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

Nicolaas Herman Oving

Nicolaas Herman Oving – practitioner, translator, and educator in the field of Chinese Medicine

Prone to an adventurous life, Nicolaas Herman Oving’s passions shift with locations and seasons. Traveling in Europe, China, and the United States he learned about different peoples and their life ways, all the while gaining a respect for their Eastern and Western knowledge traditions. Between these travels he earned a degree in sinology and studied the theory and practice of Chinese medicine.

After formally studying Chinese languages and cultures in the Netherlands and China, Nicolaas studied Chinese medicine at a private school in the Netherlands. He has practiced herbal medicine in different clinics, including one he established with a colleague. More recently, he has taken a hiatus from the clinic to devote himself to the translation of Chinese medical texts, and to grow vegetables, fruit, and medicinal plants.

Having gained notable success, Nicolaas has published translations of several key works. In 2007, he published an annotated translation of Wang Qingren’s foundational text, the Yilin gaicuo (Correcting the Errors in the Forest of Medicine). More of Nicolaas’s translations are available on the Chinese Medicine Database website. Some Dutch and English versions appeared in journals such as the European Journal of Integrated Eastern & Western Medicine and Nederlands Tijdschrift voor Acupunctuur. He is currently working on translations of two texts by Tang Zonghai (a.k.a. Tang Rongchuan; second half of 19th century): the Bencao wenda (本草問答 – Questions and answers on materia medica – see his introduction to this text here), a text discussing the way medicinal plants grow and look in relation to what they do therapeutically, and the Xuezhenglun, an influential text on blood and bleeding patterns. Another project on his desk is a translation of Wu Youke’s (a.k.a. Wu Youxing) Wenyilun (瘟疫論 On Warm Epidemic; mid 17th century). He hopes to publish these translations in the near future.  Having done editorial work for Nigel Wiseman and Paradigm Publications, he now provides private advice regarding Chinese medical terminology to several teachers and students.

Nicolaas has taught Chinese medical language and terminology since the year 2000 when he wrote a course for Dutch acupuncturists. He taught that course for seven years to groups of physician-acupuncturists and practitioners of various accreditations. In 2007 he set up an online course in Chinese medical Chinese (in English), which has become one of his great pleasures.


Online Courses in Chinese Medical Chinese

Learn to Read Chinese Medical Chinese

with Nicolaas Herman Oving

The general goal of the courses is to become able to read Chinese medical texts. The course will help you to develop a deeper understanding of concepts in Chinese medicine through the study of characters and their use in classical texts. The characters are traced to their origins, and placed in the context of the medical classics.

The design of the program takes into account that many students, practitioners, and teachers do not have much time available. An investment of one hour per day will result in your ability to begin reading real texts within a year.

Block A: Basic terminology of Chinese Medicine

  • individual guidance with feedback on homework, quizzes and tests
  • focus on memorization of handwritten characters
  • reading materials on philosophy and history of Chinese medicine
  • interaction with fellow students
  • experienced and accessible teacher
  • new for 2024: you can meet your teacher online

You can find a page with a more detailed description here.


Due to the rising costs for accreditation with the NCCAOM and the California board, we have discontinued all accreditation.  However, if you need accreditation units for this course and are willing to pay an extra fee, we can consider to re-apply. 


For students who already have basic knowledge and want to start with B & C as soon as possible, please see our Fast Track Block A option.


Block B: Basic grammar of Chinese medical language

  • continuing study of terminology
  • grammar of Classical Chinese: a thorough introduction
  • examples from Chinese medical texts
  • learn by doing: exercises, quizzes, and tests

Block C: Reading medical literature

  • reading and translating excerpts from Chinese medical literature
  • focus on value for the practice of Chinese medicine

After completing the three blocks, there is the possibility of continuous advanced study (private or in a small group).

For further information, questions and enrollment, please contact Nicolaas via hermanoving@yahoo.com

Questions and Answers on Materia Medica

A Short Introduction to Tang Zonghai’s Běncǎo wèndá

In the vast corpus of the běncǎo or materia medica literature of China, Tang Zonghai’s (唐宗海, 1862-1918) Questions and Answers on Materia Medica (本草問答) occupies an exceptional place. Tang, also known by his style or courtesy name Rongchuan (容川), wrote it late in his career at the request of one of his followers who argued that, because of all the trees (the enormity of information in the existing literature), it had become impossible to see the forest. The ability of one drug to cure a hundred diseases, as described in the materia medica, had made it hard, if not impossible, to cure even one disease. Another point in his argument to convince Tang to write the book was Tang’s knowledge of Western medicine. Through an exposition of general principles, the nature and action of both Chinese and newly introduced Western drugs could be extrapolated.

Tang is recognized as one of the main proponents of the movement to integrate Western and Chinese medicine. This is extensively reflected in his oeuvre, first and foremost by his Quintessence of the Medical Classics in view of the Convergence of China and the West (中西匯通醫經精義). While he embraced new knowledge from the West, he also countered the ridicule of Chinese medicine by Western scientific circles with elaborate and astoundingly convincing arguments. In fact, he utilized Western anatomical drawings to give further evidence for concepts like qi transformation. In the first section of the Běncǎo wèndá, after explaining how the ancient Chinese arrived at their knowledge of the viscera and bowels, he wrote:


Moreover, the Western world’s anatomical observations only [lead to] knowledge of layers and broken up [fragments] but not of channels and vessels, and they [lead to] knowledge only of traces of forms but not of qi transformation. [Western medical science] and China’s contemporary medicine each have their strengths and weaknesses, but if we compare with the ancient sages, the [Huang Di] neijing and the [Shen Nong] benjing, [the knowledge of] the Western world does not come close!

Tang also contributed substantially to the theory and clinical treatment of diseases of blood, as reflected in the key work On Blood Patterns (血證論). His elaborate thinking about the formation of and relation between qi and blood is apparent in Questions and Answers on Materia Medica as well.

In the course of that latter text, we are guided from the general to the specific. Philosophical questions are raised in the first set of questions. Why are animal, mineral and herbal substances, being of different classes than humankind, able to treat illness in humans? How do substances achieve their nature? How do methods of observation inform medical theory, and why is the ancient method of observation and tasting of drugs not inferior to the Western method of proving efficacy? As the questions begin to focus on groups of, as well as individual medicinal substances, Tang manages to swiftly move back and forth from theory to practical implications. A recurring question is: Why do drugs do what they do, such as up- and downbearing, floating and sinking, attacking and harmonizing, supplementing and draining? In the answers, Tang demonstrates the relevancy of environment, growth patterns (form, color, qi, and flavor) and/or timing and method of both harvesting and processing. The writer manages to capture and hold the reader’s attention by avoiding dry facts, choosing instead an enjoyable style of informative story-telling. The thorough investigation of how the action and quality of huángqí (astragalus root) depend on where and how it grows, is a fascinating example of this. He also explains several aspects of medical theory in new ways and combines them directly with clinical applications.


flowering-astragalusflowering astragalus 黃芪

An interesting aspect of his answers to questions on why drugs with the same flavor can have different actions is that he proposes and illustrates a refinement of established theory. All the five flavors (sweet, bitter, acrid, sour, and salty) are true to their original nature when ‘normal’, but their action transforms when they are ‘extreme’. For instance, ‘slight bitterness’ has the original nature of fire and thus the ability to warm heart fire, but ‘great bitterness’ turns into the opposite and acquires the cold nature of water (established theory holds that ‘bitterness can drain’). He combines this with what Xu Lingtai (Xu Dachun) already noted about the actions of medicinals, namely that these can variously depend on their particular qi, flavor, color, form, substance, or time and location of growth.

With all these insights partially introduced and illustrated with examples in the 75 questions, the reader gains an understanding of many principles regarding the medicinal actions of some 340 medicinals and 35 formulas. The analyses offered by Tang have the potential of widening and deepening the foundation of the practice of Chinese medicinal therapy. The writer himself says: “Although this tome is not exclusively a běncǎo book, still all the essential meanings of the běncǎo are contained in it.”

Even though the text, rich in diversity as it is, ought to be read in its entirety to fully benefit from it, the following excerpts may serve to give a first impression:


問曰 入氣分入血分,其理未易明也,請再言之。

Question:  The principles of ‘entering the qi aspect’ and ‘entering the blood aspect’ are not easy to understand. Could you please elaborate on this?

秉於天水而生者入氣分,秉於地火而生者入血分。 氣本於天,味本於地,氣濃者入氣分,味濃者入血分。 入氣分者走清竅,入血分者走濁竅。 有如大蒜,氣之濃者也,故入氣分走清竅,上為目瞀而下為溺臭。 海椒味之濃者也,故入血分走濁竅,上為口舌糜爛而下為大便辣痛。 觀此二物,即知入氣分入血分之辨矣


That which grows by grasping from heaven and water, enters the qi aspect. That which grows by grasping from earth and fire, enters the blood aspect. Qi is rooted in heaven. Flavor is rooted in earth. Concentrated qi enters the qi aspect. Concentrated flavor enters the blood aspect. That which enters the qi aspect travels to the clear orifices. That which enters the blood aspect travels to the turbid orifices. Dàsuàn (garlic), for example, is concentrated qi, and thus enters the qi aspect and travels to the clear orifices. Ascending, it creates visual distortion, descending, it leads to fetid urine. Hǎijiāo (= làjiāo, hot pepper) is concentrated flavor; therefore, it enters the blood aspect and travels to the turbid orifices. Ascending, it causes ulceration of the mouth, and descending, it leads to hot painful stool. If you look at these two substances, you will understand the distinction between entering the qi aspect and entering the blood aspect.

蓋得天水之氣而生者入氣分, 人參、黃芪最顯者也。 外如澤瀉、苡仁生於水而利水,二物同而不同。 苡仁生於莖上則化氣下行,引肺陽以達於下。澤瀉生於根則化氣上行引腎陰以達於上。百合花覆如天之下垂,旋覆花滴露而生,本天之清氣,故皆入氣分,以斂肺降氣。

As for those [medicinals] that grow by acquiring the qi from heaven and water and enter the qi aspect, rénshēn (ginseng) and huángqí (astragalus) are the most obvious [examples]. Other examples are zéxiè (alisma) and []yǐrén (coix), that grow in water and [have the ability to] disinhibit water. The two substances are similar yet different: []yǐrén grows on a stalk and so moves downward when it transforms qi. It draws lung yang to reach down to the lower body. Because zéxiè grows down at the root, the transforming qi moves upward, and [consequently] it draws kidney yang to reach to the upper body. Bǎihéhuā (flower of the tiger lily) is turned upside-down as if it droops down from heaven. Xuánfùhuā (inula flower) grows from dripping dew. They [express] clear qi rooted in heaven; therefore, both enter the qi aspect in order to constrain the lung and downbear qi.



百合花 flowering tiger lily

[… …]


The color of hónghuā (carthamus) is red. It naturally enters the blood aspect. Its flavor is bitter, so that it has the special ability to discharge blood. Moreover, the nature of all flowers is to govern lightness and buoyancy. They move upward and travel to the exterior. Thus, [the action of] hónghuā is to discharge blood in the skin, vessels and networks at the external and upper [body]. []dānpí (moutan)’s color and flavor is of the same category as hónghuā, but the nature of roots is to reach downward, which is different from flowers. Therefore, it governs the inner body and discharges blood of the center and lower burner.



紅花 carthamus, dried flowers


Táohuā (peachflower) is red and the flavor of the kernel (táorén) is bitter. They both acquire their nature and flavor from earth and fire. The kernel additionally has vital qi. That is why táorén has the ability to both break blood and engender blood. Qiàncǎo (madder)’s color is red, its flavor bitter, and its root is very long. Therefore, its power to move downward is rather strong, and its special ability is to downbear, discharge and move blood.

問曰 大黃苦寒之性自當下降,而巴豆辛熱之性,宜與大黃相反,何以亦主攻下? 而較大黃之性尤為迅速,此又何說?

Question:  The nature of dàhuáng (rhubarb) is bitter and cold, so it naturally should precipitate and downbear, whereas bādòu (croton), which has an acrid and hot nature, should do the opposite of dàhuáng. Why then does it also govern offensive precipitation, and how can it be explained that compared to dàhuáng‘s nature it is even more rapid?



大黃 rhubarb root



Here, as well, it is by its oily slipperiness that it governs downbearing. Its ability to downbear is singularly governed by that oily slipperiness and not by its acridity and heat. Whenever you eat máyóu (sesame oil) or dāngguī (Chinese angelica root), they are able to lubricate and precipitate the stool. Bādòu and bìmázǐ (castor bean) both contain oil, and both are lubricating and can precipitate stool. However, sesame oil is not hot, so its moving [action] is slow. It is not acrid, so its qi is not mobile and penetrating. Therefore, it is slow in its precipitation of stool. The flavor of castor bean is acrid and its qi is warm. This means that it has qi to move its oily-slippery nature; therefore, its movement is rapid. The slippery nature of bādòu oil is similar to that of máyóu and bìmá[], but it is highly acrid and thus harsh; highly hot and thus fierce. Because it carries out its lubricating and disinhibiting harshly and fiercely, it plunders without lingering.


[Huǒ]márén (cannabis seed) is also oily and slippery, but it does not have an acrid and harsh nature. Hence, it is only able to moisten and downbear and cannot rapidly precipitate. Tínglì[] (lepidium/descurainia seed) has oil as well, and naturally can lubricate. It also has an acrid flavor and is similar to acrid and oil-containing bādòu. Its flavor is bitter as well, so it also resembles bitter, lubricating, and moistening dàhuáng. In that way tínglì[] harbors the natures of bādòu and dàhuáng; therefore, it has the ability for major drainage of phlegm-rheum, pus, and blood from the lung. Its nature is extremely rapid downbearing. As it has the combined natures of dàhuáng and bādòu, it is a truly fierce medicinal. Out of fear of it being overly drastic [Zhang] Zhongjing insisted on ameliorating it with dàzǎo. Xìngrén (apricot kernel) contains oil as well, but it acquires a bitter flavor and lacks an acrid and harsh qi. Thus, it downbears but not urgently.


問曰 藥有以天時名者如夏枯草、款冬花,得無以時為治乎

Question:  There are medicinals that are named after the seasons, like xiàkūcǎo (prunella) and kuǎndōnghuā (coltsfoot). Isn’t it so that what they treat is in accordance with [those] seasons?

{translator’s note: [xià] = summer; [kū] = wither; [dōng] = winter; [huā] = flower}




Now, the [seasons or] heavenly periods [correspond to] the movements of the five phases and are observed as distinctions of yin and yang. Therefore, whenever we discuss medicinals, we also must discuss the seasons in which they grow and the periods in which they mature. Although it is not always so that the treatment [abilities of medicinals] are restricted by the [influences of] seasons, still there are those that derive them from the seasonal [influences]. Xiàkūcǎo grows at the end of the winter and matures during the three months of spring. This means that it principally acquires the qi of water and wood. Once summer arrives, it withers; when wood comes under the command of fire, the qi retreats and declines. That is why [xiàkūcǎo] is used to abate fire in the liver and gallbladder channel.

Kuǎndōnghuā grows in the icy and snowy winter months, and its flowers are also at the base of the root. As kan (water) contains the manifestation of yang (represented by the center line of the trigram), it therefore has the ability to draw yang qi from the lung downward and thus is a phlegm-disinhibiting and cough-suppressing medicinal. The two substances are named after the season [in which they grow] as both acquire the subtle effect of that season.

Questions and Answers on Materia Medica is full of little gems in between enlightening insights in the working of medicinals. Why do bones not rot after death, and what profundities are hidden in the relationship between blood and hair? How do you obtain bezoar from oxen, and why is it that you can treat disease with the product of a disease? What medicinals should be used for different kinds of phlegm and why? Master Tang’s explanations are sometimes surprising and do not fail to offer modern practitioners new ways of thinking about their pharmacies.



See the Appendix below for a list of discussed medicinals with their Chinese, pinyin, common English, and Latin pharmaceutical names.

Nicolaas Herman Oving is the author and translator of this introduction and he can be reached via hermanoving@gmail.com. This article was first published on Aowen Chinese Medicine, December 2016. Nicolaas wishes to thank Nadine Luchtman-Levie for her editorial work.

All photography, except for the flowering tiger lily, is by the author.  Please contact him if you want to use any of the photographic materials.

Sharing, copying, printing, etc. of the entire article is not allowed without permission of the author.  For citations, please add the author’s name, the title of the article, and the web address of publication.

For a printable version of this article, see pdf of intro bencao wenda

An annotated translation of the complete text of the Bencao wenda will be published in the near future.  



List of medicinals in order of appearance in the text

*note: Latin pharmaceutical names are chosen instead of botanical names because they indicate parts used and are thus more relevant for the practise of medicine.

Chinesepīnyīncommon EnglishLatin pharmaceutical*
黃芪huángqí astragalusAstragali Radix
大蒜dàsuàn garlicAllii Sativi Bulbus
海椒 = 辣椒hǎijiāo = làjiāohot pepperCapsici Fructus
人參rénshēnginsengGinseng Radix
澤瀉zéxiè alismaAlismatis Rhizoma
[薏]苡仁[yì]yǐréncoixCoicis Semen
百合花bǎihéhuālilyLilii Flos
旋覆花xuánfùhuāinulaInulae Flos
紅花hónghuācarthamusCarthami Flos
[牡]丹皮[mǔ]dānpímoutanMoutan Cortex
桃花táohuāpeachflowerPersicae Flos
[桃]仁[táo]rénpeach kernelPersicae Semen
茜草qiàncǎo madderRubiae Radix
大黃dàhuángrhubarbRhei Radix et Rhizoma
巴豆bādòucrotonCrotonis Fructus
麻油máyóusesame oilSesame Oleum
當歸 dāngguīChinese angelicaAngelicae Sinensis Radix
蓖麻子bìmázǐ castor beanRicini Semen
[火]麻仁[huǒ]máréncannabis seedCannabis Semen
葶藶[子]tínglì[zǐ] lepidium/descurainia Lepidii/Descurainiae Semen
大棗dàzǎojujubeJujubae Fructus
杏仁xìngrénapricot kernelArmeniacae Semen
夏枯草xiàkūcǎoprunellaPrunellae Spica
款冬花kuǎndōnghuācoltsfootFarfarae Flos




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]