Dr. Amily Guenier

Abstract:This study presents the translatability of metaphor in Traditional Chinese Medicine (TCM) in the UK context. In this article, we first examine the modern theory of metaphor from cognitive and practice-based perspectives. The role of metaphor in the construction of health communication and medical system in China and the West is then discussed. An inquiry into the metaphors used in the expression of wellbeing in English and Chinese follows. The article then focuses on the ecology of the intercultural communication and translation of TCM in the UK. The possibility is that the sharing of medical metaphors cross-cultures has broad implications for the deeper understanding of human health experiences. This research also demonstrates that anyone reaching across cultures to treat Westerners with Chinese medicine, or Chinese with Western psychology/biomedicine can benefit by learning more about the structures of conceptual metaphors in each system (Chinese and western). Although human body is a potentially universal source domain for metaphors expressing abstract concepts, cultural models that are set up from specific perspectives where certain aspects of bodily experience or certain parts of the body are viewed as especially salient and meaningful in the understanding of those abstract concepts. The classification of “five elements of wood, fire, earth, metal and water” “Qi blockage and flow” “Yin-Yang balance” allows for more positive metaphors for envisaging recovery, greater sensitivity to patients, more flexible treatment strategy, and more sensitive communication by healthcare providers.

Keywords: Intercultural communication, metaphor, traditional Chinese medicine

Introduction

Metaphor plays a key role in health communication across cultures to illuminate and explain abstract concepts and make them more accessible by comparing them to ideas already possessed in a cognitive framework (Casarett et al., 2010; Kirklin, 2007). Creating a common language can enhance the therapeutic relationship by serving as the basis for the shared understanding of clinical reality (Reisfield & Wilson, 2004, p. 4024). It provides a way to understand the health experience across affective and conceptual meaning and might have an impact on people’s health behaviour and decision making. However, understanding metaphors can present unique challenges, and the interpretation or misinterpretation depends on each individual’s prior experience and are context -specific. The traditional Chinese medicine (TCM) has been widely used in the UK due to the limitations of biomedicine and their metaphoric logic of transformation, which promises wholeness, balance and wellbeing. Fundamental concepts in TCM are metaphorical, for example, illness are due to “blockage of Qi flow” or “Yin-Yang imbalance” excessive “wind” or “fire”. However, the translatability of these key concepts as metaphors is a question in practice. Translatability is defined as the ability to translate lexical and functional meanings of elements in cultural ecology from a source language to a target language. It would also be defined as “the capacity for some kind of meanings to be transferred from one language to another without undergoing radical change” (Pym & Turk, 2001: p.273). TCM and Western bio medicine science face almost irreconcilable differences, and therefore, this study is to explore whether metaphor bridge TCM and western medicine(WM) together to help communicate TCM to the Western people and find its suitable ecology in the UK?

Traditional Chinese Medicine in the UK

Currently, there are over 3000 Chinese medicine clinics in the UK providing treatment ranging from acupuncture to herbal formulas and patent Chinese herbal medicine, Taichi, Chinese medicine massage (tuina), moxibustion, auriculotherapy, cupping, pharmacology, Qigong and bone setting to over 25 million UK residence. The clinic treatments results show that TCM in a healthcare protocol improves outcomes for patients (Maizes, Rakel, & Niemiec, 2009). For example, TCM can provide good support to patients who suffer from the conditions of chronic and degenerative, e.g., irritable bowel syndrome (Bi, Yuan, & Bian, 2017) and low back pain (Yuan, Guo, Liu, Sun, & Zhang, 2015). Documented evidence has shown the effectiveness of the integration of TCM and WM in treating pandemic viral diseases such as severe acute respiratory syndrome (Liu, Zhang, He, & Li, 2012), influenza A virus subtype H1N1 (J.-H. Li, Wang, Guo, & Li, 2016) HIV and AIDS (Wang & Zou, 2011), and hand, foot and mouth disease (X.-h. Li et al., 2017). The benefits of using TCM attracted global attention when Professor Tu won the 2015 Nobel Prize in Physiology or Medicine for discovering artemisinin, an extract of a TCM herb Artemisia annua L., used to treat malaria. In addition, Wang Zhenyi and Chen Zhu were awarded the Seventh Annual Szent-Gyorgyi Prize for progress in cancer research for combining the WM all-trans retinoic acid and the TCM compound arsenic trioxide to treat acute promyelocytic leukemia (State council report, 2016).

TCM is an integral part of Chinese culture, with unique diagnostic and treatment methods and a huge amount of historical literature to support its theories. The Neijing or Huangdi’s Canon of Medicine is used as the main source of Chinese medical theory. Compiled between 300 and 100 BC, it is regarded as the bible of TCM (Keji & Hao, 2003; Xu & Yang, 2009). In particular, Zhang Xi Chun (1860-1933) in his book ‘Records of Traditional Chinese and Western Medicine in combination’ stressed the importance of integration of TCM and WM. Patient assessment and treatment in Chinese medicine is based on a range of diagnostic tools including: pulse taking, facial and tongue diagnosis and correspondences to the five elements (water, wood, metal, earth and fire). In mainland China, diagnosis is routinely used in conjunction with modern medical technology: X-rays, MRI scans, etc. While in the UK, the Chinese medicine clinics tend to rely more on the traditional way of diagnosis.

TCM is becoming more and more widely used throughout the world. The WHO Global Atlas of Traditional, Complementary and Alternative Medicine shows that the majority of the world’s population is using some forms of TCM on a regular basis, most often herbal medicines (Bodeker et al., 2005). Currently, TCM is used in 183 countries and regions around the world. According to the WHO, 103 member states have approved the practice of acupuncture and moxibustion, 29 have enacted special statutes on traditional medicine, and 18 have included acupuncture and moxibustion treatment in their medical insurance provisions. The export value of Chinese medicines amounted to $US4.019 billion in 2022 (Xiang, Chen, Wei, & Zhou, 2022). TCM has demonstrated its effectiveness in the global context, especially when facing global health crisis such as Covid-19 (Ren, Zhang, & Wang, 2020; W.-Y. Wang, Xie, Zhou, & Liu, 2021; Jia Xu & Zhang, 2020). Chinese medicine are also the choices of many Chinese immigrants worldwide. To effectively communicate and translate TCM to the UK residents would be of great value for public benefits.

Ontological metaphors in TCM

In terms of ontological metaphors, TCM share some common ground of container metaphor as in the west. As human’s primary way of existence is substantial, our experience of physical objects and substances allows us to understand the world and ourselves beyond mere orientation. Thanks to those experiences, we can pick out parts of those experiences and treat them as discrete entities or substances of a uniform kind. Just as the basic experiences of human spatial orientations promotes orientational metaphors, our experiences with physical objects (especially our own bodies) provide the basics for an extraordinary wide variety of ontological metaphors, that is, ways of viewing events, activities, emotions, ideas, etc., as entities and substances. Ontological metaphor is generated when our experience with physical objects and substances make it possible to conceive of abstract intangible concepts such as emotions, ideas, psychological activities and states as concrete tangible entities and substances.

For example, in TCM, “Zang Fu 藏府”, originally means “depots and palaces”, a pair of images taken from life and official system, and is used to name the organs of the human body; the meridians of the human being are named by metaphorizing the rivers of the earth, an image taken from the nature; the weight and graduated arm of a steelyard as well as a pair of compasses and carpenter’s square are used to describe the pulse images of the four seasons, which are images taken from everyday life; “closing door to keep the invader” – e.g. administering tonics for a patient with externally contracted febrile disease will keep external pernicious influences inside the body.

Several translations are available for “经络系统”: “Meridian System” is the standard translation approved by WHO, but the word “Meridian” only indicates a two-dimensional grid while Jing Luo system is supposed to carry qi and blood, and thus must be a three-dimensional system; “Channel System” is the most popular translation in the English literature on Chinese medicine, but the word “Channel” is polysemous; “Vessel System”, a translation in Huang Di Nei Jing Su Wen by Paul U. Unschuld in 2003 is the best translation if we take into account the origin and development of the concepts of Mai (脉, vessel) and Jing-Luo (经络). Based on some anatomical knowledge on Mai (脉, vessel) and medical practice esp. the application of acupuncture, moxibustion, tuina or Chinese massage, and qigong or breathing exercise, the concepts of Jing-Luo (经络) are actually metaphors formed in the way of observing, taking images of and analogizing the water flow in the rivers under the earth and the longitudinal lines of the textiles, which are embodied in their writing forms. The chapter Water & Earth of Guan Tzu states that “Water is the qi and blood of the earth, running on (under) the earth just like qi and blood flowing in the vessels.”

Another typical example is the treatment principle of “Ti Hu Jie Gai 提壶揭盖 or Carrying a kettle and uncovering its lid to treat dysuria” , which was first raised by a famous TCM doctor of Zhu Danxi (1281-1358), the founder of Yin-Nourishing School of the Jin-Yuan Dynasties (1115-1368). He gained inspiration from a phenomenon in daily life that uncovering the upper lid of a kettle filled with boiling water can make the water be poured out, and then inferred a treating method named after this phenomenon “Ti Hu Jie Gai 提壶揭盖”. He treated the patient with the method of dispersing the lung Qi, then diuresis was successfully induced, and finally the patient was cured of the disease. Zhu Danxi pointed out that the disease is caused by accumulation of phlegm in the lungs, and that the lungs are located in the upper jiao and the urinary bladder is located in the lower jiao, and that when the upper jiao is blocked the lower jiao will surely be obstructed, just like a kettle, only after the lid is uncovered, can water be poured out. This therapeutic method actually refers to the method of dispersing the lung qi to induce diuresis, which is usually used to treat edema, dysuria, or anuria when the patient does not respond to the routine therapeutic methods. In fact, interpreting metaphors in Chinese medicine is one of the keys to understand, reconstruct, inherit and develop Chinese medicine.

Structural metaphor in TCM

With regard to the structural metaphor: Yin-yang, five elements, zang xiang and war metaphors are typical examples in TCM. Structural metaphor is another important form of conceptual metaphor. When orientational metaphor and ontological metaphor are elaborated in much specific terms, or when some aspects of a concept are highlighted, we turn to structural metaphor for help. Structural metaphors allow us to use one highly structured and clearly delineated concept to structure another (Lakeoff & Johnson, 1980). Structural metaphor is the case where one structured domain is metaphorically restructured and redefined in terms of another, that is to say, by virtue of the structure of a more familiar and concrete domain, we understand abstract domains.

For example the struggle between the “Upright and the Evil” – i.e. the fight between the healthy qi and pathogenic agents, which will determine whether a person will catch a disease or not, are named by metaphorizing events of military affairs.

The engendering and restraining relationships among the five phases also come from direct observation and experiences of the phenomena among the five materials. As regards to the formation of the engendering relationship among the five phases, Wu Xing Da Yi · Lun Xiang Sheng or The Great Connotations of the Five Phases· On Engendering states that “Wood engenders fire for wood is warm in nature, fire is latent inside it and makes its way out of it and burns; Fire engenders soil for fire can burn wood, resulting in ashes, ashes can be ［regarded as］ a kind of soil; soil engenders metal, for metal is usually found in a mountain which is composed of soil; metal engenders water for the metal can be melted into fluid, ［which can be regarded as a kind of water］; water engenders wood for water can nourish wood and make it grow.” The restraining relationship among the five phases was established through observing the following natural phenomena among the five materials: water can extinguish fire, fire can melt metal, metal (such as sword and axe) can cut trees (wood), tree (wood) can take its root into soil, and dykes and dams (soil) can prevent flooding (water) from occurring.

In TCM, the five-phase theory is mainly used to explain the physiological functions, pathological changes of the internal organs and their relationships, formulating therapeutic principles according to the engendering and restraining relationships among the internal organs, thus bearing practical significance in the clinical sense. Take spleen as an example, spleen is located in the middle jiao (the center) and below the diaphragm. According to its central position and its yellow color, TCM attributes spleen to soil in the five phases. Soil is sowing and reaping, corresponding to late summer in the seasons and dampness in the climate, representing the features of receiving, generating, transforming, and supporting. Therefore, spleen’s function in TCM is metaphorized as transforming the water and grain into essence, then moving and sending the essence to the whole body; thereby, spleen is regarded as the foundation of postnatal existence, the source of the formation of qi and blood, and is interrelated with the flesh, governs the limbs, opens into the mouth, manifests its brilliance in the lips, etc. Moreover, a spleen system is formed with the common symptoms of spleen diseases such as abdominal pain or distension, poor appetite, loose stool, diarrhea, jaundice, fatigue or weakness of the limbs, edema which can be successfully relieved by treating spleen in TCM. It is clear that spleen in Chinese medicine does not refer to any concrete organ, or not the organ spleen at all (according to its central position and the yellow colour, this organ can be the pancreas, which was not perceived by TCM in the ancient time), but to a functional system by applying the five-phase theory.

Both of the Engendering and restraining cycles have two aspects: engendering and being engendered (like that between mother and child); restraining and being restrained. The relationships of each organ to the other four of the five zang organs can be explained by these aspects. Take liver as an example, Liver (wood) engenders heart (fire), and is engendered by kidneys (water); Liver (wood) restrains spleen (soil), and is restrained by lungs (metal). Liver relies on kidney water for nourishment, which is known as “water moistening wood”; if kidneys fail to fulfil this function, this condition is known as “water failing to moisten wood”. The five-phase theory can also be used in disease prognosis. Generally speaking, if a condition spreads in the order of engendering cycle, i.e. the condition of disease of the mother organ involving the child organ, the prospects for a good recovery are favourable and the disease can be considered minor; If, on the contrary, a condition spreads in the opposite order of engendering cycle, i.e. the condition of disease of the child organ affecting the mother organ, the prospects are unfavourable and the disease is serious. If a condition spreads in the order of restraining cycle, the condition is more serious when over-restraining than counter-restraining.

Author information:

Dr. Amily Guenier，Languages and Cultures of Lancaster University U.K [email protected]

Changyu Guo 中國山東大學外國語學院 School of Foreign Languages, Shandong University，China [email protected]