The history of Chinese medicine in America has been a checkered one. The first students in American acupuncture schools, basically a handful of '60s idealists (myself included), were educated with a handful of acupuncture texts translated from modern Chinese textbooks.Each text had its own translation scheme: with few exceptions, there was confusion regarding biomedical terminology with Chinese medical terms. That confusion in transmission of the basic concepts of Chinese medicine continued as new texts appeared. Few Westerners had the Chinese language skills to figure out the original meanings of classical texts. The few books that were available became a de facto standard, as a majority of students were unaware of the vast amount of material in Chinese, limiting access to the resources necessary to comprehend and practice a literate medical tradition.
I have been teaching Chinese herbal medicine and internal medicine for the past 11 years. In that time, I have seen the English literature increase in quality and availability. The majority of our profession, however, still does not comprehend the importance of access to a standard technical terminology of Chinese medicine. The translation methods of many authors vary greatly, and are rarely explained adequately through a comprehensive glossary. This causes confusion among students and practitioners alike, because of the difficulty in communicating basic concepts of our field in an understandable way.
Nowhere is this more obvious than with pulse diagnosis, in which the combination of different translations of technical terms, oversimplification and overlapping definitions makes it impossible to convey what a Chinese technical term for a pulse quality implies. For example, many students and practitioners constantly confuse "tight" and "wiry" pulses. Each of these pulses, xian mai (wiry or string-like) and jin mai (tight), have distinguishing qualities and diagnostic indications. A wiry/string-like pulse indicates a quality of liver or gall bladder disorders, pain, or yin/rheum patterns. It can be replete, forceful, or thin and vacuous, especially in cases of yin or blood vacuity. A tight pulse, in contrast, is always replete and forceful, and is associated with coldness, pain or a replete constitution.
Before A Practical Dictionary of Chinese Medicine became available, it was difficult to gain a clear differentiation of these two pulses in the English language. This information is essential for the practice of Chinese medicine. Clearly, we can no longer ignore the need for clear terminologies and glossaries of technical definitions when, after all, Chinese medicine is a technical profession.
The lack of a standard technical language for Chinese medicine weakens communication between different schools of practice within our tradition, and makes it difficult, if not impossible, to communicate clinical data between Chinese medical practitioners. This also makes it difficult to communicate clearly with other health professionals. If we cannot share accurate clinical data or diagnostic information, how can we develop journals, clinical trials and intellectual discourses? Without a practical standard based on terminological precision, a practitioner has nothing to fall back on to describe what they are doing clinically.
The present strategy is to rely on biomedical disease definitions, and even testing, because there has been no criteria on which to judge pulse, palpation and questioning diagnoses that all practitioners can refer to. This only dilutes the intellectual integrity of our medicine and weakens our ability to evolve into an independent profession. If this trend continues, the technology of acupuncture and herbal medicine may survive, but not the Chinese medical tradition on which it is based.
There are also problems in testing procedures and licensing exams. Licensing bodies and schools have to rely arbitrarily on specific texts for standard testing, limiting school programs to a more narrow perspective. Fortunately, the more superior colleges of TCM have evolved past an "exam mill" perspective: perhaps licensing boards will evolve as well.
The problem of technical language also affects native-speaking Chinese and Japanese practitioners and students. Without a reference standard for translation that refers directly to pinyin and Chinese characters, native-speaking Chinese and Japanese will find it difficult to comprehend Chinese medicine in English.
The most significant event in the development of our profession, so far, has to be the publication of A Practical Dictionary of Chinese Medicine compiled by Nigel Wiseman and Feng Ye. It has the most complete reference to technical Chinese medical terms in English, with direct reference to pinyin and Chinese (simplified) characters. This information has been largely unavailable in the English language up to this point. I can safely say that this is the most important Chinese medical text in the English language. Besides being a lexicon, it is also a database of information largely unavailable elsewhere. As long as any text has the pinyin or Chinese characters, one can find a definition in English of that term. In addition, the detail of terminology necessary to practice a professional medicine is intact, with no glossing or shortcuts.
At Pacific College, we are currently debating the issue of adapting a standardized translation and terminology. There have been complaints from various writers, teachers and practitioners in the profession about some of the terminology choices. I do not personally think this is the issue. A translator or author is free to use whatever English equivalent one chooses. Equally, that choice should be available to the reader, either through access to the character or pinyin, and the choice should be explained in a glossary or footnote.
The issue of translation cannot be avoided or glossed over. The writer cannot simply assume that this issue is not important. Our profession is crippled by its inability to communicate with the ease and fluidity of native Chinese readers and speakers. If each English text has a different translation protocol, how can we ever establish databases of clinical data from Western practitioners, or a coherent, independent primary health care profession?
- Wiseman N, Feng Y. A Practical Dictionary of Chinese Medicine. Brookline, MA: Paradigm Press, 1999, p. 472.
Z'ev Rosenberg has lectured widely both to the public and to students of both Chinese medicine and macrobiotics over the last thirty years. He is the former president of the Acupuncture Association of Colorado (AAC), where he spearheaded a successful drive to register acupuncture practitioners in that state. He also has written several articles for professional Chinese medical journals, including Oriental Medicine, Protocol Journal of Botanical Medicine, Journal of Oriental Medicine in America, Journal of Chinese Medicine, and most recently The Lantern Journal. He presently continues to teach and chair the Herbal Medicine department at Pacific College of Oriental Medicine, San Diego, and has had a private practice in Chinese medicine since 1983.