WHO's term list

August 15, 2007

Just noticed this thread and it seems that a few clarifications need

to be made…

It was mentioned recently on CHA that I was at the WHO (World Health

Organization) meetings on terminology; this is not true. The meetings

I attended in Beijing were for the WFCMS (World Federation of Chinese

Medicine Societies), which is a government division in China that is

associated with China's State Administration of TCM ( " SATCM " ). These

three larger groups have each been working on English language CM

terminology standards for several years. (Both WFCMS and WHO had

extensive term meetings and voting procedures, so this probably

accounts for the confusion in these postings with regard to the

meetings.) SATCM is the main authority representing the Chinese side

in the WHO term committees. While the WHO is an international group

(this discussion particularly revolves around the Western Pacific

region of the WHO), China's SATCM is mostly a domestic umbrella

division over the TCM field in the PRC.

The current thread on CHA is referring to the newly-published term

list from the WHO (these acronyms are making me dizzy). I have been

following the WHO terminology discussions largely because I spent the

past three years studying with Nigel Wiseman, who was on the WHO

committee at the time. During that time, I attended the WFCMS

meetings in Beijing, translated for a Chinese publisher and a US

publisher, and generally ended up paying attention to most of the

major trends, figures, perspectives and politics involved in this

stuff. However, the recent web publication of the WHO list was the

first time I'd seen any definitive result from the WHO discussions so

long ago.

The WHO efforts to create standardized terminology are connected to

their development of ICD-11 codes for future use. Currently, the USA

uses ICD-9 codes for medical diagnosis and billing, while many other

countries use ICD-10 (the 9th and 10th in the series). Because

traditional medicine is a significant part of East Asian healthcare

and the WHO is generally seeking wider recognition of traditional

medicines worldwide, there needs to be a way to integrate the

diagnosis and treatment of fields like Chinese medicine into the

larger medical system. In addition, the medical world is going

increasingly digital and practical necessity requires electronic

storage and retrieval of information, which can only be done when

language is used consistently. The WHO Western Pacific region alone

includes China, Vietnam, Mongolia, Korea, and Japan, all of which

currently enjoy little access to information written in the languages

of their neighbors, despite their similarities in medical practice.

Without question, term standards are necessary if there is to be a

true international community and flowering of knowledge in the field.

There has been some CHA discussion about methodology and comparative

term lists. There is most definitely a methodology implicit in most

substantial term lists. Nigel Wiseman's terminology has a very

consistent methodology, and Xie Zhu-Fan has a different but

substantial methodology. They primarily differ from each other in

that Dr. Xie's term choices tend to favor biomedical expression, while

Dr. Wiseman tends to favor source-based translations that preserve

traditional concepts. As these two scholars are the primary figures

in the international community who have developed extensive term lists

based on a stated methodology, their term choices were the primary

ones represented at the WHO. Experts from the various countries voted

on the terms that they felt were most appropriate.

The experts involved with the voting represented a spectrum of doctors

of varying orientations. Some favor a more traditional approach,

while others favor a more biomedicalized approach. The WHO term list

contains around 5000 terms, and it is a parallel project to their

recent standardization of acupuncture point locations and medicinal

names. It is one of the most impressive displays of unity between

China, Japan, and Korea that the East Asian medical world has ever

known, and that alone is a dramatic achievement. While the WHO term

list has its flaws, its development heralds a certain level of

academic maturity in the field as a whole.

A valid criticism that has been raised by Z'ev is the inherent

inconsistency in a term list that is assembled by voting, since it

naturally includes elements from each of the two term lists presented.

Because each of the two lists was built upon certain principles, the

WHO term list is fundamentally based on solid methodology; it does,

however, represent a mixture of two term sets with different

methodology. Thus, it is less consistent than Wiseman's system, but

it does appear to have some substantial principles intact. For

example, the different terms for abnormal discharge of semen are

differentiated in the WHO document. Conditions of various types of bi

syndrome such as blood bi are referred to as blood impediment, while

bi syndrome patterns closely linked to joints are referred to as

arthralgia. This latter example obscures the common thread between

the two conditions (i.e., the fact that both are bi patterns), but it

does maintain their clinical distinction: blood impediment is

primarily characterized by numbness of the extremities, whereas the

conditions called arthralgias are in fact referring to joint pain.

While I would personally have just kept impediment for the joint pain

too, at least the variance is clinically accurate.

To a certain extent, the terms chosen represent a political

compromise, a balance between biomedical and traditional camps. The

terms could also be perceived as a balance wherein Wiseman's

comprehensive framework is used with a few substitutions of popular

common terms such as pathogen, excess, and deficiency. Thus, the WHO

term list is a very useful and neutral balance point upon which other

Western publishers can relate their terminology. There are individual

terms to debate, and there are a few inconsistencies in the term list,

but it is overall a great achievement.

The WHO document is likely to have a significant effect in Asia,

particularly among practitioners of integrative medicine. For the WHO

document to have a significant effect in the US, it will need to

penetrate into common use. Creating an interface between all the

terminologies is a natural starting point for the discussion, because

then all the various term choices can be compared and individual

arguments or errors can be sorted out. At the very least, there would

be a system intact that related all the various terminologies to each

other.

Once a comprehensive comparative list is assembled (it's done already,

in fact), the examinations could move over to the WHO system, which is

the essential thing that would need to happen to achieve a meaningful

nationwide effect. At present, the examinations have a deplorable

lack of transparent terminology, which is really inappropriate for a

medical field. However, in order to maintain commercial neutrality,

the examinations will likely feel pressured to apply a terminology

that is not connected to any given publisher. Thus, the WHO

terminology could be a good starting point for such a discussion.

I have compiled a database with Nigel Wiseman's terminology, Xie

Zhu-Fan's terminology, the WHO terminology, and Eastland Press' draft

glossary. I would like to add an additional field for the WFCMS' term

suggestions, but that list has not yet been published. I'll be

bringing this list to the AAAOM meeting in Portland, and I hope that

it could be used as a future basis for discussion. I think there will

always be some degree of variance when it comes to the terms that

people use, but at least there will be a way to connect it all

together and trace it back to the original Chinese concept.

Non-Chinese medical concepts masquerading as real Chinese medicine is

an endemic problem in the field in Western countries, and an

integrated resource like this would be a good basis for discussion for

those inclined towards accuracy.

I can already see that there are a few terms in the new WHO list that

will never stick with Western speakers. Someone already pointed out

triple energizer for san jiao. San jiao itself is not acceptable

because pinyin should be minimized in international use; China's

rising influence and tendency to dominate TCM discussions can be a

sore point between China, Japan, and Korea, so choosing Chinese pinyin

as a global standard isn't very sensitive to the overall needs of the

larger community. Triple burner is the obvious choice because that is

the term that Westerners generally use, but in this case the WHO kept

their old term, triple energizer. Interestingly, the WHO had tried to

create a much smaller list of terms way back in the days when

international point nomenclature and stuff started getting sorted out,

and triple energizer was a relic of those days. It now stands as a

symbol of the term graveyard where terms that never caught on lie

forever unnoticed, except by committees. And there's no doubt that

crapulent syncope is not going to stick.

A few terms like depression and stagnation are sometimes

well-differentiated in the WHO list but are occasionally mixed up,

presumably this comes from the voting on individual terms. On the

other hand, they do seem to have wheezing and dyspnea properly

differentiated, which is all too often not done in English books. To

me, the list overall looks quite balanced, there are only a handful of

terms that I'd be uncomfortable with as a translator, mostly issues of

biomedicalization where I am not sure enough that the biomedical term

is equivalent. I admit that I'll probably continue to use mostly

Wiseman terminology for my own work because it is so comprehensive,

and I generally agree with Nigel's arguments for most of his term

choices when I really look at the meanings of the terms. There are

many ways that the WHO list falls short of his work, and a committee

cannot create the consistency of an individual, but a committee does

have a larger ability to accept many small compromises and create

progress for the field on a grander scale than an individual can

achieve. For that reason, I welcome the WHO's contribution to the

field, I think it is monumental that they have recognized the

complexity and depth of East Asian medicine and their goal to preserve

this information accurately is noble.

I'd be pleased if the WHO list could be used as a way to bring the

community together. In the past, the only comprehensive terminology

system was Wiseman's; while many would argue that Wiseman's remains

the most accurate in relation to the original Chinese, there are

people who dislike his use of terms like vacuity and repletion. It

seems that this seemingly minor issue has escalated into an entire

debate about terminology, when in fact the terms that are in actual

debate are relatively few in number. What we need as a community is

to find a common ground so that all of the major publications can be

linked together. In turn, that can link us to the wider world beyond

the US, which is going to be going in the WHO direction regardless of

what we do here.

Someone put a link to the Eastland/PD comparative term list that I

made. All the term lists can be found on the files section of CHA,

they are already posted. The Eastland/PD/Xie list is by far the

smallest of the lists. The Eastland draft glossary only contains 1200

terms or so, while the WHO list contains over 4000. Xie Zhu-Fan's

contains 4000-5000 (if memory serves), which Wiseman's list contains a

whopping 30,000 terms. If one looks at only one list, one risks

taking the issue totally out of context. A translator doesn't need a

list to pick their favorites out of a dozen words, they need a

comprehensive system to approach an entire range of specialized

vocabulary. The new list (matched to all the WHO terms) will be

presented at the AAAOM meeting in Portland this October.

Eric Brand

August 15, 2007

Z'ev,

Maybe you can provide an example... Otherwise I don't see why it is a

problem.

-Jason

>

> On Behalf Of

> Tuesday, August 14, 2007 2:21 PM

>

> Re: WHO's " term list "

>

> Yes, I think you are missing my point. It is very confusing to

> indiscriminately choose English equivalents from various sources

> without listing them. If you take a Wiseman glossary, or the

> Eastland Press glossary, you have a consistent use of terminology

> from one source. The work has been done by a team of translators/

> authors/clinicians to produce a consistent piece of work. When you

> produce an eclectic list like the WHO list from various sources,

> without pinning each term to its original list/source, you end up

> with confusion for the uninitiated reader.

>

Version: 7.5.476 / Virus Database: 269.11.17/951 - Release 8/13/2007

10:15 AM

August 15, 2007

Eric,

?

Thanks for the extensive and informative post.

?

I would though like to say something about the size of these term lists.

Although there is no doubt that Wiseman’s list is the largest, we must put

such numbers in perspective to what they really are. Wiseman does not have

30,000 individual Chinese medicine terms. For example, Wiseman’s list

includes point names, formula names, single herbs, medicinal books etc.,

which Eastland’s gloss does not. All of these additions are helpful, but

IMO, should not be confused with medical terms. For example, if one searches

for ren shen one gets 47 hits, all of which (I think) are just herb entries.

Furthermore, Eastland press has separate lists for these.

?

Another aspect that needs to be compared are compound phrases. For example,

Eastland press’s gloss will give you the translation for zi3 (enrich). But

not zi3 yin1. It figures you are smart enough to figure out all the

compounds that go with zi3, such as zi3 yin1 ?“enrich the yin.?

?

Wiseman on the other hand does thoroughly list all the different usages.

i.e. enrich yin, enrich the kidneys, enrich and supplement, enrich the

kidney and the stomach, enrich the lung and the stomach, enrich the liver

yin etc etc. There are around 100 compounds involving this the term zi3.

Eastland does list all the components to form such compounds like “enrich

and supplement (they say tonify)?just separately. I have never found this a

problem personally.

?

Many of these compound terms are listed in dictionaries as separate entries,

this is primarily because they contain definitions. But from a transltion

perspective, IMO there is no need. Therefore I have a hard time believing

that Eastland Press is deficient for not listing these compound terms.

Another example is: one might see ???? yang3 xue4 zi1 yin1. This compound

phrase is not in Eastland press, but all the individual words are obvious.

The translation is “nourish the blood and enrich yin??One can find all the

components individually in Eastland’s gloss, and if one then has half a

brain one can string them together.

?

Therefore if one has even the most basic Chinese language skills one should

not need stock phrases to just plug in.

?

Finally Wiseman’s lists is beefed up with many grammatical particles. For

example, shi4 (the verb to be) or zhi1 (pronoun, possessive). Although nice

for the learning student, these again are not Chinese medicine (technical)

terms. These terms have little to do with Chinese medicine and more to do

with one’s understanding of grammar. Of course they appear in Chinese

medicine phrases all the time. For example zhi1 appears in 253 compound

phrases in the Wiseman gloss. But if one has basic Chinese language skills

and the basic words in the compound, there is no need to list all of these.

If one does have the basic skills and the plugs in phrases I guarantee one

will be making errors.

?

I understand the desire for consistency for these stock compound phrases.

But the consistency at this level is really about grammar. Not any think to

do with translating a technical term correctly. But it is my experience that

plugging in these stock phrases only works some of the time. Many times

because of context and writing styles, the grammar must be altered anyway.

So again, they are helpful for a beginning translator, but IMO they do

represent something that other glosses like Eastland do not just indirectly

have contained in theirs.

?

The Who list is also beefed up with such compounds. I.e. they list sheng =

“engendering.?Then they list multiple usages. Wood engenders fire, fire

engenders earth, earth engenders metal. Etc etc. Again this is nice to have

in a list, but one cannot say that another list falls short because they do

not list every permutation possible. Obviously once someone has sheng=

engenders one can figure out what “shui (water)?“sheng?“mu (wood).?Water

engenders wood.

?

IMO, all of the lists (Eastland, Wiseman, the Who lists) have about the same

number of actual technical terms. Wiseman may have a few more. But not

whopping amount more. Maybe a handful.

?

Comments?

?

-

?

_____

On Behalf Of Eric Brand

Wednesday, August 15, 2007 2:07 AM

Re: WHO's " term list "

?

Someone put a link to the Eastland/PD comparative term list that I

made. All the term lists can be found on the files section of CHA,

they are already posted. The Eastland/PD/-Xie list is by far the