length Chinese Medicine: The Ideas That Shaped It, Wiseman and Wilms, Paradigm Publications, 2121, which is largely based on Zhōng Yī Xué: Yī Ge Yǐn Yù de Shì Jiè (中医学：一个隐喻的世界 Chinese Medicine: A World of Metaphor) by Jiǎ Chūnhuá (贾春华), People’s Publishing House, 2017.

Liver: The liver belongs to wood, stores blood, and governs free coursing. It governs the sinews, opens at the eyes, and has its bloom in the nails. Its humor is tears, and its mind is anger. It holds the Office of General (将军之官 jiāng jūn zhī guān).

• The ascription to the wood phase comes from the shape and color of the liver.
• Blood storage is inferred from the color of the liver and from massive hemorrhage following laceration.
• Free coursing (疏泄 shū xiè) and upbearing effusion (升发 shēng fā) derive from the association with the “orderly reaching” (条达 tiāo dá) quality of wood.
• The sinews and eyes are directly associated with the “orderly reaching” quality of wood and are dependent on blood storage.
• Anger is associated with disturbances of free coursing and upbearing effusion.
• The liver is averse to wind, as plants in nature are easily damaged by wind when they are not sufficiently supple.
• The army general represents command over the nation’s territory and territorial expansion. His job is to make strategies (肝主谋略 gān zhǔ móu lüè). The army under his command is reflected in the sinews and nails/claws (the military power of the nation), the spreading of qì (expansion of the nation’s power), the eyes (reconnaissance and mapping of territory), anger (national indignation against foes).

Heart: The heart belongs to fire and stores the spirit. It governs the blood and vessels, opens at the tongue, and has its bloom in the face. Its humor is sweat, and its mind is joy. It holds the Office of Sovereign (君主之官 jūn zhǔ zhī guān).

• The association with fire derives from the bodily heat that develops during strenuous exercise that makes us aware that the heart is throbbing.
• The association with the blood and vessels derives from the radial formation of large vessels from the heart. Given the location in the center of the chest, this reflects the radiating quality of fire.
• Storing of the spirit derives from the sensing of all emotions in the heart. The concept of spirit derives from that of an unseen, all-powerful, all-knowing being in the other world with which fire provides a channel of communication (burning of incense, money).
• The tip of the tongue is associated with fire because it is flame-shaped (flame = fire).
• The association with sweat derives from the fact that sweating occurs during strenuous exercise, when it often streams from the center of the chest.
• The face, as the bloom of the heart, is the clearest reflection of the state of the spirit.
• Fire represents safety, the center of social life, conviviality. Hence, it is associated with joy. Fire also represents power and splendor. Hence the heart is said to hold the Office of Sovereign, who gains his mandate from heaven (the spirit world) and who ensures the safety and well-being of the nation.

Spleen: The spleen belongs to earth. It governs movement and transformation and controls the blood. It governs the flesh, opens at the mouth, and has its bloom in the lips and four whites. Its humor is drool, and its mind is thought. It holds the Office of the Granaries (仓廪之官 cāng lǐn zhī guān).

• The location on the underside (yīn side) of the stomach prompted the idea that the spleen was the storing organ corresponding to the stomach and hence an organ of digestion responsible for movement and transformation, helping the stomach to digest, extracting the essence of grain and water to produce qì and blood, and warming and transforming water-damp.
• The association with earth rests on the spleen’s being the source of qì and blood production, as earth provides sustenance for plants, animals, and humans.
• The flesh is associated with the spleen because it is marker of strength of digestion and assimilation. The mouth, lips, and drool are associated with the spleen they all directly related to digestion.
• Ideation (脾藏意 pí cáng yì) and thought derive from the productiveness of earth. Excessive thought damages the spleen is like the over-intensive use of soil. Singing is the creative use of the voice.
• The Office of the Granaries, securing food supplies for the nation, naturally corresponds to earth in nature.

Lung: The lung governs breathing and governs qì. It governs regulation of the waterways. It governs the skin and body hair, opens at the nose, and has its bloom in the body hair. Its fluid is snivel, and its mind is worry (and sorrow). Its government epithet is the Minister-Mentor (相傅之官 xiāng fù zhī guān yě). It has a special association with acridity.

• Breathing is a directly observable function of the lung.
• The lung’s governance of qì is derived from this.
• As the governor of qì, the lung governs the regulation of the waterways throughout the body, reflecting the rain cycle governed by the qì of heaven. Lung qì’s upward and outward movement, “diffusion” (宣散 xuān sàn) is responsible for exhalation and ensuring the outward movement of fluids to moisten the skin and body hair, while its downward and inward movement, “depurative downbearing” (肃降 sù jiàng) is responsible for inhalation and also regulates the downward flow of fluids to the kidney and bladder.
• The lung’s belonging to metal, the phase associated with the purification of nature in autumn, is explained by the lung’s need to inhale clear qì and expel turbid qì and by its need to keep the airways free of nasal mucus and phlegm.
• Acridity is the smell of metal, and acrid medicinals clear the airways.
• The voice is associated with the lung not only because it is located on the airway but also because the lung resembles a metal bell in that it rings clearly only when empty, i.e., when the airways are free of obstructions.
• Worry and sorrow are associated with the lung because they are felt in the chest and easily affect lung function. They also reflect the lugubriousness of the autumn.
• The lung holds the Office of Minister-Mentor because it controls the qì of the entire body. Breathing has a powerful regulatory impact on the heart rate and emotions, just as the Minister-Mentor, by his wise counsel, tempers the excesses of the sovereign.

Kidney: The kidney belongs to water and governs water (producing urine). It stores essence, governs the bone and engenders marrow, opens at the ears and the two yīn, and has its bloom in the hair. Its humor is spittle, and its mind is fear. It holds the Office of Forceful Action (作强之官 zuò qiáng zhī guān).

• Responsible for producing urine, the kidney governs water and hence belongs to the water phase.
• Storing essence derives from the association of winter with the water phase, a time when nature is silent and inactive, storing resources for warmer weather. Essence controls reproduction, development, and aging. The kidney also has a general storage function, preventing the loss of urine, stool, semen, menstrual blood, and fetuses.
• The connection with the bones (which store marrow), the brain (marrow stored in the skull), “mind” (mental faculties) including memory (memories are stored experiences) further reflect the storage function.
• The ears being the outer orifice of the kidney is related to the loss of hearing in old age, which resembles the silence of winter.
• Fear is associated with the kidney because fear and fright impair the storage function, causing incontinence, and because death, the thing we fear most, is the end of the human cycle as winter is the end of the seasonal cycle in nature.
• The kidney holds the Office of Forceful Action, reflecting the observation that the ability to work physically or mentally relies on the health of essence.

The above explanations of the internal organs show how observation-based analytical findings were interwoven with analogies based on the systems of correspondence. A similar melding of analysis and analogy is seen in 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. Yet other associations are derived by analogy: wind is said to affect the yáng 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. Wind is also understood to penetrate the skin and flesh. While, in the modern scientific understanding, wind acting on the surface of the body can trigger reactions within the body, wind, in its Chinese medical conceptions, actually penetrates the body and is even capable of arising in the body.

Analogy and Metaphor in Translation

The greater depth of Chinese medical metaphor is 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 indicate their relative importance. Fortunately, most translators preserve these metaphors. However, the names of two of the eight extraordinary vessels, the 督 dū and the 任 rèn, translated, as they often are, as the governing and conception vessels, obscure the original metaphors. The Chinese terms originally derived from administrative titles, so that more precise translations are governing and controlling vessels . The translation of 任 rèn as conception vessel derives from 妊 rèn, which means pregnancy. While this rendering is valid insofar as the vessel is associated with pregnancy, it forsakes the original metaphor and thus obscures the administrative analogy in the mind of the originators of the terms. Our translations follow Tessenow and Unschuld, A Dictionary of the Huang Di Nei Jing Su Wen, in the choice of controlling vessel (p. 341), but retain the commonly used governing vessel instead of their supervisor vessel (p. 94) since it preserves the metaphor. Another of the eight extraodinary vessels is the 冲脉 chōng mài. The character 沖 (traditional 衝) means to surge, to charge, (transport) hub, and thoroughfare, the last of these being the metaphor intended in the naming of the vessel. Though often rendered as penetrating vessel, the more precise translation is thoroughfare vessel.

The 臟腑 zàng fǔ, denoting the two major classes of internal organs have been the subject of debate. They are derived from 藏府 zàng fǔ, literally meaning “stores/treasuries and official exchange houses.” These are economic metaphors that reflect the Nèi Jīng’s description of the former as 藏而不泻 cáng ér bù xiè, storing and / but and not discharging and the latter as 泻而不藏 xiè ér bù cáng, discharging and / but not storing. Paul Unschuld renders these as depots and palaces, respectively. However, while palace is an suitable equivalent of 府 fǔ, depot suggests temporary storage for things on the move and when compared with palace has connotations of being much less important. To reflect the metaphors more accurately, we use “storehouses and dispatch houses” in explanations of the concepts. However, these terms are long and clumsy, so in most texts, we refer to them as bowels and viscera. No-one is helped by referring to them as zàng fǔ since the Pīnyīn terms are opaque to most readers.

The health-maintaining forces of the body and pathogenic forces that threaten it are called 正气 zhèng qì, right qì, and 邪气 xié qì, evil qì, respectively. The terms themselves are moralistic metaphors. Two specific elements of right qì are the paired terms 卫 wèi and 营 yíng. Although these are often translated as defensive and nutritive (qì), they 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 nutritive 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 rendering 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 healthcare 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.

These military metaphors are not the only ones. The terminology of pathomechanisms and treatment abounds in them.

The importance of military analogy has even led to explaining why evils never enter the heart. In warm disease theory, heat is said to enter the pericardium, not the heart (热入心包 rè rù xīn bāo) because of a political taboo against suggesting that evil forces could attack the heart of the nation and the sovereign (君主 jūn zhǔ) who represents it.

Here, it might be noted that the basic therapeutic concept of 补 bǔ also conforms to the scheme of military interpretation. This term appears in the combinations of 补泻 bǔ xiè, supplementation and attack, and 攻补 gōng bǔ, attack and supplementation. While supplementation and draining may be a mixed metaphor, attack and supplementation is not. Yet when 补 bǔ is translated as tonify as is often the case, a possible military metaphor is completely erased.

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 qì, evil qì, 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 cavalierly distorts the true philosophical underpinnings of the discipline.

Western texts rarely mention the phrase 肝生于左 gān shēng yú zuǒ, the liver is born / arises / lives on the left. for the apparent reason that it makes no sense since the liver is on the right-hand side of the body. This statement seems to hark back to a five-phase classification of the five viscera that predates the familiar modern one. That scheme established correspondences based on anatomical position in relation to geographic location using a map that placed south at the top and north at the bottom, so that the spleen was associated with wood (east, where the sun rises), the lung with fire (south), the liver with metal (west), and the kidney with water (north), with the heart at the center. This scheme was replaced with the one we know today when five-phase correspondences came to be based not on anatomical position but on functions. If this argument is correct, the notion that “the liver lives on the left” may have been an attempt to reconcile the two distinct schemes and hence is possibly an important at the historical development of Chinese medical theory.

The tendency to play down or omit analogy and metaphor is especially prevalent among Chinese translators. This appears to be the case in general translation as well as in Chinese medical translation. In my work teaching general translation classes, I have found that Chinese students asked to translate culinary terms such as 狮子头 shī zi tóu or 蚂蚁上树 mǎ yǐ shàng shù usually come up with descriptive renderings like meatballs and ground pork with vermicelli, arguing that foreigners might not understand the humor. They rarely offer the well-established translation lions’ heads and ants climbing a tree, even though they are usually quite happy with 热狗 rè gǒu or 血腥玛丽 xiě xīng mǎ lì as Chinese translations of hot dogs and bloody Mary. However, in Chinese medical translation, there may be an additional factor: the fear that metaphorical language might suggest that Chinese medicine is somehow unscientific. This is probably why early translators omitted mention of metaphors like the heart as sovereign and the liver as the general.

Metaphors are prevalent in every language. Awareness of them varies according to circumstances. Native speakers are consciously aware of metaphors when they are new. When the word menu was first used in computers as a list of options, speakers were aware of the metaphorical usage. With the passage of time, the use in the context of computers just becomes another meaning. Most English speakers are now unaware that a light bulb is so-called because of the similarity in shape of a traditional light bulb to an onion. They just think of bulb as having two distinct meanings. Nevertheless, when related metaphors abound as they do in Chinese medicine, they draw attention to themselves. The thoughtful Chinese reader of Chinese medical texts is aware of the web of metaphors that hint at the cognitive origins of theories.

For non-Chinese students initially encountering texts applying terminology that reflects the original meanings, metaphors stick out like a sore thumb. If such students are asked which they prefer evil or pathogenic factor (as the translation of 邪 xié), they will invariably choose the latter. When not explicitly told about the importance of metaphor, they are may may find it obtrusive and disconcerting. For them, Chinese medical theories were born in ancient times in a distant culture; hence they need more background information than Chinese students. Yet when translators have consciously or unconsciously tried to avoid translating metaphors, as they have for so long in Chinese medicine, switching to a more accurate strategy entail allowing time for readers to adjust their perceptions.

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, two tendencies can be considered 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, has 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 pulse 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 of Chinese medicine’s conceptual framework.

Using 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. Enuresis, from the Greek enourein meaning to urinate in [one ' s pants or bed] is accentable as a translation of 遗尿 yí niào. Strangury (from the Greek meaning dripping) is a good match to 淋 lìn, which also literally means dripping, and 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. Dyspnea is acceptable for 喘 chuǎn, although we prefer panting.

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 prevalence biomedical terms as translations of disease names has had the result of giving Westerners the impression that Chinese medicine has virtually no disease categories other than 病证 bìng zhèng, disease 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 yīn -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 Terminologies on Chinese Medicine [sic] shows (See table Traditional Classification Destroyed by Biomedicalized Translation).

Biomedicalized translations are not limited to disease names. Other examples include 治未病 zhì wèi bìng (lit. treating disease before it arises) translated as preventive medicine, 梅核气 méi hé qì (lit. plum-pit qì) as globus hystericus, 痹 bì (lit. impediment) as arthralgia, 活血 huó xuè (lit. quicken/enliven the blood) as promoting blood circulation, 利水 lì shuǐ (lit. free [the flow of] water) as diuresis.

The table below shows how the traditional concepts are 痈 yōng, 疔 dīng, and 癤 jié are destroyed in translation when they are equated with with biomedical entities.

Probably the worst translation has been the choice of sedate as the rendering of one of the two basic acupuncture stimuli 补 bǔ and 泻 xiè (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 qì 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, fox-creeper, plum-pit qì, joint-running wind or even long voidings of clear urine.

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 1980s 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 (*kerd-). 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?

The five viscera and six bowels (五脏六腑 wǔ zàng liù fǔ), as described in Chinese medicine, are accorded some functions that are recognized in biomedicine. The lung draws in air; the kidney excretes urine; the stomach performs primary digestion. However, they all have functions that are alien to modern medicine, such as the lung’s governance of the waterways and the kidney being the root of yīn and yáng. Some have virtually no communality with biomedicine, notably the spleen’s functions of movement and transformation (运化 yùn huà) and controlling the blood (统血 tǒng xuè, and the liver’s function of governing free coursing (疏泄 shū xiè). Despite the difference in accorded functions, the physical organs are the same. A liver removed from the body would be called 肝 gān by any Chinese as it would be recognized as a “liver” by any English speaker. This provides the basis for equivalence.

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 shèn qì xū as nephroqipenia and 中风 as anemobatia. Again, this style of translation was not adopted because nobody 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 qì, 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 Western knowledge systems into China over the past 200 years. The transmission of Chinese medicine was traditionally based on the 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, 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, a 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 / qì 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 are 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 worldview. 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 qì. 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, which resulted in WHO international standard terminologies on traditional Chinese medicine, have had little influence on translation practice because they excluded all but token representatives from the community of translators. The WHO work was carried out by its Western Pacific collaboration centers in universities in China, Japan, Korea, and Vietnam. The participants were mostly scientists engaged in research and only a very few people engaged in the transmission of East Asian medicine. Native English-speaking translators were conspicuously absent (as can be see from the title of the resulting document).

The results of the WHO debates was a highly unsatifactory terminology. Since the delegations could not agree on solid principles for the generation of terms, the organizers opted for a combined list of Chinese terms with English terms supplied by two of the participants and asked attendees to give state, for each Chinese term, which of the English terms they preferred. This led to a high degree of inconsistency in the translation of component kernel terms, as the table immediately above shows, as do those of biomedicalized translation in the previous section. All in all, it was a costly effort that was a complete waste of public money and no help to anyone.

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 an 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.