By Eric Brand

Chinese medicine is expressed through a complex body of technical terms. While an average Chinese person can read the words in a Chinese medical classic or a modern textbook, the meaning is largely incomprehensible if the person hasn’t studied Chinese medicine. While the technical nature of TCM literature is self-evident in the Asian world, in the West we find that people who haven’t studied Chinese often lack an appreciation for the depth of technical terminology in the field. It is obvious to any Chinese layperson that TCM has complex and specialized terminology, and within the Chinese community of educated practitioners, the importance of clear and accurate expression is a given.

Consequently, when the expert community in Asia ponders the globalization of Chinese medicine, significant attention is paid to the issue of terminology. After all, Chinese medicine’s depth of insight cannot reach the outer world unless there is a way to talk about TCM concepts in foreign languages. While Chinese medicine uses more metaphors and has more colorful terminology than biomedicine, the two medical systems are comparable in terms of their academic sophistication and heavy use of specific, specialized terminology.

Follow up:

When biomedicine first came to China, the Chinese language had to adapt so that it allowed for the clear expression of biomedical concepts. Biomedicine has many terms and concepts that one must study in order to have a professional-level conversation, and the Chinese language quickly created a specialized term system that mirrored the Latin-based terminology upon which biomedical language is based. By comparison, the development of professional terminology for Chinese medicine in foreign languages has largely lagged behind.

In the early days of Chinese medicine in the West, transmission of knowledge was hampered by the fact that many Chinese experts had poor English skills and many Western students did not study Chinese. Consequently, the expression of traditional concepts was often biomedicalized or simplified, and to this day many Western practitioners cannot differentiate between professional level discourse and the watered down version. The way we talk about Chinese medicine in English is often disconnected from any notion of the accuracy and academic excellence that it deserves. This is a shame because Chinese medicine has an astounding history of scholarly achievement that is rooted in a very well-developed system of precise yet flexible professional terminology.

This disparity in quality between English and Chinese sources is reinforced by the low bar set by many of the celebrity authors that write simplified books for mass appeal (admittedly, many of these “experts” don’t read Chinese well so they don’t really realize the extent to which their work is doing a disservice to the profession). At the end of the day, many of our books are driven by the market rather than the source material, and the simplistic lay terminology used in many books keeps the English literature lagging far behind the information that our Chinese colleagues enjoy.

Here in the West, we tend not to have much awareness about the terminology issue. The terminology on our exams is a joke. The exam boards don’t have any published standards on the terms they use, which is not surprising given that many of the required exam texts don’t offer much in the way of rigor or accuracy when it comes to translation (some of the most prominent authors on the exam list don’t even have the Chinese language skills to translate professionally in the first place). These same texts are the basic textbooks in the schools, so the entire profession is suspended in warped world where lax academic standards are the norm and accurately translated books are perceived as “difficult reading.” If I was on the outside of the field, I’d probably find the state of affairs to be comical, but as it is I don’t know whether to laugh or to cry.

Various solutions have been put forth to try to remedy this situation, though all of them have met with somewhat limited success. Without a doubt, the most obvious major contributor in this aspect of the field has been Nigel Wiseman. Nigel created an entire specialized English language system to mirror the technical language used in Chinese. He devised a method to preserve all the major technical concepts in Chinese medicine, and his system can be used to write and talk about CM in English without dumbing it down in any way. (see this blog for more)

Naturally, Wiseman’s system has been very popular among Westerners that read Chinese, because people that read Chinese instantly recognize that the language is full of specialized terms that need to be preserved. Wiseman wrote an entire dictionary of technical terms and over 100 books have been published using his terminology system, making his system by far the most tested and developed system in practical use. It offers a cohesive framework that solves all the common problems in translation, and individual writers often deviate from the base standard as needed to reflect variances in their term preferences or in the meaning of specific terms. Beyond the obvious benefit to translators, Wiseman’s term system allows monolingual students to learn CM without unnecessary simplification and it saves them the effort of having to actually learn Chinese to engage in a comparable level of professional discourse. For students that then go on to learn Chinese, it bridges the Chinese and English worlds so that learning CM Chinese becomes a thousand times easier.

Unfortunately, Nigel is first and foremost a scholar and a medical expert; he always prioritizes accuracy over popularity. If Nigel had caved a bit more on his principles and bowed to the demands of the marketplace, his work would have been the de facto standard for basically all the CM literature for decades. Simply changing little things like vacuity and repletion probably would have helped his work catch on, though ultimately the trends in the TCM book market reveal that most practitioners prefer books that read more like Harry Potter than the Merck Manual. Consequently, Nigel’s work has always been slightly unpopular in comparison to the easy reading books put out by celebrity authors. The students that read these books can’t discern the difference and the lowest common denominator prevails when it comes to the almighty tuition dollar and bookstore dollar.

At any rate, beyond Nigel Wiseman’s work, very few comprehensive approaches to CM translation have emerged. Dan Bensky has a very nice term set that is used by authors at Eastland Press, but it was only made publically available a few years ago and it has only about 1200 terms listed. Many of the individual terms are good choices but the scope is not really wide enough to offer translators a complete solution (by comparison, Wiseman’s term list has over 30,000 terms).

Beyond these two term sets, the only other solutions that have been put out have been done by committees. A Chinese scholar named Xie Zhu-Fan has a lot of published material on terminology, but his system is heavily biomedicalized and is not as desirable from the perspective of traditional practitioners (though it may be a good choice for biomedical journal articles where the target audience doesn’t care about CM concepts). The two largest organizations to tackle the issue of terminology are the World Federation of Chinese Medicine Societies (WFCMS) and the World Health Organization (WHO).

I studied closely with Nigel Wiseman during the time that he was an advisor to the WHO, and I’ve been involved in the WFCMS terminology conferences since their inception. Throughout this process, I’ve had the opportunity to see the politics of these committees in action. Each organization has good intentions and the scholarship that they bring from the Asian side is fantastic. There are a lot of true experts that come in to clarify the meanings of the terms and there is a widespread recognition that it is essential to preserve thousands of terms.

The WHO Western Pacific region did a great job at identifying the terms that needed to be preserved. They coordinated unprecedented cooperation between Japan, China, and Korea, and got some seriously heavyweight scholars together. The WHO team identified over 4000 terms that needed to be preserved, and they did a great breakdown comparing the overlap of terms between China, Japan, and Korea. China, Japan, and Korea agreed on 1,813 terms, with an additional 2,149 terms that overlapped between China and Korea but not Japan. Japan and China shared 100 terms that didn’t overlap with Korea, while Japan and Korea shared 138 terms that didn’t overlap with China. The scholarship that went into the selection process was fantastic, and the WHO ended up producing a final publication that had impeccable English.

By comparison, the WFCMS list is mostly focused on the Chinese system, with less emphasis on creating a harmonized system that encompasses Korean and Japanese medicine. Unlike the WHO list, the WFCMS list uses Pinyin for some terms and it generally has a slightly wider scope of terms (a bigger list). However, the WFCMS list is plagued by a higher incidence of errors in English fluency and is not quite in synch with the terms that are actually used by most professional translators.

In both cases, the term committees suffer from a problem of democracy. Both groups did a great job of creating principles, but the degree to which the principles are carried out in practice is often imperfect. In the case of the WHO, multiple terminology systems were assessed and the two best systems were selected for the term set (Wiseman’s and Xie’s). Many meetings in several nations were held to discuss the term lists and the translation choices, but at the end of the day the members voted on the terms one by one. This is a good thing from the perspective of democracy, but it makes it nearly impossible to have a system that has high internal consistency. List A and List B have different fundamental strategies and methodologies, so a hybrid list mixes the methodologies together and loses the clarity that a single approach would offer. In particular, the excellent theory of having a dual list that preserved traditional terms while offering biomedical alternatives was endorsed but didn’t make the final cut. To a certain extent, the hybrid list is a necessary political evil because politics invariably involve compromise. Complicating the issue, voting members are often important political figures that don’t consistently have mastery in both English and traditional medicine.

The WFCMS term list suffers from a similar problem. By giving everyone an equal vote, many of the people who are true experts in TCM English have their votes diluted by people that are politically connected but not necessarily qualified to judge terminology. The term list draws from many sources and there is no final native English-speaking executive editor who has the power to change the terms. Most of the members are Chinese doctors with imperfect English language abilities, and the native English speakers are outnumbered to the point that the term list lacks the vital proofreading that is necessary to have the list adopted by native speakers. Invariably, the term list is huge and the funding and time allotted is limited, so the whole committee is never assembled in a way that systematically evaluates each and every term. At the end of the day, many great scholars have come together and a great foundation is laid, but the final result will never have the impact that it deserves because it comes out looking like Chinglish.

I happen to be a Vice Chair of the WFCMS’ terminology committee and I could easily fix up the list to make it native English quality, but the structure of the group doesn’t allow an empowered gringo final editor to make executive decisions on all the problematic terms. Fixing the list would require a native speaker to trump the decisions of the committee and change 70% of the terms, and it wouldn’t be politically acceptable for one person to have that much executive authority. In China, the population density is high and it is hard to put one individual in a position of that much power over the group. At the end of the day, it ends up being more politically acceptable to let the group publish a standard that no one will use than it would be to try to take the reins and transform the list into a standard that really works with a unilateral, strong-handed effort.

Ah, politics…