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Review
A history of standardization in the English
translation of traditional Chinese medicine
terminology
Xiao Ye1,2, Hong-xia Zhang3,4
1. College of Humanities and Social Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
2. Confucius Institute, University of Coimbra, Coimbra 3004-530, Portugal
3. College of Humanities and Social Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, China
4. Faculty of Education, East China Normal University, Shanghai 200062, China
ABSTRACT
In order to facilitate and propose further international standardization of traditional Chinese medicine (TCM)
terminology, this article applies methods of historiography, philology and descriptive study to divide the history
of TCM into three phases, based on representative experts and social events; to illustrate different aspects
of these experts and their translation principles and standards and to discuss associated factors and inherent
problems. The authors find that the development of a terminology standard for TCM has generally progressed
from early approaches that were ill-suited to the contemporary needs to culturally and professionally
referenced approaches, from uncoordinated research to systematic studies, and from individual works to
collaborative endeavors. The present international standards of TCM terminology have been attained through
the work of numerous scholars and experts in the history of the field. The authors are optimistic that a more
comprehensive and recognized standard will come out soon.
Keywords: standardization; terminology; English translation; history; medicine, Chinese traditional
Citation: Ye X, Zhang HX. A history of standardization in the English translation of traditional Chinese medicine
terminology. J Integr Med. 2017; 15(5): 344–350.
1 Introduction
In the last few decades, traditional Chinese medicine
(TCM) has spread quickly in parts of the world that share
English as a common language. It has been fully or partly
accepted in many Western countries and more countries
are considering its regulation and inclusion in the medical
care system. However, TCM originates from China and
its source language is Chinese and even ancient Chinese.
TCM learners can easily find that a single TCM term
may have many translations in common use, and the
literature—including inappropriately translated ones. This
causes confusion in academic study, clinical research,
and all forms of communication. In order to solve this
problem, linguists and medical experts working around
the world, individually, and in groups, have sought to
establish a standardized English version of the TCM
terminology. This work has pursued for decades and some
progress has been made. However, to date, there is no
unanimously recognized international standard translation.
A general illustration of this history may be helpful
to contextualize the mistakes that we have made, the
experiences that we have accumulated and the problems
that we still must solve.
http://dx.doi.org/10.1016/S2095-4964(17)60357-1
Received March 27, 2017; accepted May 8, 2017.
Correspondence: Hong-xia Zhang, Associate Prof.; E-mail: evezhanghx@sina.com
September 2017, Vol. 15, No. 5
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2 History review
2.1 1960s and 1970s
The transfer of Chinese medicine across Western
countries has been intermittent for hundreds of years.
Some books of Chinese medicine were translated to
or written in Western languages during this period, but
according to the literature that has been found, it was not
until the 1960s that some scholars noticed the lack of
standardization in the translation of TCM terminology and
tried to establish such a standard by themselves.
2.1.1 Manfred B. Porkert
Manfred Porkert, born in 1933 in the Czech Republic,
had received his Ph.D. degree in Chinese studies at the
Paris Sorbonne in 1957. He is now an emeritus professor
of Munich University, Germany. He praised Chinese
medicine as a modern and future medicine, a mature
science and a genuine life science.[1] He was perhaps the
first author to cogently discuss terminology and the need
for precision and consistency in the translation of TCM.[2]
He endeavored to establish a standardized and practical
terminology system of Chinese medicine by solely using
Latin words. This was reflected in a number of papers,
written in German, which were published between 1961
and 1965,[3] and also in many of his important works, such
as The Theoretical Foundations of Chinese Medicine and
The Essentials of Chinese Diagnostics, both of which
were published in English in 1974.
Although his standardized terminology system may
be accurate in expressing the meanings, the terms
he translated were very difficult to read, recognize,
remember and popularize, because the contemporary
use of Latin has been greatly different to the situation in
the 17th century.[4] As a result, his books and terminology
system were very difficult to understand; this difficulty
extended to its application in teaching, research and
communication, especially for Chinese practitioners. His
terminology system was thus not adopted.
2.1.2 Joseph Needham
Joseph Needham, born in 1900 in England, was a
scientist, historian and sinologist. He was a member of
British Royal Society and worked in the University of
Cambridge. His greatest contribution to mankind is his
study on the science and technology of China, which
is mainly recorded in a series of monographs, called
the Science and Civilization in China Series, published
by Cambridge University Press since 1954. This work
includes considerable attention to Chinese medical history.
His other great work on Chinese medicine is Celestial
Lancets: A History and Rationale of Acupuncture and
Moxa, published in 1980. He also perceived the problem
of translating TCM terms and discussed strategies toward
its resolution. He did not agree with Manfred B. Porkert’s
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method and said, “He pursed a line rather different from
that which we would still prefer to adopt. He has largely
gone over direct[ly] to Latin.”[3] Instead, Needham tried
to create a vocabulary based on semantic roots that would
be well understood by Western readers, and invented
many new terms based on Greek and Latin roots. Aside
from this main strategy, he used a more flexible approach.
For example, he opposed transliteration, but adopted it
for some untranslatable terms, such as Tao, Yin, Yang
and especially qi, which was previously translated as
“energy”. He thought literal translation was inappropriate
for expressing the message and prevented readers
from understanding, but he used it when the semantic
connotation was clear, such as the heart, liver, lung, spleen
and kidney for respective terms in Chinese medicine.[5]
His strategy of standardization had great impact on
some future scholars and continued to be a frequent topic
of discussion among experts and translators through the
beginning of the 21st century.
Though Manfred B. Porkert and Joseph Needham
applied different strategies to the standardization of TCM
terms, their approaches were largely confined to the use of
Latin words or Latin and Greek roots, which was probably
influenced by their traditional use in Western science and
medicine. However, both of their strategies generated new
and difficult words for modern readers. Moreover, over
time, the familiarity with classical languages has faded,
and fewer people can comfortably read and understand the
words generated in these classically inspired translation
systems. Although they failed to establish a standardized
terminology system, these first efforts provided an
invaluable experience and established a need for a
standardized English translation of TCM terms.
2.2 1980s and 1990s
In 1972, American president Richard Milhous Nixon
visited China. During the trip, the use of acupuncture for
pain control was reported in the New York Times, arousing
a fever for learning TCM across the Western world.
At the beginning, many Westerners went to Southeast
Asia, China (Hong Kong and Taiwan) and Japan to learn
acupuncture. After the Cultural Revolution in China
(1966–1976), Westerners started to learn acupuncture
directly in mainland China, and could obtain a World
Health Organization (WHO) training certificate. With its
rapid expansion, and widely ranging primary sources, to
have one standard English version of TCM terminology
seemed much more urgent and a few standards emerged,
and were broadly adopted. In addition, scholars from
China began to participate in this effort.
2.2.1 Ou Ming
Though many Chinese-English dictionaries of Chinese
medicine were published in this period in China, Ou Ming
was perhaps the first Chinese author to comprehensively
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discuss the principles and methods behind establishing a
standardized English translation of TCM terms. He was
born in 1924 in China and was a lifetime professor of
TCM at Guangzhou University. From 1978 to 1986, he
and his team compiled two dictionaries, namely ChineseEnglish Glossary of Common Terms in Traditional
Chinese Medicine and Chinese-English Dictionary of
Traditional Chinese Medicine. Meanwhile, he proposed
a combined application of transliteration, free translation
and semi-transliteration with semi-free translation for
TCM terms. The sphere of their application was illustrated
and examples were given.[6] He also discussed the English
translation for many common and special terms through a
series of papers.
His exploration of the English translation of TCM
terminology laid a solid foundation for future translation
practice and standardization, becoming a source of
translation practice of TCM in China. [7] However, his
translation principles and methods were at a fundamental
stage. His dictionaries did not attract attention from
outside China and like other such dictionaries in China at
that time, their influence was generally regional.
2.2.2 Standard Acupuncture Nomenclature by WHO
With a view to achieving global agreement on a
Standard Acupuncture Nomenclature, the World Health
Organization Regional Office for the Western Pacific
sponsored four regional meetings in Manila, Tokyo,
Hong Kong and Seoul, respectively, from 1982 to 1987.
After basic agreement at the regional level, a scientific
group tasked with adopting a Standard International
Acupuncture Nomenclature was held in Geneva in
October–November 1989. [8] With cooperative efforts
from experts around the world, two editions of Standard
Acupuncture Nomenclature were published, one in 1984
and another in 1993.
Under full implementation by WHO, this international
acupuncture standard spread widely and most of its
standardized terms were adopted across the world.
Undoubtedly, it contributed greatly to the transmission
and communication of acupuncture in the world.
However, this standard is limited to the names of channels
and acupoints, which represent a very small fraction
of the total TCM terminology. Moreover, the English
words already used for some words in established
practice were different from the new the standard, and
in the years following the adoption of WHO standards,
some renowned experts opposed its way of translating
acupoints, the main part of the standard.
2.2.3 Xie Zhu-fan
Xie Zhu-fan, born in 1924 in China, studied Western
medicine at the beginning of his medical education,
and Chinese medicine later. He is now the honorary
director of the Institute of Combing Chinese and Western
September 2017, Vol. 15, No. 5
Medicines in Beijing. In 1980, Xie compiled a ChineseEnglish Dictionary of TCM Vocabulary that was mainly
used inside in the Peking University. Later in 1994,
he compiled Chinese-English Classified Dictionary of
TCM, based on the previous edition, though the English
translation for some terms had been changed. A previous
director of State Administration of TCM in China wished
in the book’s preface that “… the English terms of this
dictionary can be further improved through practice and
gradually become a well-recognized English standard of
TCM terminology.”[9] This implies his terminology system
was approved by some government institutes.
His most significant feature was his advocacy for the
wide use of modern medical terms to translate TCM,
as he thought it was more convenient for medical
communication. At the same time, he opposed literal
translation as he thought TCM terms should not be
regarded as a combination of individual Chinese
characters. His opinions aroused many debates with Nigel
Wiseman in a series of papers.
2.2.4 Nigel Wiseman
Nigel Wiseman, born in 1954 in the United Kingdom,
is a well-known linguist and speaks many languages,
including Spanish, German and Chinese. He holds a
doctorate in Complementary Health from the University
of Exeter. In 1981, he moved to Taiwan. He has taught
English and subjects related to Chinese medicine at
China Medical University and Chang Gung University
in Taiwan. With respect to English translation of TCM
terminology, he compiled a wildly used dictionary
entitled A Practical Dictionary of Chinese Medicine,
which was first published by Paradigm Publications in
1994 and later the second edition in 1998, as well as two
editions in China. His dictionary covers a wide range of
Chinese medicine and this terminology system has been
adopted as the English standard by two of America’s
largest publishers of Chinese medicine, namely Paradigm
Publications and Blue Poppy Press. [10] He mainly
advocated literal translation, used common language
equivalents, opposed applying Western medical terms and
Latin words except medicinal names, and coined some
new words and terms from common English. Meanwhile,
since 1993, he has published a series of papers in journals
or on websites, including discussion of the importance
of the translated language for Chinese medicine, the
translation methodology and theory, the extralinguistic
factors of TCM translation and debates with other experts
of terminology translation.
As the first most comprehensive, systemic and
meticulous standardized terminology system, his
dictionary and translation theory have attracted great
attention and enjoyed wide application around the world,
especially in English-speaking countries. However, his
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approaches to translation of terminology are disapproved
of by some experts and his terminology system is not yet
officially recognized as an international standard.
2.2.5 Li Zhao-guo
Li Zhao-guo, born in 1961 in China, has a Master’s
degree in applied linguistics and earned a Ph.D. in
ancient Chinese culture and its translation from Shanghai
University of TCM. He is the leading figure of TCM
translation in China. Since 1991, he has published
more than a hundred papers on the English translation
of Chinese medicine in China. He has also published
dozens of other works on TCM translation. In 1996, his
Skills of English Translation of TCM was published by
People’s Medical Publishing House, which is the first
systemic theoretical work of TCM translation in China.
In this book, he illustrated the translation principles and
methods for the TCM terminology. He was influenced
by Needham’s translation method and initially advocated
new words being coined by Latin or Greek roots at the
beginning, though that approach was quickly abandoned.
He has published many Chinese-English dictionaries of
TCM terminology as well. The earliest one was published
by World Publishing Corporation in 1997, in which five
principles of English translation of TCM terminology
were put forward, namely to be natural, concise, nationally
featured, back-translatable and prescriptive.
He exerts great influence in the field of TCM translation
in China and has played an important role in the
establishment of many national and international standards
of TCM terminology. The terminology system used in
his dictionaries has not garnered much attention from the
world outside of China, but it has served as a reference for
future international standards.
This is a period full of individual ideas and debates. At
least twenty English dictionaries of TCM terminology
were published by different authors in China, but none
of them exerted wide influence within China, let alone
internationally. Wiseman’s Dictionary was widely used
in many countries, but it was still not recognized as an
international standard, and debates over its suitability were
voiced in the 21st century. Even the Standard Acupuncture
Nomenclature, advocated by WHO, encountered great
resistance in its method of translating many terms
and acupoints. However, these dictionaries, the WHO
acupuncture standard and translation theories paved a way
to more mature standards of TCM terminology.
2.3 Proposed standards of the early 2000’s
Chinese medicine has become more widely and deeply
accepted and applied around the world in the 21st century.
In 2002, the WHO published its strategy for traditional
medicine, repeatedly citing “TCM” as an example. It also
suggested 28 diseases, symptoms or conditions for which
acupuncture has been proven—through controlled trials—
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to be an effective treatment.[11] Hence, more international
organizations became interested in setting up a standard
for TCM terminology. On the other hand, recognizing the
importance of international standards and with powerful
national politics, a booming economy and strong culture
in China, the Chinese government was eager to join the
debate.
2.3.1 English Translation of Common Terms in
Traditional Chinese Medicine by State Administration
of Traditional Chinese Medicine
Initiated in 2000, Xie Zhu-fan and his team undertook
a research program on the standardization of English
translation of TCM terminology, which was sponsored by
the State Administration of Traditional Chinese Medicine
in China. Its achievements were first seen in Newly
Compiled Chinese-English Classified Dictionary of TCM,
published by Foreign Languages Press in 2002, and later
in English Translation of Common Terms in Traditional
Chinese Medicine, published by the China Press of
Traditional Chinese Medicine in 2004. The latter was an
outcome of analysis and comparison of previous works
based on scientific, accurate, practical and acceptable
principles. [12] This dictionary was recommended for
wide use in China and used as the reference material for
international standards afterwards.
2.3.2 Chinese Terms in Traditional Chinese Medicine
and Pharmacy by China National Committee for Terms
in Sciences and Technologies
In 2000, the Committee for Terms in TCM, as an
offshoot of the China National Committee for Terms
in Sciences and Technologies, was established. In the
same year, the Committee undertook a research program
on the Standardization of Fundamental Terms of TCM
sponsored by the Ministry of Science and Technology
of the People’s Republic of China. It established many
documents and regulations for the standardization of
both Chinese and English TCM terms. After tremendous
work, the major achievement was Chinese Terms in
Traditional Chinese Medicine and Pharmacy published
by Science Press in 2004. It proposed five translation
principles, namely to be equivalent, concise, unanimous,
back-translatable and prescriptive. It applied free
translation in the first place, literal translation in the
second and tried to limit transliteration. This standard
was used as reference material for international standards
afterwards.
2.3.3 WHO International Standard Terminologies on
Traditional Medicine in the Western Pacific Region by
WHO in the Western Pacific Region
In 2004, recognizing that the main role of standards
is for maintaining levels of quality, safety, reliability,
efficiency and interchangeability, which are the most
needed features in traditional medicine, WHO in the
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Western Pacific Region (WHO-WPRO) initiated projects
promoting the proper use of traditional medicine under
the theme of “standardization with evidence-based
approaches.” Among the various standards in traditional
medicine, such as acupuncture point locations, information
and clinical practice, the development of an international
standard terminology was regarded as the very first step
towards overall standardization of traditional medicine.
It convened three meetings for developing international
standard terminology on traditional medicine in Beijing,
China in October 2004; Tokyo, Japan in June 2005;
and Daegu, Republic of Korea in October 2005. These
meetings yielded successful outcomes, as shown in the
WHO International Standard Terminologies on Traditional
Medicine in the Western Pacific Region, published online
in 2007.[13] In this standard, the translation principles are
accurate reflections of the original concept of Chinese
terms, with no creation of new English words, avoidance
of Pinyin (Romanized Chinese) and consistency with
WHO’s Standard Acupuncture Nomenclature. The
terminology standard was intended to be revised every
3 to 5 years. It implied a new step of international
cooperation in the standardization of TCM terminology.
2.3.4 International Standard Chinese-English
Basic Nomenclature of Chinese Medicine by World
Federation of Chinese Medicine Societies
The World Federation of Chinese Medicine Societies
(WFCMS) is an international academic organization
authorized by the State Council of China. Since its
establishment in 2003, it had been devoted to the work
of international standardization of Chinese medicine.
It studied various materials all around the world and
completed a draft in 2006. At the end of 2007, it
announced its completion of International Standard
Chinese-English Basic Nomenclature of Chinese
Medicine, which was formally published in 2008 by the
People’s Health Publishing House. This work was mainly
sponsored by the State Administration of Traditional
Chinese Medicine in China. In the course of compiling
this standard, WFCMS tried in many ways to comply with
the terminology system proposed by the WHO-WPRO.
More than 200 experts from 68 countries and regions took
part in its deliberations. It was recommended for use to its
174 member organizations, from 55 countries, and would
be revised every five years.[14]
The principles governing this standard stipulated that
translations were to be equivalent, concise, unanimous and
prescriptive. Major publications in China have adopted
this standard. In 2013, its second edition was announced,
which included definitions for each term both in Chinese
and English.
Along the course of establishing terminology standards,
hundreds of research papers concerning this topic were
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published worldwide, especially in China. The topics
cover a wide range from macroscopic to microscopic,
such as the terminology translation guidelines, principles,
problems and according strategies, reviews, methods,
comparisons, comments, living examples, linguistic
features and teaching.[15] They enriched the discussion
of terminology standardization in TCM, but, as they
represent the opinions of many different people applying
different perspective and theories, they fail to arrive
at consensus. With the participation of the Chinese
government and international organizations, the work of
standardization of TCM terminology has become more
and more organized and cooperative among experts
around the world. In 2008, WHO decided to develop the
11th International Classication of Diseases, in which
traditional medicine would be included as a chapter. The
major discussion in the traditional medicine section is
Chinese medicine, and international terminology standards
by WHO-WPRO and WFCMS were taken into great
consideration.[16] In 2009, International Standardization
Organization (ISO) established a new committee for the
international standard of Chinese medicine. With regard
to the terminology standard, the terminology system by
WFCMS had officially been submitted to ISO/TC 249 in
2013.[17] Especially in 2016, the terminology standard of
Chinese Materia Medica had been promoted by the ISO/
TC 249 to the stage of draft international standard.[18]
3 Discussion
The above history review shows us that the standardization
of English translation for TCM terminology is moving
toward a more and more unanimous, international and
open standard that could be revised about every five years.
Its journey has progressed from early approaches that
were ill-suited to the contemporary needs to culturally and
professionally referenced approaches, from uncoordinated
research to systematic studies, and from individual
works to collaborative endeavors. We can also see that
the successful establishment of such standards is closely
related to the gradual acceptance of TCM in the world
and the development of China’s international influence. If
official organizations had participated earlier and worked
together more cooperatively, some debates and repeated
work could have been avoided, thus saving human
resources, money and time. Though it is possible that
a unanimous open standard may be agreed upon in the
coming years, there are still some problems we must keep
in mind.
The first problem is to what extend such standards
should be applied. There has been strong opposition
to the standardization of TCM terminology by many
well-known experts in Chinese medicine. For example,
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Benskey argued that any form of standardization
betrays the multiple meanings inherent in most Chinese
medical terms—a richness that has developed over 2 000
years of use by different scholars in different contexts.
The rigid application of the principle of one to one
correspondence in translating Chinese terms into English
easily oversimplifies Chinese medial ideas. Because of
the cultural and linguistic divide between China and the
West, completely accurate translation is impossible; a
multiplicity of terms creates a “terminological chaos” that
actually benefits students as they learn to negotiate the
depths of Chinese medical concepts.[19] Giovanni Maciocia
believed the most important thing for clinical practitioners
was not how to express the language of TCM, but was the
clinical experience. The translation of TCM terminology
should focus on the interpretation of the connotation in
context rather than debates on the translation of literal
terms. Different ways of translation could enrich the
understanding of Chinese medicine. [20] Hence, even
with such standards, we should not apply them blindly
in every situation. One appropriate way may be that for
publications and scientific research, it is compulsory to
use standard translations; for classroom teaching, teachers
should use standard terms at the most extend, but can
also use alternative translations to enrich discussion with
students; and for communication with patients, the use of
language that the patient can understand is ideal.
The second problem is in its lack of terminology of
ancient literature of TCM. The terms included in the
above standards would apply to those commonly used
in contemporary practice. However, TCM has a history
of thousands of years and a large amount of cultural
wisdom, experience of disease prevention and treatment.
Researches in herbs and formulas are still buried in
this ancient literature, only a small proportion of which
have been translated to English. The full connotation
and expression of TCM terms are always evolving and
changing, so a standard of modern TCM terminology
is still not sufficient. This is exemplified in the chaos of
many English versions of Huang Di Nei Jing (Yellow
Emperor’s Inner Classic). From 1925 to 2015, it has
been translated, in part or entirely, into at least thirteen
English versions, and new versions are still emerging.[21]
The translation styles and word selection are all different
due to translators’ different educational backgrounds,
professions and goals. To this end, Paul U. Unschuld
from Germany and Li Zhao-guo from China have done an
important job, because they each compiled terminology
dictionaries for the Huang Di Nei Jing. In the face of
numerous ancient literature of TCM, this could be a small
step. We hope that more of such dictionaries or standards
can be put forward based on the significance of works
or the period of Chinese history in which they were
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composed, reflecting cultural and linguistic context.
The third problem is in its ignorance of a standard for
single characters of TCM. Different from English letters,
each Chinese character is very special, has its own shape,
pronunciation and connotation. Understanding the multimeanings of each character would surely facilitate a
better understanding of terms. It is significant in Chinese
medicine that each character of its terminology could
have very profound meanings. Some scholars once
calculated the number and frequency of characters in the
standards of WFCMS and WHO-WPRO respectively.
They found in the former standard, there were 1 886
different characters used with a total character count of
16 821, among which 48 (2.54%) characters represented
one third of the total characters used in the text, just 110
(5.83%) characters comprised one half the total character
count and 223 (11.82%) represented two thirds of the
total Chinese characters present in the document; in the
latter standard, there were altogether 1 218 characters
with a total character count of 6 131, among which 23
(1.89%) characters took up one third of the total count, 38
(3.11%) ones took up one half and 106 (8.70%) took up
two thirds.[22] This clearly shows some characters occur
more frequently in the terminology of Chinese medicine,
which could be regarded as the core characters. We
can easily find that such characters usually have heavy
cultural coating and multiple meanings and can frequently
be combined with other characters, which become
difficult to translate, and the use of the same English term
for each of these combinations would be insufficient.
Nigel Wiseman may have made such a mistake when he
defined one English term for each of the 638 Chinese
characters in his dictionary and used the same English
term for each occurrence of the character independent of
its accompanying characters.[23] What we need is probably
a standard that contains a standard English term for each
meaning of a character and phrase examples where that
character and meaning are provided. This could be very
meaningful for further standards to be made in this field.
4 Conclusions
Just as Isaac Newton said, “If I have seen further, it is by
standing on the shoulders of giants,” the present achievement
of international standards of TCM terminology is attained
by endeavors of numerous scholars and experts across the
history of this effort. Though several standards of TCM
terminology still co-exist and there are still some inherent
problems, we are optimistic that a more comprehensive
and recognized standard will come out eventually with
the broadening use of TCM around the world, the deeper
integration of TCM with the Western medical system and the
further participation of international organizations.
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5 Funding Sources
This study was supported by funding from the Zhejiang
Key Program of Humanities and Social Sciences for
Colleges and Universities in 2014 (No. 2014QN050).
12
13
6 Conflicts of interest
None declared.
14
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