Inspection (望), one of the four diagnostic methods traditionally used by traditional Chinese medicine (TCM) practitioners to examine patients, means to observe the body and specific regions as well as secreta and excreta of the patients in order to understand the general and pathological condition of the patient［1］.
The parts to be carefully observed and examined in inspection include spirit (神), complexion (色), body (形) and condition (态) of the patient. To observe and examine the state of spirit makes it possible for doctors to understand whether essence is sufficient enough and whether prognosis is favorable or unfavorable. To observe and examine the changes of complexion, body and specific parts enables doctors to know whether the disease is light or severe and whether the disease is located deep or shallow.
Tongue examination is also an important part of inspection because the tongue is closely connected with qi, blood and viscera through meridians. For this reason, careful inspection of the tongue will make it easy for doctors to understand the conditions of qi, blood and viscera. In addition, examination of the tongue can also reveal whether pathogenic factors have attacked the external or internal parts of the body and whether stomach qi is sufficient or insufficient.
There are many terms and expressions concerning inspection, some of which are easy to translate and some of which are difficult to render. The author tries to make a comparative study on the English translation and international standardization of the essential terms and expressions concerning inspection according to WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region［2］ (abbreviated as WPRO Standard) and International Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies［3］ (abbreviated as WFCMS Standard) in the light of the studies made in the book entitled International Standardization of English Translation of Traditional Chinese Medicine: Study of Theory, Summarization of Practice and Exploration of Methods［4］. For the convenience of comprehension, the definitions provided by WPRO Standard are also quoted after each term.
望诊inspection: one of the four diagnostic examinations, including observation of the patient’s mental state, facial expression, complexion, physical condition, condition of the tongue, secretions and the distribution of superficial venules of the infant’s fingers
Traditionally望诊is translated as inspection. But occasionally it is also translated as observation or observing diagnosis.
望神inspection of the vitality: inspection of the state and vitality, especially mental and physical activities such as consciousness, thinking, facial expression, speech, and response to external stimuli
得神 presence of vitality: the general state marked by high spirit and mental and physical exuberance with prompt and appropriate responses, indicating that the healthy qi is not damaged and improvement from a pathological condition can be expected
失神loss of vitality: the general state marked by indifference, low spirit and impaired mental and physical functions with sluggish and inappropriate responses, indicating the existence of a serious pathological condition
少神lack of vitality: the general state marked by indifference, listlessness and low spirit
假神false vitality: transient improvement in spirit in a critical case, often indicating approach-ing death
The Chinese character神is quite clear in meaning and easy to understand in Chinese, but appears really difficult to deal with when being translated into English because there is no exact equivalence in English language. The connotation usually varies under different conditions and that is why it is difficult to use one single English word to render it. For instance, in the Chinese expression心主神, 神is usually translated as mind. However in the Chinese expression精气神, which is regarded as the three treasures in the body, 神is often rendered as spirit. While in the Chinese expression神采奕奕, 神tends to be translated as vitality. In WPRO Standard, 神is rendered as vitality, another common practice in dealing with神.
昏蒙 mental confusion: clouding of consciousness with sleepiness, but responsive to calling
昏厥fainting: sudden loss of consciousness, usually of short duration, sometimes accompanied by cold limbs, also called syncope
The Chinese term昏厥sometimes is also rendered as syncope, as done in WFCMS Standard. Comparatively speaking, faint seems better than syncope in translating晕厥. In TCM, 昏厥means sudden loss of consciousness with coldness of limbs due to stagnation of visceral qi and blockage of orifices and meridians resulting from disorder of qi activity that exhausts yang in the upper part and expels yin in the lower part of the body (因气机逆乱，造成上有绝阳之络，下有破阴之纽，引发脏腑经络气机阻塞，窍络不通而出现突然昏仆，不省人事，四肢逆冷)［5］. According to such an explanation in TCM, 昏厥is a quite serious pathological condition and the patient suddenly becomes unconscious and cannot be “responsive to calling” as described in WPRO Standard.
谵妄delirium: a mental disturbance characterized by confusion, disordered speech and hallucinations
烦躁agitation: vexation followed by irritabil-ity, irascibility, and restlessness
The Chinese term烦躁is usually rendered in many different ways, such as restlessness, irritability, fidgetiness and dysphoria. This is partly due to the fact that烦躁is a common expression, not a technical term. That is why we can find a number of similar ones in English language.
望色inspection of the complexion: observation of the patient’s skin color, particularly the color of the face
面色(facial) complexion: color and luster of the face
面色淡白 pale white complexion: a colorless complexion, often indicating deficiency or profuse loss of blood
The Chinese character淡means light-colored and白means white. But when淡and白are used together as a single term, it simply means that the complexion appears somewhat white or whitish, not necessarily pale. In English pale means “having a skin color that is very white or whiter than it usually is”. According to such an explanation, pale is quite equivalent to苍白but not to 淡白in Chinese.
面色苍白pale complexion: a white complexion with a hint of blue or gray, a complexion often caused by yang collapse or exuberance of cold
面色白光 白bright pale complexion: a white complexion with puffiness, often seen in cases of yang deficiency
The Chinese character白光 in the term面色白光 白appears difficult to understand and translate. According to TCM, 白光 means white with clear appearance (白中透亮) which is a pathological condition. But many translators use the English word bright to translate白光 , which is, of course, inproper.
面黑darkish complexion: dark discoloration of the face, often occurring in kidney deficiency, cold pattern/syndrome, water retention or blood stasis
面红reddened complexion: a complexion redder than normal, indicating the presence of heat
Since the Chinese character黑in the term面黑 (in the above) is translated as darkish and the Chinese character青in the term面青(in the following) is rendered as bluish, 红in the term面红seems better to be translated as reddish instead of reddened. That will make the translation consistent in practice.
面青bluish complexion: bluish discoloration of the face, often occurring in cold pattern/syndrome, pains, qi stagnation, blood stasis or convulsions
面黄yellow complexion: yellow discoloration of the face, generally suggesting spleen deficiency or accumulation of dampness that causes dysfunction of the spleen
面色萎黄sallow complexion: yellowish withered complexion, which usually occurs in cases of spleen qi deficiency
In WFCMS Standard, 萎黄is translated as shallow yellow. Comparatively speaking, sallow is better than shallow yellow in expressing the original meaning of this term.
面浮puffy face: a soft swollen face, usually indicating a deficiency condition
The Chinese term面浮means dropsy or edema of the face. So it is also frequently translated as facial edema, facial dropsy or facial puffiness.
主色governing complexion: normal natural color of the skin
The so-called主色just means normal complexion or normal natural color of the skin as defined after this term in WPRO Standard. To translate it as governing complexion seems somewhat rigid and unclear. In WFCMS Standard, this term is rendered as normal complexion, which is cer-tainly equivalent to the original meaning of this term.
客色visiting complexion: a normal complexion influenced by a change of climate
The so-called客色simply refers to variation of face or skin color due to changes of living or working conditions. The definition of this term in WPRO Standard is quite clear and correct, but the translation of it as visiting complexion is really not quite clear in meaning. In WFCMS Standard, this term is translated as varied normal complexion, quite clear in meaning. Of course this term also can be translated as normal changes of complexion.
病色morbid complexion: abnormal color of the face caused by disease
善色benign complexion: bright and lustrous complexion indicating a favorable prognosis, also the same as healthy complexion
恶色malign complexion: dark and gloomy complexion indicating an unfavorable prognosis, also the same as unhealthy complexion
To translate善色 (bright and lustrous complexion indicating a favorable prognosis, also the same as healthy complexion) as benign complexion and病色 (dark and gloomy complexion indicating an unfavorable prognosis, also the same as unhealthy complexion) as malign complexion appears unclear. In fact in these two terms善and恶simply mean favourable and unfavourable. So in WFCMS Standard, these two terms are respectively translated as favourable complexion and unfavourable complexion.
真脏色true visceral color: color reflected in the face indicating exhaustion of the genuine qi of internal organs
胕肿pitting edema: edema associated with pitting of the skin, which resolves only slowly, usually occurring on the instep
The Chinese term胕肿usually refers to edema in the dorsum or instep of the foot as indicated by the structure of the Chinese character. If the translation is changed into instep edema, the meaning will be clearer.
肌肤甲错encrusted skin: dried, roughened and scaling skin, indicating chronic blood stasis
The Chinese term肌肤甲错is also frequently translated as squamous and dry skin. To render it as encrusted skin appears concise, but unclear. In WFCMS Standard, this term is rendered as scaly skin, appearing both concise and clear.
抽搐；瘛瘲convulsions: sudden, violent uncontrollable movements of the limbs caused by contraction of muscles
便血；圊血bloody stool: loss of blood through anus, with stool
远血distal bleeding: bleeding far from the anus, generally referring to bleeding from upper digestive tract
近血proximal bleeding: passing fresh blood before or during defecation, indicating anal or rectal hemorrhage
望指纹inspection of finger venules: a diagnostic method for infants, based on observation of the superficial venules on the palmar side of the index finger
三关three bars: a collective term for the three segments of the index finger used for measuring the extension of the visible venules, i.e., “wind bar”,“qi bar” and “life bar”, also known as three gates
The Chinese character关in三关means pass, not bar. So风关should be translated as wind pass instead of wind bar, 气关should be translated as qi pass instead of qi bar, and命关should be translated as life pass instead of life bar. In WFCMS Standard, 三关is translated as three passes, agreeing with the basic meaning of this term in Chinese.
风关wind bar: the proximal segment of the index finger in the inspection of venules, also known as wind gate
气关qi bar: the middle segment of the index finger in the inspection of venules, also known as qi gate
命关life bar: the distal segment of the index finger in the inspection of venules, also known as life gate
舌诊tongue diagnosis: inspection of the size, shape, color and moisture of the tongue proper and its coating
望舌inspection of the tongue: examination of the tongue body and its coating
舌象tongue manifestation: changes in the appearance of the tongue, relating to changes in the color and form of the tongue body and its coating
In the current translation practice, 舌象is also rendered as tongue condition or tongue picture. Comparatively speaking, tongue manifestation is better than other translations in expressing the basic meaning of this term.
舌尖tip of the tongue: the anterior end of the tongue
舌边margins of the tongue: the lateral borders of the tongue
The Chinese term舌边is sometimes translated as sides of tongue. Both translations are clear and understandable.
舌中；舌心center of the tongue: the central part of the tongue
舌根；舌本root of the tongue: the part of the tongue that is attached basally to the bone
舌体；舌质tongue body: the musculature and vascular tissue of the tongue, also referring to tongue substance
舌色tongue color: color of the tongue body, which reflects the condition of qi, blood and the visceral organs
舌神tongue spirit: the general vitality of the tongue manifest in its luxuriance or witheredness
荣枯老嫩luxuriant, withered, tough and tender-soft: a luxuriant tongue is moistened and fresh red in color; a withered tongue is dull, dark, dry and shriveled; a tough tongue is firm with rough texture; a tender-soft tongue is delicate with fine texture
The Chinese characters荣枯老嫩refer to the four basic conditions of the tongue. To translate 荣枯老as luxuriant, withered and tough is clear and understandable. To translate嫩as tender is already quite clear and expressive, so the English word soft seems unnecessary. In WFCMS Standard, 荣枯老嫩are rendered as flourishing, withered, tough and tender, basically understandable and acceptable.
淡白舌pale tongue: a tongue less red than normal, indicating qi and blood deficiency or presence of deficiency-cold
淡红舌pale red tongue: a tongue of normal color
According to the analysis made above about the translation of the Chinese characters淡and红, it may be better to translate淡红舌into reddish tongue.
红舌red tongue: a tongue redder than normal, indicating presence of heat
青舌blue tongue: a tongue of bluish color, indicating congealing cold and static blood
紫舌purple tongue: a tongue purple in color, indicating stagnant circulation of qi and blood
青紫舌bluish purple tongue: a cyanotic tongue, indicating blood stasis or heat toxin in the nutrient-blood
绛舌crimson tongue: a tongue deep red in color, indicating intense heat
胖大舌enlarged tongue: a tongue that is larger than normal, pale in color and delicate, usually bearing dental indentations on the margin
肿胀舌swollen tongue: a large and bulging tongue that makes the mouth full or difficult to open
瘦薄舌thin tongue: a tongue thinner than normal
点刺舌spotted tongue: a tongue with red, white or black spots as well as thorn-like protrusions on its surface
芒刺舌prickly tongue: a tongue with thorn-like protrusions on its surface
齿痕舌teeth-marked tongue: a tongue with dental indentations on its margin
裂纹舌fissured tongue: a tongue with fissures on its surface
光剥舌peeled tongue: a tongue that has lost its normal coating, giving the appearance of having been peeled
镜面舌mirror tongue: a completely smooth tongue free of coating, like a mirror
地图舌geographical tongue: a tongue with irregular shedding of the coating and distinct demarcation between the shed and unshed areas, looking like a map
舌衄spontaneous bleeding of the tongue: bleeding from the tongue not due to traumatic injury
强硬舌stiff tongue: a tongue that is stiff, moves sluggishly, and inhibits speech
痿软舌limp wilting tongue: a tongue that is flabby and cannot move easily
The translation of the terms listed above quite accords with the current translation practice, except the translation of痿. In the current translation practice, 痿is often rendered as flaccid or flaccidity and 软is sometimes translated as soft. In fact, to translate the Chinese character软in the term痿软as soft is unclear in meaning because the English word soft also refers to something lovely and desirable. In WPRO Standard, 痿软is translated as wilting and limp, sounding much better than flaccid and soft.
颤动舌trembling tongue: a tongue that involuntarily trembles as it moves
歪斜舌deviated tongue: a tongue that inclines to one side when extended
短缩舌contracted tongue: a tongue that cannot be fully extended from the mouth and appears to be contracted
In WFCMS Standard, 短缩舌is translated as shortened tongue, also a clear and concise translation.
吐弄舌protruded agitated tongue: a pathological condition in which the tongue hangs out of the mouth and moves in a circular motion whereby the tip is extended from and retracted back into the mouth, or licks the lips
The Chinese character吐in 吐弄舌is often translated as protruding and弄in this term is frequently rendered as waggling, which appears quite vivid and clear. In WFCMS Standard, 弄舌is rendered as waggling tongue, reflecting the common practice in translating this term.
舌纵protracted tongue: a tongue that is habitually extended out of the mouth and cannot be retracted
舌干dry tongue: a tongue lacking moisture and rough to the touch
麻痹舌paralyzed tongue: a numb tongue unable to move
舌态motility of the tongue: the ability of the tongue to move spontaneously
舌形form of the tongue: referring to the shape, luxuriance and witheredness, toughness and softness, thinness and swelling, spots, fissures, and dental indentations
舌苔tongue fur: a layer of moss-like material covering the tongue, also called tongue coating
The Chinese character苔in the term舌苔is also frequently translated as coating. So in the current translation field, both tongue fur and tongue coating are commonly used in translating舌苔and they can be taken as two equivalences of this term.
苔色fur color: color of the tongue coating, white, yellow, gray or black, and in rare cases, green
苔质texture of fur: characters of tongue coating, including thickness, moisture, sliminess, roughness, etc.
白苔white fur: tongue coating white in color
白砂苔white sandy fur: white dry and thick tongue coating like a layer of sand
黄苔yellow fur: tongue coating yellow in color
黑苔black fur: tongue coating black in color, indicating either excessive cold or extreme heat in the interior
灰苔gray fur: tongue coating gray in color with similar clinical significance as black fur
绿苔greenish fur: tongue coating green in color
薄苔thin fur: tongue coating through which the underlying tongue surface is faintly visible
厚苔thick fur: a tongue coating through which the underlying tongue surface is not visible
霉酱苔rotten-curdy fur: a reddish thick tongue coating with black and yellow tinge
润苔moist fur: a moderately moistened tongue coating
燥裂苔dry and cracked fur
黏腻苔sticky slimy fur
All the terms about the conditions of the tongue listed above are quite clear in structure and meaning. The characters used in these terms are all common ones used by people in their daily life. Thus it is easy to understand and translate these terms. And in the current translation field, the translation of these terms tends to be similar to or identical with each other. The only exception may be腻苔because腻in this term is also translated as greasy. Semantically speaking, greasy and slimy are synonyms. In English, greasy means to be covered with greasy, slippery materials or to produce an excessive amount of oily secretions. In addition, it also refers (of people or their behaviour) to insincerely flattering and smooth, unctuous. While slimy is the adjective of slime (thick soft slippery liquid substance, especially mud) which means being of, like or covered with slime, disgustingly dishonest, flattering, hypocritical. Comparatively speaking, greasy seems better than slimy in translating腻in this term. In WFCMS Standard, 腻in this term is rendered as greasy.
舌卷囊缩curled tongue and retracted testicles
舌下络脉sublingual collateral vessels
The so-called舌下络脉actually refers to the vein beneath the tongue. So the better translation may be sublingual vein. The terms listed above are the ones included in WPRO Standard. However, in WFCMS Standard, we can still find some more terms about inspection of the tongue, such as糙苔膜(rough tongue coating), 无根苔(rootless tongue coating), 药苔(medicinal-stained coating) and染苔(stained coating), etc.
The terms about tongue inspection in-cluded in WPRO Standard and WFCMS Standard have been briefly analyzed in this article. Objectively speaking, most of the terms in these two international standards are well rendered and standardized. Of course nothing is perfect in this world and so is translation and standardization practice.