The Challenge of Translating Chinese Medicine

By Alex Gross
http://language.home.sprynet.com

alexilen@sprynet.com

Published by Language Monthly, April, 1987

Q. How does one get into something as recherché and specialized as translating Chinese medical texts?

A. I suppose it's what our colleague in Mexico City recently called El Demonio de Traducción. While in England, I had done some play translations for the RSC and became fascinated with the overall problem of putting across one culture in terms of another without sacrificing either one's value system. Just because a line was funny in German or French didn't guarantee it would be in English—a lot of other factors were at work: phonetics and usage of course, but also the totality of values shared by a culture. I started looking for other outcroppings of similar linguistic problems and collided with medicine. What different cultures accept as medical terminology—and even medical treatment—could just turn out to be as arbitrary as what they accept as humor.

Q. But aren't there lots of specialists working in this field—doctors, pharmacologists, anthropologists, sinologists...?

A. There you've hit on it. I don't think there are a lot of people in this field, and those that are involved are indeed specialists: the doctors and pharmacologists, whether Chinese or Western, don't know too much about foreign languages in general, much less the subtleties of translating (and far less still of linguistics), while most sinologists are fairly ignorant about both oriental and western medicine. Anthropologists have a fine overall view but often have a poor eye for clinical details or fail to relate to the other specialists.

Q. Precisely what are the issues in this field as they relate to language and linguistics? Is there really anything new and important here?

A. I think there's something old and important. In their famous hypothesis, Benjamin Lee Whorf and Edward Sapir raised some eyebrows by suggesting that people speaking different languages may be discussing quite different things when they are allegedly talking about the same subject. And Louis Hjelmslev, Hans Jørgen Uldall and others of the Glossematics school actually maintained that linguistics may be logically prior to science, that instead of linguistics being that branch of science which deals with language, science may in fact merely be a branch of linguistics dealing with nature according to linguistically predetermined prejudices, a sort of Procrustean nightmare preset for error. It could just be that both these theories have been lying around like mathematical formulas awaiting a major application to prove their validity, and Chinese Medicine may be that application.

Q. How is translating Chinese Medicine different from other technical translation, say mechanics from German into English or Islamic law into English, or even Oklahoma State law into Arabic?

A. I'd be willing to bet there's both a qualitative and a quantitative difference, though the Arabic examples come closer than the German one. Let me start by telling you a story, and then I'll become more technical. When my wife and I lived in Italy, she did the shopping to help her learn Italian, and she came home complaining she couldn't get certain cuts of meat from the butchers. I told her to concentrate on speaking better Italian, and it would work out. But she still couldn't get the cuts of meat she wanted. Finally, I was forced to go with her to the market place and patiently explain to various butchers in Italian what she wanted. But we still couldn't get it. It doesn't even exist. The Italians cut their meat differently than we do. There are not only different names for the cuts but actually different cuts as well. The whole system is built around it—they feed and breed their cattle differently so as to produce these cuts. So you could argue it's not even the same steer—technically, anatomically, it might just qualify as a different subspecies.

Q. Are you suggesting that the Chinese may be a different species of human beings?

A. Not at all, simply that we have to be aware that in their medical system they slice the human animal differently and use quite different terminology than we do. This drives some western medical people—and others convinced our system must be not merely the best but the only possible one—up the wall. Probably most of the misunderstandings surrounding Chinese Medicine in the West spring from the fact that we are poor linguists, especially here in America.

Q. How do they cut the human animal differently?

A. In just about every way. The relationships they observe and measure are not the ones we do, the measurements and benchmarks are not the same as ours, their interpretation of such benchmarks will be different from ours, the diagnosis these suggest is not the same, and the treatment and interpretation of a patient's progress can also radically diverge from our own. Yet the whole process is quite logical and consistent, so logical that I am now working on a way to represent Chinese Medicine in terms of computer logic, using AI as a basis. The Chinese language, especially medical Chinese, is in fact similar to certain computer languages in its constant reiteration of If/Then/Else Structures.

Q. And yet one frequently hear people describing Chinese as a totally chaotic language, that its characters are unwieldy and impossible to learn, that its word order and syntax are so loose and illogical that a single Chinese sentence can be translated in several different ways.

A. That's exactly how many people experience Chinese, especially if they don't get beyond a certain learning stage. But this business of chaotic, illogical sentences, isn't this all a bit familiar? Haven't we heard this all before in another context, isn't it just what the French say about English? Let's take the classic example of "a French teacher," which the French quite correctly point out could mean either un maître français or un maître de français. Or the example that Vinay and Darbelnet use, un moteur de propulsion à jet, which we in English hopelessly distort by calling it a "jet propulsion motor," let alone a "jet motor."

According to the French, we are suffering from cumulative linguistic breakdown by omitting these vital charnières or hinge-words such as de and à. But what the Chinese would do is take the whole example one step further and express "jet propulsion motor" in terms of their own language of course, as something like jepromo. They're even more speeded up than we are. And their language allows them to get away with it. One could in fact formulate the general equation that Chinese : English = English : French.

Q. Then you're saying that Chinese in general, and especially Chinese medical language, is so much more speeded up than English that the translator has to slow it down and provide explanations in order to make things clear. But don't other people in the field recognize this?

A. Unfortunately not. Whether it's speeded up or simply more concise, I'm not sure. Everyone in translation is accustomed to seeing a text in other languages shrink when it turns into English. But characters are intrinsically more concise than words—they take up less room and also take less time to say. English shrinks when it goes into Chinese, Chinese expands—sometimes double or triple—when it becomes English. But not too many people want to admit or even hear this. It has to be linguistic chauvinism, though that's the last thing we need in this field. Chinese Medical Linguistics is so new that there really are no experts yet, but one practitioner who knows some Chinese recently generalized that "because Chinese has 5,000 characters and English has 20,000 words," anything expressed in English is thereby far more valid than anything expressed in Chinese. His figures were totally mistaken, and the whole notion is basically pretty shaky anyway, but this is typical of the blundering and blustering going on among those trying to build a bridge in this field on both the Chinese and Western sides. But the real relationship between the two languages may end up being a bit less favorable to us. Let's suppose for a moment that the Chinese only had 3,OOO characters...

Q. How many does it have?

A. That's a can of worms. About the only thing people agree on is that you need from 2,000 to 3,000 for basic literacy. Beyond that we get into grounds for technical disputes—claims run from 6,000 to 40,000, and even higher...But even with only 3,000, you have to remember a Chinese character is not the same thing as a word. Benjamin Whorf said it best and first—there is no Chinese word for word.

A character can be anything from a piece of a word, sometimes similar to a prefix or suffix, to an unbound particle to a full unmistakable word on its own to a free-standing abbreviation for a two-character phrase, which might be either one word or two words in English, or even an abbreviation for a four character construction (or "aphorism," as they're sometimes known). But let's just assume it's part of a two-character phrase, by far the most frequent construction. Here you have to visualize a table 3,000 characters across and 3,000 characters down, and wherever any of these pairs of characters intersect, you have the possibility for something like a word as we know it. That makes 9,000,000 possible slots for words in Chinese. Let's assume they put only 1% of those to practical use, that still gives them the possibility of 90,000 words, with over eight million slots left potentially free for new meanings as they come along.

This also explains how they have been able to swallow western medical terminology whole—and numerous other western technical vocab-ularies—with only a few predictable bouts of indigestion. But it also explains why we are still just nibbling at the edges of Chinese Medicine in this country and possessed by myriad preconceptions when we try to deal with it. We may be dealing with so vast a network of ideas that we are quite literally unable to conceive of its scope or import. Also, their translations of western medical terms are much more transparent than our originals...

Q. What do you mean by transparent?

A. By transparent and opaque mean how much we really understand of the meaning and structure of our own language. I once overheard a nine year old Italian boy make the following comment as his elder brother urinated in a gutter Ma, che inondazione! That is transparent—a nine year-old Italian can know the word inondazione, because it is meaningfully related to onda, wave. Virtually no nine-year old English speakers will know the word "inundation" because it is a latin book word in our language. The equivalent anglicism, if it existed, would be something like infloodment, or even infloodscape. Chinese words are transparent in this way, at least when read and often when spoken as well. Thus, the Chinese phrase for adrenal gland is shenshangxian, kidney-atop-gland, quite similar to the Latin ad renem, and hence means a lot more to the Chinese than even the phrase "adrenal gland" does to most of us. All of western medical terminology is translated into Chinese this way—what it loses in terms of "pure abstract conceptualizing" it gains in everyday understanding. Which is preferable?

Q. Can you give some more examples?

A. Take the two bones in our lower arm. The only names we have for them today are ulna and radius. These are the "scientific names," the ones medical people—and few others—learn. Those bones are important to you every day, yet you have no everyday way of referring to them at all. But there is clear evidence from historical linguistics that these bones once had other names. The ulna was once called the "el", the radius possible something like the "spoke." We know about the "el" from Seventeenth Century poetry (maid to lover: "if I give you an inch, you'll soon take an el") but also from modern German, where the words are die Elle and die Speiche.

Even in modern English the place where the "el" makes a bend or "bow" (sich beugt) is called the elbow. In Chinese these words translate as foot-measure bone (close to the meaning of "el") and rowing bone. All bones and all locations in the body have similar down-to-earth names in Chinese. Which people are likely to be on better terms with their bodies—one that has names such as these or one where everything is linguistically off-limits except to doctors? German continues to a better job here even today with such words as Gehirnhautentzündung and Harnröhre for meningitis and urethra.

Q. It also occurs to me that a German child could understand words like Riss- und Quetschwunde, whereas an English-speaking child would not understand "lacerations and contusions." Could you say something more about the four-character constructions?

A. That's at the very heart of the way the Chinese systematize and store their knowledge. They like to sum up a whole subject in just four characters, four syllables long, which they then use as a mnemonic. Dah-dah-dah-dah—it's like half of Big Ben ringing. If it's a truly difficult concept then they will occasionally go for eight syllables, or full Big Ben. It's very close to being like a computer macro, a brief series of keystrokes to stand for something much longer. And they can, if need be, even macro-ize the four character phrase down to two characters—or even one. We have a few such structures even in English. Here's one: Spring Ahead Fall Behind. It sums up a specific procedure Americans go through twice each year when they change from Standard Time to Day-light Savings Time and tells them which way to move the clock's hands. It's a fairly good example of Chinese-like thinking in English.

Here's another: Blows Strokes Sweep Breaths. I've left out the punctuation because there wouldn't be any in Chinese. There wouldn't even be an 's' marking three of the words, because the Chinese don't usually record the plural in nouns and verbs. So let's try

Blow Stroke Sweep Breath.

How would you translate that into another language? Would you imagine it as something poetic and inspiring, such as "The vast wind beats on my heart, sweeping my breath away?" Or is it a tale or oarsmen being swept away while pursuing a whale? Or could it be something overtly sexual? these are the sort of errors awaiting anyone trying to translate medical Chinese—and some have fallen into such traps.

The precise meaning of the phrase Blows, Strokes, Sweep, Breaths refers to a medical context in American English: it is a mnemonic for remembering the correct order of actions in dealing with an unconscious non-breathing patient and is taught in courses on cardio-pulmonary resuscitation: blows on the back, artificial respiration, clearing the patient's air channel with one's fingers, and the "kiss of life."

Q. Can you give some examples of these four character summations as they occur in Chinese medicine? Are they used frequently?

A. I can give lots of examples. They're used almost everywhere in Chinese medical texts, for diagnosis, treatment procedures, theoretical explan-ations—and almost always in these incredibly abbreviated forms that sound either bizarre or quaint or poetic in translation. That may be a good rule of thumb for determining a bad translation in any context. A translation may possess a certain cultural distance from its original, but if it sounds too quaint or bizarre or poetic, it's likely to be a poor one. People in other societies do not normally go around being quaint or poetic or bizarre—they wouldn't survive very long.

And the Chinese have not only survived—they have burgeoned and flourished. You want some examples—look at any text in the medical literature, better yet look at these Chinese herbal pill bottles. There are hundreds like them—this one says "Indications: Treatments of vulnerary (stricken or fallen), shocken and twisten, septic burns and hemorrhagia per diaresin (Tesuit's drops), etc." Here's another:"Invigorating the spleen and reinforcing the vital energy, relieving flatulence and regulating the functions of stomach. Used for asthenia of the spleen and stomach...borborygmus, sticky stool." Do I have to tell you that's a bad translation? This is the sort of thing that might be published in the `Tickler File' of our ATA newsletter, it's what the New Yorker used to print under the heading `The Mysterious East."

Q. You mean it doesn't sound like that in Chinese?

A. Not in the slightest. It's positively beautiful in Chinese. Medical technical language to be sure, but concise, incisive, elegant. Almost entirely phrased in these four character `aphorisms' (`slogans' might be closer) that Chinese uses to make a long story very short. We expect medical language to sound Greco-Latinate and, well, medical. But Chinese medical language and thought, beyond the problems posed by the four-character summaries, is much more geometrical, mathematical, even legalistic in feel. There is continual talk of confirmations, of evidence, of methods of proof. The language couldn't be more empirical in tone, but almost all of this gets lost in the translation. It hasn't helped that one of the chief `popularizing' books in the field mistranslates the term for `evidence' or `confirmation' as pattern.

Q. You mention a Chinese "medical literature—how extensive is it, and how much has survived?

A. Vast amounts have "survived." We tend to think in terms of Greek or Roman medicine, where we have allowed innumerable volumes to be lost. But the Chinese haven't made this mistake. With some exceptions, libraries were not allowed to burn. Consequently, a vast medical literature is still central to Chinese culture, even with the advent of western science. One library in Peking claims over 50,000 volumes. A few hundred new books are published each year, and there are several national and local journals. Varieties of Chinese medical language include ancient, modern, and a number of stages in between, all with their peculiarities in vocabulary, as is proper for an ongoing developing field of knowledge. If we fail to see this, it's only because of a disease I call "culture blindness."

Q. Is Chinese Medicine antithetical to Western Medicine? Or is there some way the two can be reconciled?

A. Of course they can be reconciled. No intelligent observer would suggest the contrary. Western medicine has a more sophisticated view of some problems, but the Chinese view can be sophisticated in other ways. But we have to go beyond the unvoiced preconceptions on both sides, and to do this we have to recognize that they exist. We must become bimedical instead of merely monomedical. It's a task that linguists and translators can perhaps do best, by really looking carefully at the original, seeing what is actually there, and arriving at an accurate version in western languages. It represents an opportunity for linguists and translators to show that their skills are not just academic and parochial but can play an enormous part in a field that is not merely practical but absolutely central to human life and health.