Course Review

My name is Debbie Smith and I have an MAOM from the New England School of Acupuncture, class of 2005. I’ve been studying with Nicolaas since 2019. My past experiences with language study include a BA in Russian Language. I’ve also studied non-medical classical Chinese with other teachers at the continuing education level, along the way, just to satisfy curiosity about other types of literature that have had influence on our foundational literature.

This is what I’d like to communicate about the benefits of studying with Nicolaas:

  1. Robust material. The notes he teaches from are dense with information. I continue to go back to them to review and find more layers to understand each time as my own ability to grasp an idea improves. These notes are his original content. You will not find them in a book anywhere. When I have taken other classes, when I’ve hit a confusing concept, his notes ultimately are my final resource to put an idea in order in my head.
  2. Investment in his students. He corrects all submissions personally and meticulously. When reaching certain levels of testing, you will not only have your work corrected with direct comments, you will also receive a discussion sheet to go more in depth into the broader issues at hand. Every test is another learning experience.
  3. Thoroughness. He is thorough even at the beginner level. You will learn terms, but you will also learn the context in which these terms are used. This will be invaluable when you start reading medical literature.
  4. Care for character writing. Nicolaas will help you understand how to draw the characters well. To me, each character is a small piece of art, so to have that help with my writing was just wonderful! You wouldn’t think that would be possible through distance learning, but it certainly is!
  5. Foundational ethics. The ethics and history of translation of medical terminology are explained in detail. This is not a small thing to understand.
  6. Academic rigor. This one is a bit hard to explain without sounding a bit snooty, but I’m going to be honest. This class is refreshingly challenging. You are treated like you are capable of learning something that is indeed, quite difficult. This is unlike most of my experiences with continuing education of late, where you are left with superficial instruction that does not allow for practical application of skills learned. He understands that we have busy practices to attend to, but he can accommodate that in ways that do not involve diluting content. You will finish blocks A through C with the skills to read confidently, with a thorough understanding of the underlying grammar structures. It’s not always going to be easy, but he will never treat you like you are incapable of figuring it out, nor will he ever refuse to answer a question when you get stuck.
  7. Class format: Correspondence style learning seems like the ideal format for material at this level. I can read and take my time with this. I’m not sure a lecture would help me learn this any better, as the notes take time to contemplate, vocabulary takes time to memorize and you need time to practice reading and writing. I quite frankly love that the timeline for my study is in my control, and I don’t have to present myself to a zoom camera each week. I can just study quietly until the material makes sense and then turn in my homework. I can send questions when I have them instead of sitting on them for class time, which allows my questions to be more thoughtfully asked and thoughtfully answered.
  8. Relevance of material. You will immediately start working with medical vocabulary and then medical texts. There are other classes available that use popular texts that are based on Warring States period philosophical literature, as this is often the entry point of interest in classical Chinese language. While that is a worthy endeavor also, I would say from my personal experience that these are very different types of literature. For someone like myself, only a few years into this journey, the difference between the two still feels like comparing apples to oranges. If your interest is in medical texts, it seems to make more sense to start building your vocabulary and your reading skills in this area from the very start. You will find satisfaction in your efforts much sooner.

    In summary, I say without hesitation that I feel that this is the best class available to our professional community for developing the language skills to read our foundational literature.

Short history of the Chinese term for ‘nerve’

I originally wrote this in response to a colleague who suggested that the Chinese term for ‘nerve’, 神經 [shénjīng], implied that the Chinese conceived of this concept as meaning: ‘links of transmission () of spirit ()’. Over the years I have shared it with students and in some discussion groups as well. The feedback I received has encouraged me to correct, expand, and polish it. I also added some illustrations in this new version. I hope you will enjoy it.

I am greatly and gratefully indebted to Hugh Shapiro for his thorough research on this topic.


Can we say that the nerves are ‘the links for the transmission of spirit within us’? Is that the way the Chinese saw it when they began to use the term 神經 [shénjīng] for ‘nerve’? When I heard that I had serious doubts, mostly because the Chinese already had an elaborate system of transportation in the body, consisting of channels, vessels, and a network of smaller conduits. I simply could not imagine that when descriptions of the nerve and the nervous system reached China, they thought: “Ah, that’s what was missing, that could be the vehicle for spirit transmission!”

I was prepared to give it the benefit of the doubt, though, and decided to see if there was any evidence for it. The combination of the two characters and by itself (be it very interesting) is not enough for me to believe that it became part of Chinese medical philosophy in the way that my colleague had put it.

I specialize in the Chinese-English terminology of Chinese medicine, a medicine that I have practised as well. Besides my studies in Chinese languages and cultures I have done studies in lexicology and terminology. A brief introduction to what terminology is and how it works in our field of knowledge can be found here.

Of importance for the following is: A term is only a term when it has a definition. A definition describes the concept that is conveyed by the term. When a term is translated into another language, the definition does not change. This principle is a prerequisite for adequate translation and communication in any specific subject field. There is nothing special about it; it is the way knowledge is communicated in this world. Nevertheless, it often is overlooked in one particular field of knowledge, namely Chinese medicine.


<Anatomiae amphitheatrvm, Robert Fludd, 1623>


So, it is the definition of ‘nerve’ that applies to 神經 and vice versa. There are many ways new terms are formed and for the Chinese terminologies of Chinese medicine and that of biomedicine (a.k.a. Western medicine) there are some specific problems. When the Chinese create new terms for concepts that they did not invent themselves, like ‘nerve’, what they are doing is trying to understand what the foreign term means (by investigating the definition of the concept) and then come up with a term for it in their own language.

If you translate that new word back into the foreign language without taking into account what definition is attached to it, you can come up with something different. And that is what happens when you translate 神經 as ‘spirit transmission’ or ‘lines for the transmission of spirit’, or ‘spirit channel’. Regardless of the problem that both characters have multiple meanings (an ignoramus could say that 神經 means ‘divine menstruation’), what you are doing when you follow this method, is giving a new and different definition to an existing term. And that makes communication in any discipline very difficult if not impossible.

The compound word 神經 [shénjīng] in the meaning ‘nerve’ is interesting because as a term it raises several questions. Imagine a doctor in China who comes into contact with Western anatomy for the first time in history. What would you say they will think? They see drawings of human bodies with lines, read the description of this new concept, and why o why don’t they come up with something like 腦經 ‘brain channel’, 腦氣經 ‘brain qì channel’ or another combination that fits what they read and see?


<De humani corporis fabrica, Andreas Vesalius, 1543, Basel>

As an aside:

The word [nǎo] in Chinese has the same definition as ‘brain’ – like many other anatomical words that were invented in different cultures without intercultural exchange. Think of ‘blood’, ‘heart’, ‘little toe’, ‘nose’, etcetera – all very straightforward terms, because they mean the same for everyone in all cultures and times.

Such questions occupied my brain when I was thinking about what my colleague brought forward, and they motivated me to search for references. And guess what? I found (at least part of) an answer to this intriguing issue that could make it even more intriguing. I have tried to summarize the story.


The history

The concept ‘nerve’ was first translated into Chinese by Johann Schreck (1576-1630), a member of the Society of Jesus who, before he sailed to China as a Jesuit missionary, had an impressive reputation in European courts as a gifted healer. Working with a Chinese scribe, he prepared a translation into Chinese of a Latin text in two parts, namely on anatomy & physiology and on perception, sensation, & movement (by Caspar Bauhin, first published in 1597 in Basel).


<Theatrum Anatomicum, C. Bauhin, 1605, Frankfurt>

After Schreck had served the Chinese rulers with his knowledge of astronomy (medicine and medical translation were private occupations) for a while he died, and Adam Schall (1592-1666), who had traveled on the same boat as Schreck, found a Chinese scholar, Bi Gongchen, whom Schall asked to translate the text into (more polished) literary Chinese. It was published in a single volume together with a text by Matteo Ricci, one year before the collapse of the Ming dynasty (1644).

In the text, entitled ‘Western Views of the Human Body, an Abbreviated Treatise’ (Taixi renshen shuogai ), ‘nerve’ is translated as 細筋 [xìjīn], which literally translates as ‘fine sinew’. The choice for ‘sinew’ reflects the understanding of nerves in Europe at that time. ‘Nerve’ and ‘sinew’ were, for instance, used interchangeably in early 17th century texts on anatomy. Also, the Latin ‘nervus’ means ‘bow-string, tendon, sinew’.


<Taixi renshen shuogai>

In Schreck’s text nervous function is explained by using the concept of qi circulation. The ‘fine sinews’ contain qi and no blood, and when they are cut, people lose their ability to move, etc.. The book did not give the Chinese much reason to become interested in an alternate method of healing, and the concept of nerves did not take hold in China until much later.

In Wang Qingren’s Yilin gaicuo (‘Corrections of Errors in the Forest of Medicine’), which after publication in 1830 became one of the most widely read medical texts in China (as it still is today), we find no mention of a term for ‘nerve’. Dr. Wang, however, recorded several anatomical notions that were revolutionary for Chinese medicine and in several ways heralded a period of modernization. For our story it is relevant that he presented anatomical ‘proof’ for what Li Shizhen had claimed in the Bencao gangmu, namely that the brain, and not the heart, was the mansion of the original spirit.


<Yilin gaicuo, Wang Qingren>

It was Benjamin Hobson (1816-1873), a medical missionary from England, who instigated renewed attention for the concept of nerve in China. With his text ‘A New Theory of the Body’ (Quanti xinlun, published in 1851) he had considerably more influence than Schreck. In the chapter on the brain and the nervous system, he introduced the term 腦氣筋 [nǎoqìjīn], which literally translates as ‘brain – qi – sinew’, that is, the sinew through which brain qi travels.


<Quanti xinlun>

Although China was in the middle of a modernization movement, in the beginning of the 20th century, the concept of the nerve was still not easy for the Chinese to digest. Of the twelve different words that had been invented for ‘nerve’ since the beginning of the 17th century, five made it to the shortlist of a terminology committee meeting held in Shanghai in 1916. The purpose of that meeting was to standardize Chinese terms for numerous scientific concepts coming from the West and biomedicine was the most important subject. The term for ‘nerve’ was debated for over two hours before 腦經 ‘brain channel’ or ‘brain tract’ topped 神經 ‘spirit channel’ by eight votes to seven.

Why did it take 300 years for the concept of nerves to take hold in China?

1. It was not particularly relevant for Chinese medicine.

2. It was associated with the Western notion of ‘volition’. The Greek term for ‘motor nerves’ was, translated literally, ‘capable of choosing, purposive’. The action of nerves was inseparable from exercise of will. In the West, volitional action was a crucial defining feature of identity. For the Chinese, who did not hold such a view of identity, the idea of incorporating nerves into medical theory was not attractive.


<Theatrum Anatomicum>

The term 神經 came to China via a different route. It was introduced in 1902 as a translation of the Japanese shinkei, which is written with the same characters. In 1774 it was coined by a Japanese doctor trained in Chinese medicine. He came up with the word after studying a post-Vesalian Dutch text on anatomy.

The story of the Japanese doctor resembles that of Wang Qingren. He went to an execution ground to observe the dissection of a cadaver in order to see whether the illustrations in the Dutch text made sense. When he was convinced that they did, he formed a translation group to study and translate the text, and that text is seen as the seed of biomedicine in Japan. He judged that the Dutch term zenuw (nerve) corresponded with keimyako經脈 [jīngmài], channels and vessels, and the term zenuw-vogt (nervous fluid), he argued, pointed to shinki神氣 [shénqì].

神氣 in Chinese medicine can mean several things: 1. spirit, vigor 2. In the Neijing, ‘spirit qì’ refers to the spirit, channel qì, right qì, the blood, and the yáng qì of the bowels and viscera. < Practical Dictionary of Chinese Medicine>. It is interesting to note that the Dutch word ‘zenuw’ (nerve) is directly related to the English word ‘sinew’.

Combining 神氣 and 經脈, our Japanese doctor-translator formed the neologism shinkei 神經 which consists of the first part of these two terms. Historians have not found evidence that the Chinese of the early 20th century were aware of the history of the term (namely that qì was part of its original full version), and argue that that is one of the reasons they favoured 腦經 [nǎojīng] as translation of ‘nerve’ in 1916.

Another note is that the word 神經 [shénjīng] already existed in classical Chinese as a designation for a genre of esoteric books. The Japanese shinkei 神經 is a new construction, derived from words unrelated to that classical meaning.

In the text mentioned below Hugh Shapiro asks the important question: Why then, did they eventually adopt the term 神經 [shénjīng] for ‘nerve’? According to Shapiro the reason can be found in the fact that thousands of Chinese trained in Japan and came back to China with Japan’s analysis of biomedicine in their luggage – accompanied by the terminology the Japanese used. Biomedicine (a.k.a. Western medicine) rapidly gained ground as part of the movement in China to modernize and catch up with the West. But more importantly, the Chinese were interested in the pathology of the nerves – a thing that was never described by the Jesuits who introduced the anatomy. And the Japanese doctors instructed the Chinese in nerve pathology as they had translated it from biomedicine.


<brain dissection, Japan, 18th century>

The concept of nerves as such did not appeal to the Chinese medical professionals (they didn’t really need it) but when they studied the illness neurasthenia as described by the biomedical literature of that time, they connected it to their understanding of depletion. In fact, neurasthenia, in Japanese shinkei shuijaku and Chinese 神經衰弱 [shénjīng shuāiruò], became much more important in China than in the countries where the idea originated but soon was discarded. Also, the foreign idea of ‘nervousness’ became very common in 20th century China.

Shapiro further argues that this can inform us that the Chinese and Western concepts of emotional and corporeal depletion were rather close, and that this is often overlooked when the differences between the two medical systems are discussed.

I might add that the ideas about several pathologies as described by Wang Qingren in connection to his, for China, rather new and revolutionary ideas about the brain and other anatomical parts, have contributed to the development of a more open view in Chinese medicine towards ‘facts’ instead of rigidly adhering to ‘theories’ only.


<Utriusque Cosmi …, Robert Fludd, early 17th century>


– Hugh Shapiro’s contribution in: ‘Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures’, a collection of essays edited by Helaine Selin (Kluwer Academic Publishers, 2003)

– Bridie Andrews’ Introduction in Yi Lin Gai Cuo – Correcting the Errors in the Forest of Medicine, and the chapter ‘On Brain Marrow’ in that book (published by Blue Poppy Press, 2007)

see also:

– Marta Hanson’s keynote lecture: Jesuits and Medicine in the Kangxi Court (1662-1722).

Fast Track version of CMC Online

Chinese Medical Chinese Online:  Fast Track version

Aowen Chinese Medicine offers a ‘fast track’ version of CMC Online.  It is meant for those students who already have basic knowledge of Chinese language, some knowledge of Chinese medical terminology, and who want to begin their studies of Classical Chinese without the need to follow Block A in a regular class.

This fast track course prepares you to study Blocks B & C where we focus on learning the grammar needed to read classical medical texts.

Fast Track contents

  • you will receive all the study and reading materials of the 10 assignments of the regular Block A
  • please see Chinese Medical Chinese Online for Block A details
  • you will write three tests, the third one being the final exam of Block A
  • you will receive individual guidance with full access to your teacher

The Block A portion of this Fast Track version of the courses takes about six-seven weeks.  During that time you review the characters and terms covered by Block A:  Chinese Medical Characters, Volume One: Basic Vocabulary plus some additional characters.  Total characters: 110.  The reading materials of Block A will give you a solid foundation to continue your studies in Blocks B & C.


  • You have basic knowledge of Chinese language and Chinese medical terminology.
  • You commit to study CMC Online Blocks B & C in the next available session (or individually).
  • You have Chinese Medical Characters Volume One available (note: we can help you to get started while you are waiting for the book)


The next session of Blocks B & C will start April 2022.  However, we can offer you the option to study B & C individually.   You can work at your own pace but have to finish the three tests (and pass the exam: the third test) before starting at the B & C portion of the course.


The price of the Block A (review) part of this Fast Track version of the course is $ 475 (US dollars), due at the beginning of the course.  The total (including Blocks B & C) will be $ 2,225.   Your fee is refundable only if the course is cancelled.

Continuing Education Units

Contact your teacher Nicolaas via if you are curious to know what we can do regarding continuing education credits.

For further information also please do not hesitate to contact Nicolaas (

Terminology in Chinese Medicine

Terminology in Chinese Medicine: A Critique of the WHO term list

N. Herman Oving, translator of Chinese medical literature


This paper shows severe flaws in the terminology as proposed by the document WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. After an overview of general principles applied in terminology, the methodology behind the WHO list is discussed, illustrated by an analysis of several terms and definitions.


What is terminology?

Most of us are familiar with the term “terminology” in the meaning of “a set of special words belonging to a science, an art, an author, or a social entity.” The second meaning of “terminology,” relevant for the discussion and evaluation of term lists, is “the language discipline dedicated to the scientific study of the concepts and terms used in specialized languages (languages for special purposes – LSP’s).”

Terminology describes terms (terminological units) used in LSP’s, while lexicology describes words in language for general purposes (LGP). A dictionary is designed to describe a language in all its variety of expressions, whereas terminological systems are used in education, scientific research, translation, and on the work floor (in our case, in the clinic).

The main concern of a terminologist is to identify clearly defined meanings of terms. Although terms with multiple meanings (polysemy) exist in LSP’s, they target the ideal of monosemy, that is, each term designating only one concept. To reach that goal, conceptual systems are created, based on the knowledge of, and literature created by subject-field specialists. In the process of creating terminologies and choosing terms in a second language, the first step is always to define the concept of the original term. In lexicography, context is often of major importance in describing usages of words, whereas in terminography, it certainly is not (although context may provide additional information to complete a definition of a concept, and for translators, it is useful if terminologies contain examples of usage).

LSP’s are subject to evolving conventions and change. In the course of time, definitions of concepts may change, for instance by new discoveries, or by different social circumstances. Terminologists carefully take this into account. Systematic comparisons of terms already in use can be important in the process of creating conceptual systems.

Translators mostly do not have time to systematically and coherently investigate all the terms they encounter in their translation of LSP texts (or discourse). If no reliable term list is available, or if a certain term is not included in such a list, translators will (indeed, have to) come up with a term themselves, and ­­­-hopefully for the readers- use that chosen term consistently. In scientific discourse, it is generally obligatory to include such terms in an index, glossary, etc. Translators should ideally consult specialists in the process of selecting a ‘new’ term.

Basic principles of terminology

A terminology created for the purpose of discourse in a certain knowledge field should adhere to the following principles:

  • It should be based on a system of clearly, intelligibly, and transparently defined concepts.
  • New terms (in our case, terms in the target language) should be well-motivated, logical, (preferably) self-explanatory, systematic, productive of derivation, not contain superfluous elements, and preferably not have synonymous, homonymous nor polysemous terms.
  • Ideally, the system should be flexible and open-ended, to accommodate the inclusion of terms at a later stage.
  • Polysemous terms in the source language have to be clearly indicated: if a term has multiple meanings, it should also have multiple definitions. In the target language, polysemous terms should be avoided by the formation of different terms for the different meanings of a term in the source language.
  • Synonymous terms in the source language should be listed, but (ideally) the use of synonyms should be avoided in the formation of new terms.
  • All terms used in definitions should also appear as separate entries.
  • Circularity should be avoided. Circularity occurs when the term or part of the term being defined is used in the definition. It also occurs when a synonym of the term is used to define the term.

In general, creators of term lists should always bear in mind that the terms and definitions will be received and used by students, translators (who cannot be expected to be specialists in all the technical subsets of a terminology) and, possibly, other lay persons. If concepts are not systematically defined, educational material cannot be built upon the terminology as presented, and nobody will be able to trust information contained in the specialized literature of the field.

As we will see below, the WHO committee seems to not have paid much attention to the end users of their list in this most important respect.

While discussion of single terms can often broaden our understanding of concepts used in our field, evaluation of terminologies like that which has recently been presented by the WHO can only be thorough if we look at them from the viewpoint of terminology (in its scientific meaning). I hope that this brief introduction will serve as context for the following review.

(I have drawn on The Pavel Terminology Tutorial -web publication- and Terminology: An Introduction by Picht and Daskau)

Brief review of the WHO term list

I am aware of the fact that this presentation of my findings is not a systematic analysis. However, I hope it is sufficiently illustrative, and may serve for further discussion.

About the Introduction

In the introduction to the WHO term list, the committee’s objective is stated: (for the sake of clarity, I have italicised the quotations from the WHO document)

  • Provide a common nomenclature for better understanding, education, training, practice and research in TRM” (TRM = Traditional Medicine – in the Western Pacific Region). The target audience, the authors say, consists of “researchers, educators, practitioners, regulators and students in the field of TRM” adding: It will thus assist in raising standards within TRM and, also, be of use to those who are not familiar with TRM, such as Western medical practitioners.

After stating that there is ‘an urgent need for unification and standardization‘ because of confusion amongst readers caused by the various English words available as equivalents for single terms or single characters, the introduction further informs us about the methods that were followed:

[…] this abundance (the abundance of English terminology – HO) also provides a rich source for selecting the most appropriate English terms to be used as the standard.

If I understand this correctly, users of the list (people who read or create English texts on Chinese medicine) may expect to find many terms that are already in use, and (more or less) accepted by the field. Or at least, that the terms selected by the WHO to become standard terms, are drawn from representative existing literature.

  • On the Chinese Herbal Academy (CHA) email-exchange-list, some people have already mentioned a few terms that were rather surprising to them, ‘’energizer” for jiao1 (as in san1jiao1, shang4jiao1 etc.) being such an example. There are some other terms on the WHO list that do not seem to be well chosen in this respect:

For the term 气机 qi4 ji1 ‘qi movement’ is selected. I personally know of no English sources that use that term; I think the terms (most) commonly used in English literature are ‘qi dynamic’ or ‘qi mechanism.’ Other examples include ‘ideation’ for yi4 意 , ‘innate’ for xian1tian1 先天, ‘meridian.’

We might categorize these kind of terms as ‘unlucky choices.’ I agree with others who think it doubtful that they will be adopted for use by Western English language publications / schools. Since there are already several term lists in use, it is likely that the WHO list will only be used by publishers in the Western Pacific Region.

I would like to note here, that for future cross-referencing, Eric Brand has prepared a comparative list of several term collections (those of Xie Zhufan, Wiseman/Feng, the Eastland glossary, and WHO). Of course, the corpus of literature is wider than that. There are other glossaries out there, notably in the work of Unschuld. (By comparison, the Maciocia books include only very small glossaries.) Overall, the WHO committee seems to have paid little attention to contributions of Western experts in the field.

  • Although the classical conceptual foundations of the ancient foundation texts still appeal to those seeking an alternative to Western modes of thinking, increasing numbers of people seek direct access to the conceptual content and clinical applications of TRM, primarily through studying contemporary publications. In view of the purposes of this document, which are for present day education, training, practice and research, and for information exchange, the technical terms were chiefly selected from recent publications.

This may be quite disappointing for the many people in our field who are studying and translating classical literature. I think, and others have stated that elsewhere, that it is a reflection of the role of politics in the WHO committee: apparently, a majority of the members consider contemporary texts, which predominantly reflect the recent trend of scientification/ biomedicalization in CM, as the basic source for the development of terminology. Contemporary Chinese medical discourse is still full of literary language derived from classical sources which the WHO document acknowledges a bit further down in the introduction: […] there are many classical works using different terminology in Chinese, which are still of practical significance. However, this appears little more than a platitude when considered in terms of the body of the document as a whole.

The phrase that follows is problematic:

When translating these terms, particularly from a literal approach, each alternative name should have its rendering, and as a result, one single concept may have several expressions in English. In fact, this diversity in English equivalents is of no technical significance.

No technical significance? From the viewpoint of terminology, this most certainly has wide implications. It causes problems for consistent use of terms and it causes many problems for implementation in computerized databases, etc.. What the committee actually proposes here, is that synonyms used in the source language can, or may, be rendered in the English terminology. That is ok of course, but actually such synonyms should be listed and marked in term lists, and thus linked to definitions of concepts if only for the sake of cross-referencing. If we just assume that the diversity of terms used for one concept in CM literature should or could be rendered in a diversity of English terms as well, without listing such terms, how will readers know that these different words refer to the same concept? Lists of such synonyms should be created for this aspect of CM terminology. If we want to understand all the terms ever used in CM, there is still much work to be done!

What must a translator do when encountering (more or less rare) synonyms if they are not included in a term list? He or she can do two things: use another English word, but then an annotation is required (a note which says: this term is synonymous to ….); or use the term that is listed in the standardized terminology right away. However, the translator must be able to identify the concept, and make sure the synonymy is 100% accurate.

  • Because of the evolution of TRM, the original concepts of some traditional medical terms have been changed or only one of the multiple concepts has been adopted at present. In this case, the English expression of the contemporary concept should be regarded as the standard.

What English expression of what contemporary concept? Is there anyone who understands this? I would love to see examples… Is there really a solution offered here for this -comprehensive- problem? Or is my confusion due to the fact that the underlying idea is that we are only talking about contemporary texts? In that case, what should we do with all these quotations from the classics?

  • The number of commonly used terms in TRM is estimated to be more than 4000, most of which are included in this document.

4000 is a good start, but the term list will probably have to include more like ten times as many terms. There is nothing shocking about that; most knowledge fields have enormous term lists, and CM is an enormous field. How many terms are there in WM? I once did a study of terms involved in cell division as a project for my terminology studies. I had to stop (there was a time limit) after concluding: in science, if you focus on a seemingly very small subject, the literature, and consequently the terminology, grows and grows and grows. This will happen with CM as well, as more and more books are translated. People might say: Ah, but there are a lot of alternative terms (synonyms) used, but then still, the synonyms must be acknowledged and verified by peers etc. There are no translators who can build up knowledge of all the terms ever used; it is team work, and the teams should not be too small (!) and consist of terminologists/linguists and subject-field experts (preferably people who are proficient in both languages). The question is not: How many terms are there to learn to be able to translate a text?, the question is: How do we create a conceptual system in which all the terms have there proper place?

  • To expedite the process of term selection, the Zhongyiyao Changyong Mingci Shuyu Yingyi: English Translation of Common Terms in Traditional Chinese Medicine: Xie Zhufan, China TCM Pub. Co., Beijing, 2004) was adopted by voting through the main reference for the development of the international standard terminology.

Since the creation of terminology in our field is in a developing stage, it is a pity no other sources have served for this purpose. I have copied this statement, because the introduction is not very clear about what criteria were used to designate a term as ‘commonly used.’

  • We are informed that the committee voted on each term individually, to decide which English term would be selected. I have understood that many (or at least some­­­­ – I don’t know the exact statistics) of the people who voted, either had little knowledge of Chinese medicine or were not linguistically schooled, not to speak of the many members who did not have sufficient proficiency in English. From the names in the annexes two things are conspicuous: representatives from China, Korea, and Japan always formed an overwhelming majority and native speakers of English were enormously under-represented.

If term choices are made by voting term by term, it is rather predictable that no systematic/ coherent list can be created. It is clear that the WHO list is a mixture of different approaches, and if viewed from the perspective of a terminologist, it all the more looks like a hotchpotch of terms from different origins, with a strong emphasis on trying to get in as many Western medical terms as possible. It therefore, unfortunately, cannot be seen as a term list based on sound terminological principles.

Use of Western medical (WM) terms

Since both traditional and modern medicines aim at maintaining health and treating diseases, there must be some overlap between the two systems of medicine in concept and hence in terminology. On such occasions, the only difference exists in wording. When a traditional term in Han character has a corresponding Western medical term expressing the same concept, use of that Western medical term is not only reasonable but also necessary. Otherwise, creation of a new English term from the original term in Han character would cause confusion. On the other hand, improper use of Western medical terms is misleading and therefore is excluded from this document.

It would have been helpful to know what exactly is meant here by ‘improper use.’ I don’t suppose ‘hematochezia’ (the term listed for 便血 bian4 xue4) is considered more proper then ‘bloody stool’ or ‘hemafecia,’ so I think we should understand this phrase to mean that WM terms ought not be used when the definition of the CM term suggests there is a difference with the WM term. So, why then are there so many terms included that are taken directly from WM without being accompanied by definitions that confirm they are representing the same concept?

There are a several things we can say about this. Firstly, the use of WM terms for Chinese medical concepts is questionable in many instances because the concepts do not fit seamlessly (we cannot be sure there is a one-to-one relationship). The introduction of so many WM terms looks suspiciously as though it were mostly inspired by the wish to let WM experts believe that CM recognizes disease patterns that correlate to the conditions defined by WM. Of course, it is useful to know when a certain WM disease resembles a certain CM disease etc., but WM terms serve better as additions to the definitions, especially when it is clear (from those definitions!), that there is a conceptual difference in, at least, understanding the disease.

Secondly, a few more important terminological principles are neglected, for instance the desirability of clarity for the users. The designers of the list ignore the fact that a large part of the audience are not trained in Western medicine and give us the strong impression that we all should embrace the integrative approach. Furthermore, there is a considerable group of Chinese medical terms describing diseases that, if translated literally, are self-explanatory to some degree. This means that they contain information relevant to the outward expression or the pathomechanism involved, and thus may tell us directly how CM conceived of them. An audience sincerely interested in learning Chinese medicine would be much better served if such valuable information were preserved. In short, for an accurate transmission of Chinese medical knowledge, it can hardly be argued that the use of WM terms is the preferred option.

To illustrate this,

Let us look at the term 風牽偏視 [feng1 qian1 pian1 shi4]. The WHO term is paralytic strabismus, and the definition reads: sudden onset of squint with impaired movement of the eye and double vision attributed to an attack of wind. Now, paralytic strabismus is a WM term, but the definition in WM certainly does not include wind as cause. The composition of the Chinese term suggests, however, that wind is the cause of the condition, and that information is lost when we use the WM term in translation. If we use ‘wind-induced squint’ (the term proposed by Wiseman) and add to the definition that this condition is known in WM as paralytic strabismus, we kill three birds with one stone: we have a term that is understood by many more people; the term tells us something about how CM theory understands this condition, and we have a reference to the correlative term in WM. I think this approach is much better, (and it is followed consistently throughout Wiseman and Feng’s proposed terminology). It has the extra advantage of leaving translators the option to choose the WM term (provided that there is a one-to-one correlation of course), or use it in a note. I mean, for translation of contemporary journal articles directed to an audience of WM trained professionals, there is no objection per se to the use of the WM term (again, one should be sure about the correlation).

However, if we want to create source-oriented translations of pre-modern CM medical literature, why would we want to loose the ‘wind-induced’ part of the term and replace it with ‘paralytic?’ In my opinion, using such WM terms in our translations could be categorized as ‘improper use.’

Especially for the translation of classical texts it is not desirable to use WM terms, as the majority of these terms have been created at a much later date in history and are part of a different conceptual system. Other writers have directed our attention to this problem; the Paradigm site is actually full of materials in which this and other problems with CM terminology are described. I wished to repeat it here, since the WHO list does not provide translators with the means to preserve original ideas contained in the terms. To speak for myself, as a translator, I do simply not wish to use instruments that are designed to divert the attention away from the source concepts. Terminologies should not be used for the purpose of changing descriptions of knowledge and the perception of concepts, but solely to describe them.

On the CHA list, the term used for 食厥 [shi2 jue2], namely ‘crapulent syncope’ (translated by Wiseman and Feng as ‘food reversal’) has been discussed; the drift being that it is not going to be used.

I think that this is exactly what will happen with many other terms in the list: simply, people will not use them.

As for concepts known to both Western and Chinese medicine, there are some striking anomalies in the WHO list. The committee proposes the use of ‘water wheel, blood wheel, flesh wheel’ (etc.) for terms that are identified in the definitions as ‘the pupil, the canthus, the eyelids.’ It leaves us to wonder why the committee here prefers to use the literal translations.

Terminological confusion: Boils, furuncles, pustules, snake-heads, and clove sores

In the subset of disease conditions for which the WHO committee could not find a Western equivalent, there are yet other problematic issues. I have deliberately chosen to investigate some terms and definitions in a field that I am not particularly familiar with (namely, external medicine), in an attempt to objectively illustrate specific problems translators may encounter when using this list. Since it is cumbersome to always indicate where the committee offends what principle applied in terminology, I refer readers to the first section of this paper. Some examples that directly relate to those principles are provided in the last section of this paper.

  • The WHO committee has chosen the term ‘deep-rooted boil’ to represent the term 疔 ding1. They define it as ‘a boil with its central core deeply rooted.’ The character 疔 appears in several other terms:

耳疔 er3 ding1 – ear boil is defined as: ‘boil of the external auditory meatus’ – an example of circularity, as ‘boil’ is a separate term in the list (and because 疔 ding1, as a separate term, is ‘deep-rooted boil,’ I don’t think we can assume it is a synonym of ‘boil’). The word ‘boil’ is not defined as a separate term, but is presented as synonym in the definition of ‘furuncle’ – which is the term used for the Chinese 癤 jie1, and defined as: ‘an acute localized inflammation of the skin, having a hard central core, and forming pus, also known as boil.’

The character 癤 jie1 (as separate term ‘furuncle’), appears in the WHO list in:

螻蛄癤 [lou2 gu1 jie1] mole cricket boil (adopted from Wiseman)

消癰散癤 [xiao1 yong1 san4 jie1] disperse abscesses and boils

Questions arise:

Does it make sense that an ‘international standardized terminology’ retains boil and furuncle as synonyms, and also uses them for two differently defined Chinese terms?

Why doesn’t the list clarify whether there is a difference or not between ‘boil’ and ‘deep-rooted boil?’

The confusion becomes worse when we look at other terms in which the character 疔 ding1 appears:

鼻疔 bi2 ding1 is nasal boil – ‘a boil occurring at ….’ in definition;

舌疔 she2 ding1 tongue boil – ‘a pustule on the tongue’ is part of the definition;

脣疔 chun2 ding1 is lip pustule and ‘furuncle on the lip […] with pustule formation’ is part of the definition.

(To add to the confusion, pustule is the term used in the list for the Chinese 膿皰 (pus-blister), which is defined as “small circumscribed elevation of the skin, containing pus.”)

  • Where does this bring the teacher and the student?

For any person trying to gain a better understanding of these skin conditions and their manifestations, this is simply confusing. For my part, after several hours of investigation, my head was spinning.

If boil is furuncle, and furuncle is pustule, we have to conclude that 癤 jie1 = 疔 ding1 …, but we cannot, because the definitions are different ….

A terminologist would simply conclude: These terms are not logical and not systematic, and the conceptual relations are not reflected in the definitions.

If certain terms, according to the list, are synonyms, why do the definitions differ, and why does the committee suggest that we use different synonyms in different terms?

If the terms are not synonymous, why are the users of the list left with the problem of sorting it all out? How could it ever be sorted out in this way?

  • For 蛇頭疔 she2 tou2 ding1, the WHO has selected the term ‘snake-head whitlow.’

This is a curious term, since it is a mixture of CM (snake-head) and WM (whitlow).

The term suggests that it is a special form of whitlow. Is this true? The definition says: ‘a swollen fingertip resembling the head of snake, referring to digital pyogenic inflammation.’

Merriam Webster gives for whitlow: ‘a deep usually suppurative inflammation of the finger or toe especially near the end or around the nail.’

What, exactly, is the WHO’s motivation to use the Western medical term ‘whitlow’ in this term? And what, exactly, is the difference between the WM whitlow and CM snake-head whitlow?

Looking at all these confusing examples above, how can we take the WHO committee seriously when they present this as ‘international standard terminology?’

And what about ‘clove sore’ ?

In Wiseman & Feng’s Practional Dictionary of Chinese Medicine, we find 疔 ding1 as the first component of the term 疔疮 ding1 chuang1, which is translated as ‘clove sore.’ The definition says: ‘A small, hard sore with a deep root like a clove or nail, appearing most commonly on the face and ends of the fingers.’ At the end of the entry, we learn that the character 疔 ding1 is composed of a part signifying disease and a part meaning nail or clove. All other terms in which the character appears are translated consistently, and when there is correlation with a biomedically defined disease, the entry notes it. Several of the WHO terms with 疔 ding1 quoted above are not listed in the Practical Dictionary (they are, however, listed in Wiseman’s database). Two other terms with 疔 ding1, notably ‘red-thread clove sore’ and ‘clove sore running yellow,’ are, the last with the note that it correlates with WM septicemia. In the database (used by translators), there are 40 terms of different types of clove sore. For example, besides clove sore that looks like the head of a snake, snake’s-head clove sore, we also find: snake’s-back clove sore, snake’s-belly clove sore, snake’s-eye clove sore. Some terms with 疔 ding1 indicate the appearance, others the location. I mention all this, because if translators use the WHO list they would not have a clue how to translate unlisted terms with 疔 ding1 (should they use boil, pustule, or whitlow?). Wiseman and Feng’s approach is to make the system open-ended, meaning that it allows for new terms to be incorporated in a systematic and transparent way, without neglecting the Western medical correlation when available.

More problems with definitions and term choices in the WHO list

Lack of system in definitions

There is a severe lack of systematization in definitions of the WHO list. Some examples have already been mentioned above. To illustrate that this problem does not only occur in a few definitions, but is rampant throughout the list, I have listed some further examples:

  • ‘Abscess’ is the term selected for 癰 yong1. It is defined as: ‘A pyogenic infection with localized collection of pus buried in tissues or organs.’ The definitions of the various types of abscess included in the list show us that the WHO failed to apply a sound methodology. An ‘axillary abscess’ is defined as: ‘a pyogenic infection with abscess formation in the axillary region;’ an ‘gluteal abscess’ is defined as: ‘a pyogenic infection with abscess formation in the gluteal region’ and so forth. In a well-designed terminology, these definitions should be: ‘abscess in X, Y region’ (since ‘abscess’ is already defined). Furthermore, the character 疽 ju1 is often translated as ‘abscess’ as well, but the list fails to give us a definition of the separate term, nor does is indicate that 疽 ju1 is a synonym of 癰 yong1. It might be of interest to note that both characters appear in terms that are translated into biomedically defined diseases, such as in 乳癰 [ru3 yong1] ‘acute mastitis,’ which is defined as: ‘acute pyogenic inflammation of the breast.’ In short, if we compare all these definitions, we can only conclude that they give rise to confusion.
  • The term selected for zheng4 qi4 正气 is ‘healthy qi’ which, according to the definition is ‘… the same as normal/ genuine qi’. The definition of ‘genuine qi’ (the selected term for zhen1 qi4 真气) says: ‘… also known as true qi.’

If we take this at face value, zheng4 qi4 and zhen1 qi4 are synonyms; the WHO proposes the standard ‘healthy qi’ for the first and ‘genuine qi’ for the second; the WHO adds that the synonyms for zheng4 qi4 are normal qi and genuine qi, and the synonym for genuine qi is true qi.

How can the WHO committee expect users of the list to make sense of this? After a cursory look at the definitions, any terminologist, but also many educators who have to deal with this in class, will immediately scream and shout ‘They are different!’.

  • The two terms yuan2 qi4 原气 and yuan2 qi4 元气 (different characters yuan2) are translated with one term, ‘source qi’ and the definition says: ‘… the same as original/ primordial qi.’ Is this helpful? I’m not so sure. How is this motivated? What is primordial qi, and has it really been used in English literature to translate the two terms yuan2 qi4 in question? I think that is unlikely, and suppose it has been used as translation for 先天之气 xian1 tian1 zhi1 qi4, ‘qi4 of earlier heaven’ (‘innate qi’ in WHO terms). I may be wrong regarding this detail, but I guess anyone can see that this all is very confusing.

Note that the phrases ‘the same as’ and ‘also known as’ are used throughout the document to indicate what are supposed to be English synonyms of the terms that the WHO proposes to be the standard ones.

  • Static blood is defined as ‘a pathological product of blood stagnation ….’ but the definition concludes with ‘… the same as blood stasis or stagnant blood.’ Confusing, also because there is no mention of the term static blood nor of stagnant blood in the definition of blood stasis.
  • Hydramnios, selected for both 子满 zi3 man3 and 胎水肿满 tai1 shui3 zhong3 man3, is defined with the phrase: ‘that causing abnormally enlarged abdomen, sensation of fullness and dyspnea’ . There is no mention of pregnancy at all, although it may be that the first part of the definition is missing here. Hydramnios, by the way, is yet another WM term that is not very transparent; the second term literally translates: fetus water swelling fullness. Doesn’t Wiseman’s suggestion ‘water swelling and fullness in pregnancy’ make much more sense when you study Chinese medicine?

Polysemy, synonymy: the WHO non-solution

Several authors have written about the problem of Chinese medical terms having multiple meanings and the wide use of synonyms in Chinese medical discourse. While these problems are far from impossible to solve, the WHO list fails to even acknowledge them. I present a few examples below:

  • The term ‘qi collapse due to humor depletion’ is selected for 气随液脱 qi4 sui2 ye4 tuo1. Any translator wishing to use the WHO list would ask: Why ‘collapse’ and why ‘due to’? Since the WHO committee decided to translate the term 血随气逆 xue4 sui2 qi4 ni4 as ‘blood flowing counterflow with qi’; ‘qi collapsing with humor’ would have been the better choice if the WHO had been consistent. As a note, ‘qi4 deserting with humor’ as Wiseman and Feng translate 气随液脱 qi4 sui2 ye4 tuo1, reflects much better what is actually happening (the Chinese term consists of the words: qi-following-humor-escape from …).
  • The term 络 luo4 is translated as ‘collaterals,’ but 肺絡 fei4 luo4 is translated as ‘lung vessels’ in the term 肺絡損傷 fei1 luo4 sun3 shang1, and the term 络穴 luo4 xue2 is coined to the English ‘connecting point.’ If 絡 luo4 is a term with different meanings, the definition should tell us. However, 絡 luo4 is not recognized as a separate term in the WHO list.
  • There are also several instances of two different English terms for the same concept in different terms while there is no reason to do so (at least, the definitions do not motivate the choices): sun3 损 : ‘detriment’ and ‘collapse’ (‘collapse’ is used for tuo1 脱 as well in some terms); sheng4 盛: ‘excess’ and ‘exuberance’; jie2 结 : ‘binding’ and ‘accumulation.’ (just a few examples!)
  • The English ‘counterflow’ is adopted for 逆 ni4, but in the term 回阳救逆 [hui2 yang2 jiu4 ni4], 逆 ni4 is translated as ‘collapse’. The WHO fails to give us a reason why a different term should be adopted.

More problems with circularity

As we have seen from the example of terms with the component ‘abscess’ above, the WHO list neglects the principle applied in terminology to avoid the use of terms in definitions that are not defined themselves. Western medical terms are a special case in this respect. While the WHO decided to make use of an existing terminology to select terms for Chinese medical concepts, they also use WM terminology in defining terms. To illustrate how confusing this can be, I have listed a few examples. Please note that the problem of circularity overlaps the problem of term choice discussed above and in the last section below.

  • The term given for 昏厥 [hun1jue2] is ‘fainting,’ and the definition says ‘also called syncope.’ Syncope is the term used for 厥 jue2, and the definition of that term says ‘the same as collapse.’ Collapse does not have its own definition, but appears in terms like collapse of essence and yang collapse. What can we make of this? Again, I find it highly confusing.
  • The term ‘pyretic convulsion’ is used a few times in definitions for terms that include ‘febrile convulsion.’
  • The WHO proposes ‘tranquilize’ for 安神 [an1shen2] and defines this concept with: ‘a general term for tranquilizing measures.’ Regardless of the question whether a term like this is not doing a disservice to the transmission of concepts, the obvious problem with the definition is that the term ‘tranquilize’ is not defined.

Inconsistency of term choices

If you compare terms in the list, it is impossible to overlook the inconsistencies. Several examples have already been given above; here are a few more:

  • One term is given for 固表止汗 [gu4biao3 zhi3han4] and 斂汗固表 [lian3han4 gu4biao3]: The WHO proposes ‘secure the exterior to check sweating’ for both. This seems quite reasonable, until we find the terms:

固表止汗藥 [gu4biao3 zhi3han4 yao4], which the WHO translates as ‘exterior-securing anhidrotic medicinal,’ whereas for the term

斂汗固表藥 [lian3han4 gu4biao3 yao4] the WHO proposes ‘sweat-constraining exterior-securing medicinal.’

In the logic of the WHO, 止汗 is synonymous with 斂汗 in the first two terms above, but later, we find 止汗 translated as ‘anhidrotic’ and 斂汗 as ‘sweat-constraining.’ I think it is obvious that if you say that the first two terms are synonymous, this should be reflected in the subsequent terms (as the components 止汗 and 斂汗 do not suddenly mean something different there).

  • If 攻下藥 [gong1xia1yao4] should be translated with ‘offensive purgative medicinal,’ why should 攻下劑 be rendered with ‘purgative formula?’
  • Why does the WHO use two different words for 瀉 xie4 (drain/draining and purge/purgation) where it clearly refers to one concept? The list seems to suggest that 瀉 means ‘to drain’ in acupuncture and ‘to purge’ in medicinal therapy. No explanation, however, is given about that different usage.

The famous quotation 實則瀉之 [shi2 ze2 xie4 zhi1] is translated as: ‘treat excess conditions by purgation or reduction.’ Whether ‘reduction’ is the same as the WHO usage of ‘draining’ we cannot find out from the list, as no separate definitions are provided.

The term 瀉火 [xie4huo3], ‘purge fire’ (and also purge the lung; purge the heart etc), we may note, seem to be reserved by the WHO for therapeutics using medicinals, since the definition is: ‘a therapeutic method of removing pathogenic fire by using bitter-cold medicinals.’ Even this, however, is not done consistently, since 瀉下劑 [xie4xia4ji4] is ‘purgative formula’ and 瀉火劑 [xie4huo3ji4] ‘fire-draining/reducing formula.’

If you look up ‘purgation,’ you will see that the list uses it for both 下法 [xia4fa3] and 瀉法 [xie4fa3]. To add to the confusion, 下 is ‘laxation’ in a few terms, and ‘purgation’ in others, whereas in the definition of these terms, ‘relieving constipation’ and ‘inducing bowel movement’ are crucial to the explanation – there is no conceptual difference in usage to justify different terms.

Miscellaneous problems

  • The term ‘vagina’ is listed, but ‘penis’ is not.
  • The list has: vomiting, retching, belching, and then: “choke” (instead of ‘‘choking”).
  • The spelling errors and erroneous usage of English grammar make the list difficult to search systematically.

These last examples may be categorized as nitpicking on my part, but since they are not isolated -there are more omissions and errors like this in the list – I think they should be mentioned, since this list is intended to be used by publishers, translators, and other institutions.

Many more examples of inconsistency and downright terminological confusion can be given. It has not been my intention to make a systematic analysis of the list. However, the more I look at it, the more problems I find.


A terminology of a certain subject-field is used for educational purposes, to design scientific studies, to translate documents, and as a tool in clinical practice. It can only serve as a reliable tool if conceptual relations between the concepts are reflected in the terms and definitions. Several examples have shown that the WHO term list is nothing more than a list of terms; it is impossible to say it is a terminology. Many terms are not well-motivated, many definitions are unclear and cause confusion, and the relations between concepts are not indicated.

The WHO list offends internationally accepted terminological principles on several levels. As such, it will fail to serve as a reliable instrument for translators and educators. Although the list can be seen as reflecting an important step that has been taken, namely that of acknowledging that the terminology of Chinese medicine should be described and standardized, an (albeit superficial) analysis of the terms and definitions, and the way they are connected, leaves little option but to conclude that it needs to be thoroughly revised (if not completely re-done) if it aspires to become a tool for further development of knowledge in the English speaking and reading world. Moreover, since many term choices and definitions appear to be primarily guided by the trend toward biomedicalization of Chinese medicine, the questions: To whom is this list addressed? and What is its purpose? are utterly legitimate.

N. Herman Oving, September 2007.

You can find the WHO term list, WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region (2007; ISBN 978 92 9061 248 7) on:

WHO term list

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Heaven, above and below


About impersonating a character and some history and medicine

Nicolaas Herman Oving

When I teach Chinese medical Chinese classes ‘live’, one of the characters I most like to introduce is . A reason for that is that it is so demonstrable—physically demonstrable. First, there is [rén]. Stand still, arms hanging down, and legs apart: . Then, stretch your arms wide: [dà]. The step towards requires more. While standing like , first focus on your head, then let thoughts about the big wide space around and above you fill your head, making it larger and larger.

The best is to do this exercise outside, standing on real soil if possible. Also, try it on a clear night on a location where you can see stars.

The concept of  is also interesting from an historical perspective. It played an important role in the earliest forms of religion we know of and remained to be crucial in the structures of political power as well. From the earliest written records found and deciphered thus far, we have come to understand that in the early cultures we now call ‘Chinese’, divinity was experienced as ‘a complex network of integrated supernatural influences rather than as a power represented in the figure of a single antropomorphic deity’ (Major, p. 169).

During the Shang, the top part of that hierarchically structured network consisted of the deceased ancestral kings who were named Di after they passed on. Above them stood Shang Di, the ‘High God’ (上帝 [Shàngdì]). Ancestor worship and rituals for the dead (at their funerals, but to be continued after that) formed the core of religious life. 上帝 can be seen as ‘the ancestor of all ancestors’. During the Zhou, the top position was occupied by [tiān], Heaven. Shang Di became one aspect of this larger power, Heaven. Heaven became the highest focus of worship. In relation to this, the ruler who stood on top was not longer called a king ([wáng]) but bore the title of  天子 [tiānzǐ], ‘Son of Heaven’. The Son of Heaven carried out the Mandate of Heaven 天命 [tiānmìng] (can also be rendered as ‘command’), and the state he ruled, viewed as the cosmic center, occupied ‘All Under Heaven’  天下 [tiānxià].

The concept of heaven as overarching power that entrusts rulers with carrying out its mandate was projected on the past and formed a central idea in myths of origin. It continued to play a crucial role throughout history, and changes of power in China are always associated with the ‘losing of the Mandate of Heaven’.

Towards the end of the Warring States period the meaning of  shifted from ‘heaven’ towards ‘heaven/nature’. We can see this as the beginning of a process of demystification and rationalization that took more shape during the Han and in the formulations of the principles of Chinese medicine. The concept of heaven, or ‘heaven/nature’, became essential in Chinese medical philosophy.

The definition and explanation in the Practical Dictionary of Chinese Medicine reads:


tiān : The sky or heavens; the highest cosmic principle or force.

The Chinese concept of heaven includes not only the physical sky or space covering the earth, but also weather and the seasons, and the notion of Nature and the forces and laws that govern it.


In the realm of politics, heaven is (or was believed to be) able to give indications to rulers whether their government was sound or not. Natural phenomena such as specific star constellations, floods, plagues, etc. were the means of heaven to do so. Likewise, in the realm of medicine, heaven (and earth) indicators could warn humans about improper government of their individual bodies. (see Suwen 20)

Furthermore, in the system of correspondences that is seen as the foundation of Chinese medical thinking, heaven is yang and earth is yin – as stated in Suwen 29:




Yang is the qi of heaven. It governs the outer body.

Yin is the qi of earth. It governs the inner body.


A large part of physiology and pathology in Chinese medicine is an elaboration of these central concepts.

Heaven also plays a crucial and specific role in the doctrine of the Five Periods and Six Qi (五運六氣 [wǔyùn liùqì]) as documented in Suwen 66-74. This section, almost one third of the entire Suwen text, is discussed in detail in an appendix of Huang Di neijing suwen – Nature, knowledge, imagery in an ancient Chinese text – P. Unschuld’s introduction to his Suwen translation.

As can be glimpsed from this brief overview, the concept of  plays an important role in the religion, politics, culture and philosophy of China. What makes it of even more interest for me is that I carry this character with me all the time. I can express it with my body and, while doing that, reflect on the meaning of life. It tells a story in a beautifully simple way.






上帝 [Shàngdì]

天下 [tiānxià]

天子 [tiānzǐ]

天命 [tiānmìng]



– Major, John S. and Constance A. Cook, Ancient China – A History, Routledge, 2017.

– Unschuld, Paul U., Huang Di nei jing su wen – Nature, knowledge, imagery in an ancient Chinese text, University of California Press, 2003.

– Wiseman, Nigel and Feng Ye, A Practical Dictionary of Chinese Medicine, Paradigm Publications, 1998.



Chinese herbology (simplified Chinese: 中药学; traditional Chinese: 中藥學; pinyin: zhōngyào xué) is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in traditional Chinese medicine (TCM). A Nature editorial described TCM as “fraught with pseudoscience“, and said that the most obvious reason why it has not delivered many cures is that the majority of its treatments have no logicalmechanism of action.[1]

The term herbology is misleading in the sense that, while plant elements are by far the most commonly used substances, animal, human, and mineral products are also utilized. In the Neijing they are referred to as 毒藥 [duyao] which means toxin, poison or medicine. Unschuld points out that this is similar etymology to the Greek pharmakon and so he uses the term ‘pharmaceutic’.[2] Thus, the term “medicinal” (instead of herb) is usually preferred as a translation for 药 (pinyin: yào).[3]

The effectiveness of traditional Chinese herbal therapy remains poorly documented.[4] There are concerns over a number of potentially toxic Chinese herbs.[5]