Research and Analysis on the Origin of the Term “Xinche” in Traditional Chinese Medicine and Its Translation

Wang Erliang and Chen Xiao＊

Shanghai University of Traditional Chinese Medicine

Abstract: Translating the terminology of traditional Chinese medicine (Thereafter referred to as TCM) is the core of translating TCM culture. By analyzing the connotation and denotation of the word “Xinche” (心掣) in Huangdi Neijing (Yellow Emperor’s Canon of Medicine), the earliest existing TCM classic, and by comparing different English translations of the term“Xinche,” we hope to provide certain reference for the standardization of TCM terminology and to share some ideas for the translation of TCM classics.

Keywords: Yellow Emperor’s Canon of Medicine, Terminology of Traditional Chinese Medicine, Xinche, TCM classics, translation of classics, standardization of Chinese medicine

To translate TCM term, it is necessary to return to the original text,to carefully analyze its meaning and clearly understand its context.Only by interpreting the term within its cultural and historical contexts can we fully comprehend its profound academic connotation. It is necessary to explore the intrinsic features of the TCM terms, ensuring one term for one concept only and emphasizing the one-direction, definiteness and stability of the terms. It is also necessary to build a complete system for terms and concepts: to define new concepts in accordance with the names and rules of the terms. In communicating the TCM terms to the rest of the world, we should strengthen our cultural confidence, with the initial purpose of “introducing the Chinese culture abroad.” While we take foreignization as the main strategy, we should also take the target culture and target readers’acceptability into consideration.

Classics of traditional Chinese medicine contain abundant knowledge. However, its translation and introduction face great challenges due to the unclear classification of TCM terminology, the difficulty to formulate diagnoses and treatments and the vulnerability of clinical efficacy to various factors. To worsen it, the original medical texts might contain misused words and misinterpretations. As history and society develop, interpretations by later practitioners of the TCM terms vary, which have had a huge impact on the translation and standardization of TCM terminology. Therefore, in the process of translating TCM terms, the research on the original meaning, the analysis of the context, and the changing interpretation of the later generation play important roles.

Textual Research on the Term “Xinche” in Yellow Emperor’s Canon of Medicine

Xinche (dragging pain of the heart and chest) is a disease name from TCM. Its clinical manifestations are “心动不宁，若有所引” (The heart moves and is uneasy as if it is dragged). If accompanied with symptoms of short breathing and cough, and diarrhea, it could be Shaoyang Disease (少阳为病). Due to the unease of Jun Fire (君火, Monarch-Fire) and Xiang Fire (相火,Minister-Fire), and the invasion of the Xie Fire (邪火, Pathogenic Fire) into heart, the heart moves and is uneasy as if it is dragged. At such time, if wood-fire impairs the metal (木火刑金), cough occurs; if the wood reaches the soil of the spleen (木乘脾土), diarrhea happens. There is another interpretation: “Feeling heart being dragged and hurting” is the main symptom of “Xinche.” It also has its theoretical basis and clinical evidence for further research.

“Xinche” Is a Disease Name in Yellow Emperor’s Canon of Medicine

The word “Xinche” only appears once in Yellow Emperor’s Canon of Medicine, contained in Plain Conversation: Yinyang Bielun (素问·阴阳别论) (Figure 1):

“一阳发病，少气，善咳，善泄。其传为心掣，其传为隔。”

One Yang disease is marked by frequent cough and diarrhea. [Prolongation may] leads to Xinche（dragging pain of the heart and chest） and Ge (inability to swallow food) (Wang, 2015).

Meaning, the disease results from the morbidity of the gallbladder and Sanjiao Meridian of Shaoyang and causes cough and diarrhea. It may deteriorate into Xinche and Ge. There are two other texts using the same sentence pattern:

Figure 1: Photocopy of Yellow Emperor’s Canon of Medicine

“二阳之病发心脾，有不得隐曲，女子不月；其传为风消，其传为息賁者，死不治。”

Disease of double Yang (the stomach) involves the heart and spleen, leading to unmentionable problems (difficulty in urination and defecation or sexual disorder) and no menstruation in women. If changing into Fengxiao (emaciation) and Xiben (rapid and asthmatic breath), it is incurable.

“三阳为病发寒热，下为痈肿，及为痿厥腨（疒肙），其传为索泽，其传为颓疝。”

Three Yang diseases are characterized by chills and fever, Yongzhong (carbuncle and swelling or dropsy) in the lower (part of the body) and Wei (weakness), Jue (cold sensation) and Chuaiyuan(ache of the calf of the leg). [Prolongation may] change into Suoze (exhaustion of blood and dryness of skin) and Tuixian (swollen scrotum).

Comparing these three texts concerning meridian morbidity, we can find that “传” (leading to;changing into) is the pattern of sentences describing these diseases. The Ge (inability to swallow food), Fengxiao (emaciation), Xiben (rapid and asthmatic breath), Suoze (exhaustion of blood and dryness of skin) and Tuixian (swollen scrotum) following “Chuan” are disease names in Yellow Emperor’s Canon of Medicine. Hence, from the perspective of writing coherence, Xinche should also be regarded as a disease name instead of a symptom. In General Records of Holy Universal Relief“heartache,” Xinche is also listed independently as a disease name under the category of heartache.In Yellow Emperor’s Canon of Medicine—Plain Conversation Xuanmingfanglun: Zhuzhengmen,there is individually listed “Xinche Disease,” paralleling the well-known diseases of “Jianjue (煎厥,boiling reversal)” and “Bojue (薄厥, sudden reversal)” in Yellow Emperor’s Canon of Medicine. In this sense, from the perspective of medical principles, Xinche is an individual disease instead of a simple symptom.

Xinche Means Pulling and Dragging in Yellow Emperor’s Canon of Medicine

We can find two meanings of “Che.” One is dragging or pulling. In The Annotation of Classics(经典释文, Jingdian Shiwen), it says “Che, to drag.” In Erya: Shixu (尔雅·释训, the Annotation of Erya), it records “Che is to drag.” In Yupian (语篇), Che is equaled to Chi, meaning to pull. The other meaning of “Che” is convulsion. The Che in Yellow Emperor’s Canon of Medicine should refer to the first meaning of dragging or pulling.

Different Understandings of Xinche by Medical Practitioners in the Past Dynasties

Xinche is a disease named in accordance with its primary symptom. The word Xinche is also used to describe the primary symptom. Medical practitioners in the past dynasties made annotations on Yellow Emperor’s Canon of Medicine, from which we can learn that they hold different understandings of the word “Xinche”: Gao Shizong, Zhang Qi, Zhang Zhicong and Danbo Yuanjian refer to Xinche as “the dragging pain in the heart”; Zheng Jiebin, Yao Zhiyan,Wu Kun consider “Xinche” as “the uneasy heart as if being dragged”; Feng Zhaozhang in Jinnang Milu (锦囊秘录, Secret Records) says “In the past, we didn’t have the word ‘Zhengchong (怔忡, palpitation).’ It was called ‘Xinche’ then.” In conclusion, there are mainly three kinds of understandings of the Xinche disease by past medical practitioners: Dragging pain in heart,uneasy heart and “Zhengchong.”

Study of the English Translations of Yellow Emperor’s Canon of Medicine

Yellow Emperor’s Canon of Medicine, laying a foundation for traditional Chinese medicine,is the earliest existing TCM classic. It contains two parts, Suwen (素问, Plain Conversation)and Lingshu (灵枢, Spiritual Pivot), 81 volumes for each. The basic information of the English translations published so far can be seen as follows (Table 1). Li Zhaoguo, Wu Liansheng and Paul Unschuld provide the complete translations of Yellow Emperor’s Canon of Medicine (including both Suwen and Lingshu), and the others are translations of Suwen only. From the perspective of forms,the translations of Yellow Emperor’s Canon of Medicine can be categorized into verse translation,compilation, and cover-to-cover translation.

Table 1: The basic information of the English translations of Yellow Emperor’s Canon of Medicine

Ilza Veith’s version was published in 1949. As the first English translation version of Yellow Emperor’s Canon of Medicine, it is of great historical importance. Considering the academic background of the translators and the completion time of the translations, we take the most representative four versions as the materials to analyze their translations of “Xinche.” In terms of translators’ academic backgrounds, Ilze Veith received her PhD from Johns Hopkins University in the History of Medicine, majoring in the translation of TCM classics; Li Zhaoguo is an outstanding domestic translator in TCM; Paul Unschuld, a German sinologist, produces quite a lot in TCM classics translation including his translations of Nanjing (The Classic of Difficult Issues), Suwen, Lingshu, Yinhai Jingwei (A Profound Treatise on Eye Diseases) and Bencao Gangmu (Compendium of Materia Medica), and his works of Forgotten Traditions of Ancient Chinese Medicine, Medicine in China, and Chinese Traditional Healing; Wu Liansheng and Wu Qi are overseas Chinese, mainly engaged in clinical practice. Those translators’ four English versions have different publishing times, social contexts, and translator identities, thus having important comparative significance.

Analysis of the Translations of “Xinche” in the Four Versions

[Original text] “一阳发病，少气善咳善泄，其传为心掣，其传为膈。” (素问·阴阳别论)

—Yellow Emperor’s Canon of Medicine Plain Conversation: Separate Discussion on Yin and Yang

[English translation]

Ilza Veith：It is said that one element of Yang causes shortness of breath and makes the people susceptible to coughing and diarrhea. When these diseases are spread they cause a throbbing of the heart, and when perpetuated they cause irregularity (of the bodily functions) ( Ilza, 2002).

Li Zhaoguo: One Yang disease is marked by frequent cough and diarrhea. [Prolongation may]leads to Xinche (dragging pain of the heart and chest) and Ge (inability to swallow food) ( Li &Liu, 2005).

Wu Liansheng: The disease of the first Yang indicates the disease of Shaoyang. Shaoyang is the stage of Yang newly born when the Yang is tiny, and Yang will be even tiny when the disease is contracted. The Shaoyang being the prime minister-fire, when the fire scorch the lung-metal, cough will occur. The large intestine and the lung being the superficies and the interior, when the adverse rising lung energy being hurt, the energy of the large intestine will be unstable, and diarrhea will occur. As the prime minister-fire is vigorous inside, the heart will be affected and become uneasy.As the wood fire restricts the spleen and stomach, the food intake will be obstructed and cause dysphagia (Wu & Wu, 2010).

Paul U. Unschuld: When the first Yang develops a disease, one is short of Qi and has a tendency to cough. [There is also] a tendency to outflow. Its transmission causes heart-tugging. Its [further]transmission causes a barrier (Unschuld, 2011).

Table 2: Compare the translations of “Xinche” in the four English translations of Yellow Emperor’s Canon of Medicine

A Throbbing of the Heart

In the earliest translation of Yellow Emperor’s Canon of Medicine, Ilza Veith translates the word Xinche into “throbbing.” According to the dictionary, “throb” is a noun as well as a verb. Here, Ilza Veith uses it as a verb. According to etymology, “throb” first appeared in Middle English in the 14th century. Its synonyms include beat, palpitate and pulse. There are two definitions of “throb” in the dictionary: One is the feeling of hurt, which is quick, repeating; another is the beating which is powerful and rhythmical. “Throb” is also a medical noun referring to pulsation that is too p.owerful or quick. “Xinche” is in a two-character pattern consisting of one character indicating disease location and the other indicating symptom. The translation of “a throbbing of the heart” implies that the heart is the disease location and also that the primary symptoms are the hurt and abnormal beating of the heart. However, from the perspective of word formation, this translation does not adhere to the two-character pattern.

Xinche (dragging pain of the heart and chest)

Li’s version is “dragging pain of the heart and chest.” According to etymology, “dragging”first appeared in 1887. There are two dictionary definitions: One is pulling, which often refers to the immovability of something or somebody due to overweight; the other is dragging to cause something to move on the ground. Li’s translation emphasizes the pain in the heart and the chest, i.e.,the Che pain in the heart. This translation has its theoretical evidence since the annotations by Gao Shizong, Zhang Zhicong and Huang Yuanyu of Yellow Emperor’s Canon of Medicine all interpret it as the dragging pain in the heart.

The Heart will Be Affected and Become Uneasy

Wu Liansheng and Wu Qi’s version is “the heart will be affected and become uneasy,”emphasizing that the heart is uncomfortable. It does not convey the core meaning of Xinche. The word “uneasy” means feeling unsettled or uncomfortable, which is applicable in many contexts. It cannot specify that “the heart is moving uneasily as if being dragged.”

Heart-tugging

In Paul Unschuld’s translation, he quotes Zhang Jiebin and Yang Shangshan in his foot notation.This might be indicating that he is not very sure of the translation of Xinche, so he adds others’annotations for support. It is very likely that Paul Unschuld does not agree with the translation of“heart-hurting” by quoting these two annotators.

Paul Unschuld translates Xinche as “dragged heart.” He wrote, “When the heart fails to move peacefully, but rather as if it were pulled, this is called Xinche，‘dragged heart.’ ” and tries to explain that “dragged” cannot only imply “若有所引” but also contain the meaning of “心动不宁”.

However, he again quotes Yang Shangshan’s “一阳发病，少气喜咳喜泄，传为心瘛，其传为膈。(One Yang disease is marked by frequent cough and diarrhea. [Prolongation may] lead to Xinche(dragging pain of the heart and chest) and Ge (inability to swallow food).” He interprets “Che” as“Ge,” saying “The Tai su has 瘛 ‘to tug,’ instead of 掣.” In the formal translation of the original text,he uses “heart-tugging” for translating “Xinche.”

According to etymology, “tug” originated from middle English and first appeared in the 14th century. It means pulling something with a quick, forceful movement. In the medical field, “tug” is often seen in the phrase “tracheal tug.”

It can be seen that the two translations are almost the same, focusing on fulling and dragging.Yet, in Zhang Jiebin’s opinion, the focus should be “心动不宁 (the heart fails to move peacefully)”and the latter part of the sentence “若有所引 (as if it were pulled)” is to modify the former part“心动不宁.” Therefore, we think that although Paul Unschuld senses the problem of translating Xinche as “the pain in the heart” and quotes Zheng Jiebin’s annotation, he does not correctly convey Zhang’s opinion. In this sense, neither “dragged heart” nor “heart-tugging” is the ideal translation.

To conclude, Veith translates Xinche into “the abnormal pulsation of heart” and at the same time remains the meaning “heart-hurting”; Li translates it into “the dragging pain of heart”; Paul Unschuld translates it into “tugged heart” and Wu translate it into “the heart is uneasy.”

As we have discussed before on the research of Xinche’s contextual meaning, we think Veith’s translation is closer to the original meaning of Yellow Emperor’s Canon of Medicine. From the perspective of medical science, his translation conforms to the actual meaning of “心动不宁，若有所引” and also contains the possible symptoms of heart accompanying this disease. Li Zhaoguo and Paul Unschuld emphasize too much on the pulling and dragging of Che. Wu Liansheng’s translation does not properly convey the original meaning. Since Xinche itself is a disease name, considering its word class, we also suggest that it be translated as “heart throbbing,” which not only adheres to the two-character pattern of Xinche in form but also conveys the primary symptom of “uneasy heart (心动不宁)” in meaning.