By Micah Arsham
This essay grew out of a series of online discussions that were part of Medical Chinese classes offered at PCOM. The discussion forums centered on translation issues facing contemporary scholars and were led by Robert Damone and Sonya Boynton-Pritzker.
At the Pacific Symposium 2008 in San Diego, publisher and translator Bob Flaws remarked that, ‘it has yet to be seen if Chinese medicine has a future in this country.’ As part of the first generation of Americans to practice and teach Chinese medicine, Flaws gave one piece of advice to today’s students—learn Chinese. Specifically, one must know medical Chinese to access not only primary sources but also a specific way of conceptualizing the practice of medicine. There is a glass ceiling to learning entirely from secondary sources, yet many students never read a primary text in their preparation for licensure. Are students missing something critical? If the unique nature of Chinese medicine is grounded in language, then our relationship to and understanding of Chinese medical terms has direct clinical importance. The language of Chinese medicine draws upon poetic imagery and metaphor to form a technical jargon. Is literary analysis, therefore, a tenable way to seek clinical truth? How much Chinese, if any, does one need to know to practice Chinese medicine well? Does it help the clinical decision-making process to have a deep knowledge of the etymology and history of terms? Do better translations of Chinese and other East Asian texts yield better clinicians?
It is easy to have a perfunctory knowledge of Chinese medical terms, and it is also easy to misinterpret them. As a student accumulates conceptual understanding, the process depends on the language used to define terms. Some terms are more accessible than others. For instance, “jumping-round phlegm” is actually tuberculosis of the hip joint, but without looking it up or realizing the connection with GB-30 (Jumping Circle), one might misconceive the meaning. Often, we define terms only in English and do not reference the characters and/or pinyin. Translator Eric Brand has written about this phenomenon and the misunderstandings that ensue from an inaccurate and incomplete grasp of Chinese medical concepts: “[a]fter a generation or two of Western practice, some translation errors have come to be accepted as normal, and this leads to poor concept acquisition in a new generation of students.” Despite learning terms in translation and looking them up in A Practical Dictionary of Chinese Medicine, many concepts remain ambiguous or obscure. Part of this problem is the lack of consistency in translation that is the basis for Nigel Wiseman and Paul Zmiewski’s call for term standardization, without which the student “will be completely at sea” (55). However, it seems less important to standardize the terms than to engage with them. In scholarly works, translators often put the original term in parenthesis after a translated term, especially if the term is unusual or technical. In this way, the author’s original word is immediately clear to the reader, without the intervention of the translator. Our textbooks should increase our knowledge of Chinese language, not assume that we have none. We need familiarity with Chinese terms themselves, not merely consistent translations. Standardization of terms, i.e. the codification of a technical language, is less about being dogmatic or overly academic than it is about raising the level at which we engage terminology.
There is tension today in how we speak about Chinese medicine among ourselves. This tension is ultimately a good thing, for it raises questions and urges us to be careful with language. More of a question is how best to speak about Chinese medicine with Western medical professionals and layperson audiences, such as our patients. The push for standardization is really a way to say, ‘wake up, understand these terms, it’s not as easy as you think….’ For this reason, Wiseman deliberately selects anachronistic and unusual terms to draw attention to the fact that Chinese medical language is a technical language. Wiseman elaborates that “[i]nsistence on the use of familiar expression as far as possible creates the impression that Chinese medicine is conceptually more familiar than it actually is” (“Not Just Words,” 8). An accurate, detailed, and habitual way to talk about Chinese medicine is needed. It is about getting the concepts right and knowing what words mean, in a technical and historical context. Is not Chinese medical terminology farther outside our ken than Western medical terminology?
Indeed, our conceptual understanding of terms often overlooks historical associations, ideological resonances, and affinities with certain doctors. This is the danger of textbooks that summarize and generalize information (let alone the study guides to which many students resort as a quick source of information). When we learn entirely from English sources, we often do not know when a concept or phrase is meant to evoke a specific author or school of thought. Thus, Wiseman and Zmiewski note that when a Chinese student reads, “han4 chu1 ji2 ji2 ran2” (“a constant stream of sweat”), this refers to a particular section of the Shang Han Lun (Treatise on Cold Damage) (60). American students miss the allusion, for even if they think ‘big sweat, part of the four bigs,’ it is fundamentally different from knowing a line from the Shang Han Lun.
Similarly, the verbs used to explain physiological and pathological dynamics, as well as language describing treatment methods, are poorly and inconsistently translated. This leaves the student unsure of what words to use to talk about certain things. The language of pathomechanism relies on specific ways of expression for its authenticity. Without getting the vocabulary right, students may feel like they are making it up as they go along. Wiseman and Zmiewski call this category of words “conditionally stipulated terms,” and quantifies it as about two hundred ideograms (60). For instance, Wiseman and Feng differentiate various words to describe the effect of heat in the body; each has a distinct meaning. ‘Deflagrate’ (fen2) means to “burn fiercely; describes heat in the exuberant heat stage of warm disease” (121). ‘Deflagrate’ should be contrasted against kindred terms that describe the actions of heat in the body: ‘blaze’ (fan2), indicates the qi and construction levels are ‘both ablaze;’ ‘effulgent’ (wang4), refers to burning brightly (as in yin-vacuity fire); ‘stream’ (zheng1), is a gentle rising, as in steaming bone disease; ‘flame upward’ (shang4 yan2), produces upper body signs, as in liver fire flaming upward; ‘scorch’ (zhuo2), means to damage slightly by burning, as in the network vessels of the lung; and ‘condense’ (lian4), in which heat reduces fluids and produces phlegm. The non-Chinese student may not grasp these conceptual differences and so has less knowledge as a result. However, differentiating these terms is not merely an academic luxury. How much linguistic carelessness can we afford when prescribing Chinese pharmaceuticals? What we do in the clinic follows from our understanding of concepts, an understanding that is rooted in language.
Although A Practical Dictionary of Chinese Medicine is a good start, much more scholarship is needed to trace the changes in medical concepts over time and through different regions of East Asia. Many times, historical usage lends nuance and connotation to language. Accordingly, language is the entry into understanding the thought process of another culture; the Chinese view of health and disease is inseparable from its description in language. Thus ethnographer Yanhua Zhang points out that understanding emotional disease (qingzhi) in contemporary Chinese medicine “is not ‘culturally bound,’ but certainly is ‘permeated with culture’” (1). What constitutes disease is tied to our cultural perceptions of disease, as they are expressed in language. In the West, we need to unfold terms and concepts as they are written about in primary sources. This is how we deepen our understanding of terms and bring this insight into a clinical setting. If we do not engage with these texts, we are creating something new—something that is not Chinese medicine but rather our interpretation of it.
METAPHOR AND SYMBOLISM: CLINICAL APPLICATIONS OF LITERARY CRITICISM
Chinese medical texts can be viewed as literary works: there are poems and songs to describe pulse images; many herbs have folk legends surrounding them; the body is viewed variously as a kingdom, a natural landscape, a society. How we speak of Chinese medicine really does matter: will we learn point names, not just their number? The Chinese view of anatomy traditionally describes body parts and relationships among them in an especially poetic way. Thus, the lung is a “florid canopy” and the intestinal tract contains the “dark gate” and “screen gate.” Structures like the gao huang, san jiao (triple burner), and mo yuan (membrane source) have no Western biomedical equivalent, and where we do draw strict parallels between Western anatomy and the Chinese view of the body, we lose part of the Chinese concept. Viewing the body in terms of yin and yang is finally a literary conceit. In this way, the raw power of Chinese medicine comes from a poetic view of the body and of disease processes.
In Chinese medicine, the basis of clinical application depends not only on empirical knowledge but also on conceptual deduction. Theory forms the basis of diagnosis and treatment. The examples of using the conceptual framework of Chinese medical theory to justify clinical decisions are manifold. For instance, Chinese Herbal Medicine: Formulas and Strategies cites the Convenient Reader of Established Formulas (1904), in which Zhang Bin-Cheng posits a Song-dynasty physician’s opinion that Ding Zhi Wan (Settle the Emotions Pill) treats near-sightedness:
“[The eyes] ability to see [what is] distant depends on their having fire. If one cannot see [what is] distant, this is due to lack of fire. The appropriate strategy is to tonify the Heart…. Even though the eyes are the orifices of the Liver, the Heart, too, attaches itself to the eyes. How is this? When the eyes perceive the characteristic quality [of something] and judge it to be good or bad, this [type of] complete knowing comes from the heart. Therefore, when the Heart lack the power to perceive distant [things], how can one cure this by way of a strategy [aimed at] enriching water and softening the Liver?” (467)
According to the above passage, the sovereign fire of the heart is finally responsible for vision, and to improve eyesight Ding Zhi Wan (Settle the Emotions Pill) may be given. In this way, the correct interpretation of a text justifies a formula’s clinical application. If we don’t get the words right due to translation errors or poor conceptual understanding, how can we explain certain applications of formulas? If literary theory is a way to approach clinical fact, being sensitive to language is absolutely necessary. Translators must take care to preserve what Wiseman calls the ‘cognitive aesthetic’ of a given text by staying close to the source.
WHAT IS GOOD TRANSLATION?
Translation is an act, a force—it is matching one’s creativity against a text and trying to convey the essence of the original in another language. Cultural theorist Walter Benjamin (1892-1940) observes that there is always distance between the original and the translation: “While content and language form a certain unity in the original, like a fruit and its skin, the language of the translation envelops its content like a royal robe with ample folds” (Illuminations, 75). While translation is always a difficult project, the ‘royal robe’ of which Benjamin writes need not fit quite so loosely, to the point of unknowingly sacrificing our own conceptual understanding of Chinese medical terms. Translating Chinese medical literature is especially challenging, and many primary sources, both historical and modern, remain un-translated. Translations should be more widely funded, and we should value the position of Chinese medicine halfway between literature and science. It is not only through scientific inquiry but also through literary explication that the future of Chinese medicine can develop. Only then will we recognize and benefit from the unique value of Chinese medicine—a value that comes from a conceptual framework inextricable from the words used to describe it.
Benjamin, Walter. “The Task of the Translator.” Illuminations. Schocken: NY, 1969.
Brand, Eric. “Clinical Implications of Accurate Translation: Will (Zhi) and the Kidney, Sinews and the Liver.” Blue Poppy Blog, June 18th, 2009. http://www.bluepoppy.com/blog/blogs/blog1.php/2009/06/18/clinical-implications-of-accurate-transl#more167
Scheid, Volker, et al., comp. and trans. Chinese Herbal Medicine: Formulas and Strategies. 2nd ed. Eastland: Seattle, 2009.
Wiseman, Nigel and Paul Zmiewski. “Rectifying the Names: Suggestions for Standardizing Chinese Medical Terminology.” Approaches to Traditional Chinese Medical Literature: Proceeding of an International Symposium on Translation Methodologies and Terminologies. Ed. Paul Unschuld. Kuwer: Dordrecht, 1989.
Wiseman, Nigel and Feng Ye. A Practical Dictionary of Chinese Medicine. 2nd ed. Paradigm: Brookline, 1998.
Wiseman, Nigel. “The Transmission and Reception of Chinese Medicine: Language, the Neglected Key.” Clinical Acupuncture and Oriental Medicine 2: 29-36. http://www.paradigm-pubs.com/WisemanWork
Wiseman, Nigel. “Translation of Chinese Medical Terms: Not Just a Matter of Words.” Paradigm: 2001. Accessed online: http://www.paradigm-pubs.com/WisemanWork
Zhang, Yanhua. Transforming Emotions with Chinese Medicine: An Ethnographic Account from Contemporary China. SUNY: NY, 2007.
Micah Arsham attends the M.S.T.O.M. program at the San Diego campus. She holds a B.A. in dance from Columbia University and has studied German literature at Princeton University and the Freie Universität Berlin.