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English Translation of TCM
Journal of Chinese Integrative Medicine: Volume 10, 2012   Issue 3
Comparative study on WHO Western Pacific Region and World Federation of Chinese Medicine Societies international standard terminologies on traditional medicine: Triple Energizer Pattern Identification/Syndromes Differentiation
Zhao-guo Li (College of Foreign Languages, Shanghai Normal University, Shanghai 200234, China E-mail: zhooushi@163.com)

Received December 28, 2011; accepted December 30, 2011; published online March 15, 2012.
Full-text LinkOut at PubMed. Journal title in PubMed: Zhong Xi Yi Jie He Xue Bao.

基金项目: 国家社会科学基金资助项目(No. 08BYY009); 国家中医药管理局资助项目(No. ZYYS20090010-2); 国家质量监督检验检疫总局资助项目(No. 200910263)
Correspondence: Zhao-guo Li, MD, Professor; E-mail: zhooushi@163.com; Blog: zhooushi.blog.163.com

  


     The so-called三焦 (triple energizer), a collective term for the three portions of the body cavity, through which the visceral qi is transformed, also widely known as three burners or three heaters or three warmers, is a special anatomical concept used in traditional Chinese medicine (TCM), generally referring to the region from below the thoracic cavity to the region from above the pelvic cavity.
According to Lingshu (Spiritual Pivot, one of the fascicle of Huangdi Neijing or Yellow Emperor’s Canon of Medicine), the upper energizer (上焦, the chest cavity, namely, the portion above the diaphragm housing the heart and lung, also known as the upper burner) starts from the cardia, runs along the throat and distributes in the chest; the middle energizer (中焦, the upper abdominal cavity, namely, the portion between the diaphragm and the umbilicus housing the spleen, stomach, liver and gallbladder, also known as the middle burner) starts from below the diaphragm and above the navel; the lower energizer (下焦, the lower abdominal cavity, namely, the portion below the umbilicus housing the kidneys, bladder, small and large intestines, also known as the lower burner) starts from the stomach to cover the internal organs below.
     The physiological functions of the triple energizer include governance of the activities of all kinds of qi in the human body and regulation of the movement of water passages. These two physiological functions of the triple energizer are interrelated. The transportation of water and fluid to the whole body depends on the ascending, descending, exiting and entering activities of qi. However, qi also relies on the passages of water and fluid to flow all through the body.
     In the current translation practice, 三焦is translated quite differently, such as three warmers, three burners, three heaters, tri-jiao, Sanjiao, etc. When World Health Organization (WHO) Western Pacific Region was trying to standardize the nomenclature of acupuncture and moxibustion, it translated三焦as “triple energizer”, which, though not quite equivalent to the original term in Chinese, is now also widely used. In order to avoid misinterpretation and unify the translation of this important concept of TCM, it was suggested to be transliterated into “Sanjiao” by experts at the WHO Meeting on the International Classification of Traditional Medicine held in Tokyo in December 2010. This suggestion was eventually adopted at the plenary meeting, but still in need of final approval.
     In the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region[1] (abbreviated as the WPRO Standard), 7 terms related to三焦 are included while in the International Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies[2] (abbreviated as the WFCMS Standard), 9 terms related to三焦 are included. The following is a brief analysis about the English translation and international standardization of the related terms included in these two international standards according to 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[3].
     三焦辨证triple energizer pattern identification/syndrome differentiation: categorization of patterns/syndromes according to the theory of the triple energizer
     Syndrome/pattern differentiation of triple energizer, a method used for differentiation of syndrome/pattern in warm diseases, was developed by Wu Jutong, a renowned physician in the Qing Dynasty. The triple energizer is the pathway along which water and fluid ascend, descend, exit and enter. For this reason it is compared to an official in charge of dredging water pathway. Disorder of the internal organs contained in the triple energizer or disorder of the triple energizer itself will inevitably lead to certain disease and syndrome/pattern.
     上焦病证upper energizer disease pattern/syndrome: a pattern/syndrome arising when the pathogen invades the lung meridian at the early stage of epidemic febrile disease, marked by chills and fever, sweating, headache, cough, thirst, reddened tongue tip and edges, and rapid floating pulse; or marked by high fever without chills, cough, dyspnea, sweating, delirium and even loss of consciousness if the pathogen adversely passes to the pericardium
     The upper energizer is located above the diaphragm, including the heart and the lung, functioning to transport nutrients of water and food transformed by the spleen and stomach to all parts of the body. Traditionally it is believed that the upper energizer functions like fog, which means that the upper energizer diffuses and distributes qi, blood and body fluid to nourish the whole body. The upper energizer also governs reception, which means that the upper energizer takes in fresh air and nutrients of water and food. If any of the internal organs contained in the upper energizer is in disorder, it may affect the physiological function of the upper energizer and lead to certain disease and syndrome/pattern.
     In the definition, the expression “epidemic febrile disease” may be the translation of the Chinese term温病which is usually translated as “warm disease” or “seasonal febrile disease”, both of which are occasionally used in the WPRO Standard. According to the theory of TCM, “seasonal febrile disease” may sound more semantically equivalent to 温病, while “warm disease” may appear more morphologically equivalent to the original term. The part “the pathogen adversely passes to the pericardium” in the definition may be the literal translation of the Chinese term逆传心包which is also rendered as “reverse transmission to the pericardium” in the WPRO Standard.
     中焦病证middle energizer disease pattern/syndrome: a pattern/syndrome attributed to invasion of the pathogen on the stomach meridian at the middle stage of epidemic febrile disease, either marked by dryness-heat in the stomach with yin damage, or marked by dampness-heat in the spleen with yin damage
     The middle energizer is located in the region below the diaphragm and above the navel, including the spleen, stomach, liver and gallbladder, the common function of which is to digest, absorb and transport nutrients of water and food. According to the theory of TCM, the middle energizer functions as soaking pond and governs transformation, which means that the middle energizer digests water and food, absorbs nutrients from them and transforms them into blood.
     下焦病证lower energizer disease pattern/syndrome: a pattern/syndrome due to impairment of liver-kidney yin at the later stage of epidemic febrile disease
     The lower energizer is located below the navel, physiologically including the large intestine, small intestine, kidney and bladder. The basic function of the lower energizer is to discharge urine and stool. According to the theory of TCM, the lower energizer infuses fluid into the bladder for discharge. Originally water and food are kept in the stomach. When transformed into waste, they are transmitted downwards into the large intestine in the lower energizer for discharge. After being further separated, the remaining fluid then flows along the lower energizer into the bladder. That is what “the lower energizer governs discharge” means. The reason that the lower energizer is compared to a sluice is that it discharges urine and stool.
     三焦湿热证triple energizer dampness-heat pattern/syndrome: a pattern/syndrome attributed to invasion of the pathogenic dampness-heat on the whole body involving all three energizers
     This syndrome/pattern is caused by widespread dampness and heat all over the body that affect the upper, middle and lower energizers. The common clinical manifestations include dull fever, thirst without much drinking, cough, chest distress, abdominal distension, vomiting, nausea, sloppy stool, unsmooth defecation, scanty urine, difficulty in urination, reddish tongue with yellow and greasy coating, soggy and rapid or slippery and rapid pulse, etc.
     上焦湿热证upper energizer dampness-heat pattern/syndrome: a pattern/syndrome occurring at the initial stage of dampness-heat disease, generally manifested by chills and fever, heaviness feeling of the head and body, oppression in the chest, cough, absence of sweat and rapid soggy pulse
     This syndrome/pattern is caused by invasion of dampness and heat that leads to obvious symptoms related to the upper energizer in the beginning. The common clinical manifestations also include aversion to cold, yellow and white tongue coating, soggy and moderate pulse.
     下焦湿热证lower energizer dampness-heat pattern/syndrome: a pattern/syndrome attributed to invasion of the pathogenic dampness-heat on the large intestine or bladder
     This syndrome/pattern is caused by invasion of dampness and heat into the large intestine, bladder or other organs in the lower energizer. The common clinical manifestations include dribbling urination, burning pain or retention of urine, loose fishy stool, or constipation, distending pain of lower abdomen, or yellow white leucorrhea with fishy odor, general fever, thirst, reddish tongue with yellow and greasy coating, slippery and rapid pulse, etc.
     There are still some other syndromes/patterns related to the triple energizer that are frequently encountered in clinical practice, but are not included in these international standards, such as中焦实热证 (syndrome of excess-heat in the middle energizer) caused by superabundant heat in the middle energizer that leads to accumulation of excessive dryness inside with the clinical manifestations of fever, thirst, epigastrium, distending pain of abdomen, constipation, scanty brownish urine, reddish tongue with dry and yellow coating, strong and rapid pulse, etc; 瘀阻下焦证 (syndrome of stasis obstructing the lower energizer) caused by stagnation of blood stasis in the intestinal tract, bladder, uterus, etc, with the clinical manifestations of pricking pain that cannot be pressed or distending pain of lower abdomen, or touchable mass, painful and bloody urination and defecation, dark purplish tongue or tongue with spots, wiry and unsmooth pulse, etc.

  
References
1. World Health Organization Western Pacific Region. WHO international standard terminologies on traditional medicine in the Western Pacific Region. 2007.
2. Li ZJ. International standard Chinese-English basic nomenclature of Chinese medicine.Beijing: People’s Medical Publishing House. 2008. Chinese-English.
3. Li ZG. International standardization of English translation of traditional Chinese medicine: study of theory, summarization of practice and exploration of methods. Shanghai: Shanghai Scientific and Technical Publishers. 2008. Chinese.
  
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