Author(s): Kathy Lin

Community Reviewer(s): Nadine Chan, Editor

Chinese Language Script
Chinese script. Photo by Simon Shek (cc license).

Written Language

The Chinese language is the oldest written language in the world with at least six thousand years of history. Chinese character inscriptions have been found in turtle shells dating back to the Shang dynasty1 (1766-1123 BC) proving the written language has existed for more than 3,000 years. The Chinese written language uses single distinctive symbols, or characters, to represent each word of the vocabulary. The vast majority of characters are written versions of spoken sounds that have meaning. A large dictionary usually contains 40,000 characters.2 One must be able to recognize 2,000 to 3,000 characters to read a newspaper. Although the written system has been altered over time due to revolutions and political changes, the principles of the language along with the symbols and characters have remained basically the same.

Although many Chinese dialects exist, the written language is a common form of communication. Even though people are not able to verbally communicate in different provinces, they are able to understand each other in writing. However, the written language can be further subdivided into three forms: simplified, traditional, and informal slang or phonetic. There is also a form called “pin-yin” which is the Chinese language transcribed using a roman spelling.

Chinese Women Project - written in traditional and simplified characters

Simplified Characters

Primarily Chinese in China uses simplified characters. It is taught in Mandarin-Chinese classes internationally as well. These characters are simpler, i.e., have less pen-strokes, than traditional Chinese characters. Simplified characters have existed for hundreds of years, but only became officially acceptable in formal writing after the founding of the People’s Republic of China in an attempt to improve literacy among Chinese in China, during the 1950’s. 3 The Chinese newspaper “Ren Min Ri Bao” or “People’s Daily” uses simplified characters as do subtitles of news reports or videos that come from China. Because there are not as many readers of this paper in the United States, the paper is not commonly carried in local Chinese stores. People who are literate in simplified Chinese characters may not be literate in traditional Chinese.

Hypertension and Diabetes written in traditional Chinese characters

Traditional or Classical Chinese

Traditional or classical Chinese characters is taught and used by Chinese in Hong Kong, Taiwan, Malaysia, Korea, Japan, and elsewhere. Many textbooks, newspapers, and subtitles for movies are written in traditional Chinese. Examples of Chinese newspapers distributed in the United States that use traditional Chinese characters is “Ming Pao” or “Sing Tao” newspapers. Cantonese speaking Chinese from Hong Kong generally reads these papers. On the other hand, Mandarin-speaking Taiwanese reads the Chinese “World Journal” newspaper in the States. Both papers are commonly sold in local Chinese stores and restaurants.

Informal Slang or Phonetic Characters

Are you sick? Written in traditional Chinese and informal slang in Cantonese.

Cantonese speakers have also developed an informal slang or phonetic characters. These characters are used in addition to traditional Chinese characters in an informal setting, such as in comics or entertainment sections of newspapers or magazines. The informal characters are used to sound out the Cantonese dialect. Often, you cannot find these characters in the dictionary. People from China, Taiwan or other countries have to learn to recognize these characters before they can read all sections of Hong Kong-based news papers.

Pin-yin, the English form of Chinese

In an attempt to make the Chinese language more understandable to the western world, China developed the “pinyin” (pin-yin) system.4 The pinyin system uses the western alphabet and spelling to pronounce Chinese words. Chinese languages have been transliterated into the pinyin system since 1892 5 (except personal and location names). In 1977, Chinese officials made a formal request to the United Nations (UN) 6 to use the pinyin system for naming geographical locations in China. People who use pinyin are those who are more familiar with the western alphabet and are learning to speak Mandarin Chinese.

Hypertension and Diabetes written in Chinese pin-yin

Verb Tense

Grammatically speaking English and Chinese are very different languages. There is no rule that verbs, nouns, and adjectives must agree with one another in Chinese writing. There is no such thing as singular or plural in the Chinese language. Often a number or word will be added to the sentence to account for plurality. There are no verb tenses in the Chinese writing. Additional words are used to clarify the past and future tenses. These words are usually placed at the beginning of the phase to help indicate time. In a medical setting, it is important to pay particular attention to time indicators. For example: if a provider asks, ” Have you been vomiting?” the Chinese patient may answer ” No”. Actually the patient may mean “not now, but two days ago I did.” In this case, the provider is not getting the correct information. It would be clearer to ask the patient a question with a time indicator such as “Have you vomited in the last week?”

Spoken Language

China covers a very broad area of land. There are more than 70 million people belonging to 55 different national minorities living in China.7 Each minority has their own spoken language. Many of the minority groups do not have a distinguishable written form for their languages.

The spoken Chinese language is comprised of many regional variants called dialects. Modern Chinese dialects evolved between the 8th and 3rd centuries BC.8 The differences in dialect are due to the different pronunciation and vocabulary. The official dialect of China is Mandarin, also call “Putonghua”. More than 70% of the Chinese population speaks Mandarin, but there are also several other major dialects in use in China: Yue (Cantonese), Xiang (Hunanese), Min dialect, Gan dialect, Wu dialect, and Kejia or Hakka dialect.9

Major Chinese Dialects Spoken in the United States

The 3 most commonly used dialects in the Northwest

Mandarin or Putonghua is the most common dialect used in China and has been adopted as a second language by those who speak other Chinese dialects. The official language of China, Mandarin is the dialect taught in Chinese schools. It is the universal language used throughout the northern, central, and southwestern provinces of China. Mandarin is also spoken in Taiwan, where it is referred to as Chinese rather than “Putonghua.” Often, Mandarin is used in local TV and radio media. Next to Cantonese, it is the most common Chinese language spoken in the Northwest. The Chinese newspaper, “World Journal” is distributed in the States and is published for Mandarin speaking Chinese.

Immigrants from China or Taiwan who speak Mandarin come from diverse backgrounds. Some have fled China for political freedom after incidents such as the Tiananmen Square10 events where students who spoke up for democracy were rapidly crushed by Chinese government. Others are well-educated professionals seeking business and educational opportunities in the United States. Still others have little education and have come to the States in search of better life for themselves and their families.

Cantonese, also known as Yue or Guangdonghua, is spoken in Hong Kong, most of Guangdong, and the southern Guangxi Zhuang autonomous region. There are large groups of Cantonese-speaking immigrants located in the Northwest area. Many of these immigrants are from Southeast Asia, Mainland China, and Hong Kong. More recently, a number of ethnic Chinese has fled Southeast Asia as refugees.11Hong Kong’s return to Chinese control in 1997 also stimulated a great deal of movement from both Hong Kong and China. Although Cantonese is a common dialect spoken on a daily basis in Hong Kong, government officials and schools are required to use Mandarin dialect. Cantonese is arguably the most commonly spoken dialect in the Pacific Northwest, Northern California, and the East Coast. Local Chinese TV and radio media also commonly broadcast in Cantonese. A couple of Chinese newspapers distributed in the States for Cantonese speakers are “Ming Pao” and “Sing Tao.”

Toisanese another dialect commonly used by Chinese in the Northwest is call Toisanese. This dialect came from the rural area of Guangdong. In the mid 1900s, many Toisanese emigrated from Toisan area to the States as railroad workers. More recently, Toisan people continue to immigrate to the States for improved economic opportunity. Many of the immigrants have adopted to learn the Cantonese dialect but some speak only Toisanese. There is no separate written language or broadcasting media in Toisanese.

Other Dialects Spoken by Chinese Living in the Northwest

Xiangdialect12 is also known as Hunanese and is spoken primarily in the Hunan Province, located in southern China.

Min dialect13 is spoken mostly in Fujian, Taiwan and Hainan, and parts of eastern Guangdong and the Leizhou Bandao Peninsula, and in areas of Southeast Asia. During World War I, a large number of Chinese emigrated from Fujian to Taiwan.

Gan dialect14 is used mostly by the people living in Jiangxi and the southeastern corner of Hubei. They are located at the north side of China.

Wu dialect15 is spoken by a majority of the people living in Zhijiang and the southern areas of Jiangsu and Anhui.

Kejia or Hakka dialect16 is spoken in the northeastern Guangdong area, southwestern Fujian, southern Jiangxi, and in areas throughout southeastern China and Southeast Asia.

Interpretation & Translation Issues

Over the last several decades, the Northwest has seen large immigrant influxes from China, Hong Kong, and Southeast Asia. The primary language of these multiple ethnic groups is a Chinese dialect. Therefore, interpretation and translation services are necessary in every field ranging from government officiating, law enforcement, and court activities, to medical encounters, insurance affairs, and industrial business and so forth.

These non-English speaking immigrants have various levels of educational and professional backgrounds, such as doctors, professors, teachers, business owners, engineers, labor workers, housewives, and scholars. No matter what kind of background they have, they all must face the most challenging task of learning how to speak and write English. Learning the English language is very difficult for many individual reasons including finances and time restraints, limited education, and age. Often due to the difficulties in communication, non- English speaking immigrants will try to get help and resources in their own community or postpone their problem until it is unavoidable.

Inappropriate but Common Interpretation Methods

An English speaking person cannot understand or even imagine how frustrating and frightening it can be for a non-English speaker to answer the phone or door. Quite often they must rely on their children and relatives who speak better English. The children have taken over many of the parents’ traditional duties because of their English skills like reading the mail, relaying school news and information, answering the phone, assisting in shopping, making appointments, and interpreting. However, even though the children can speak English fluently they often have a difficult time conveying information completely back to the parents because of their lack of sophistication with the Chinese language or because the subject is inappropriate for a child to interpret. Also, English speaking children or relatives are often busy with their own daily lives to be constantly translating for their non- English speaking family members. The whole issue of language knowledge has created a lot of tension and frustration in Chinese households and has led to power struggles between the parents and the child or family member.

Interpretation- Legal Guidelines

Title VI of the Civil Rights Act of 1964 is a federal regulation that applies to all health care providers receiving federal financial support from the US department of Health & Human services. The regulation requires that providers use effective methods of communication with people who, because of their national origins have limited proficiency in English.

All interpreter and translation services have contracted interpreters and translators in multiple languages who are ready to be sent out to the field for different functions. Most of the interpreters and translators are certified through the State of Washington. The State provides a written and oral certification exam for all medical, administrative, and court interpreters. Interpreters for many languages are certified by the State. The languages with certified state interpreters are Spanish, Russian, Vietnamese, Cantonese, Mandarin, Cambodia, Mien, Japanese, Korean, Romanian, and Somalia. Certifications for additional languages are being developed as needed.

Interpretation Styles

There are three different styles of interpreting: consecutive, paraphrase and simultaneous. Hospital and clinical settings usually use one of the first two styles. The simultaneous style often is used in court and other legal settings. The role of the interpreter is to act as a voice bridge between two parties. Some pointers to keep in mind when speaking through an interpreter are as follows:

  1. Maintain eye contact with the client or the patient at all times and talk to them directly (not to the interpreter).
  2. Be open-minded and aware of cultural differences.
  3. Use simple, clear and direct terms or phases
  4. Pause periodically.
  5. Make sure the client or patient fully understands what is translated.
  6. Encourage questions.
  7. Schedule extra time for the interpreting process.

Interpretation Resources

Many multi-cultural services and agencies provide seminars and classes to the public. Locally, the Cross Cultural Health Care Program ( offers such seminars. Currently, Washington State provides one of the best translation and interpretation services in the nation. A majority of the non-English speaking immigrants have been pleased with the interpreter services and feel very fortunate to live in the Great Northwest!


  1. A concise history of China by Roberts, J.A.G., Harvard Univ. Press, 1999
  2. Microsoft Encarta 98 encyclopedia: China section.
  3. John DeFrancis, The Chinese Language, University of Hawaii Press, 1984, pg. 214, 258-260.
  4. Modern Chinese History and Socioliquistic by Ping Chen.
  5. A concise history of China by Roberts, J.A.G., Harvard Univ. Press, 1999
  6. A concise history of China by Roberts, J.A.G., Harvard Univ. Press, 1999
  7. Microsoft Encarta 98 encyclopedia: China section.
  8. Microsoft Encarta 98 encyclopedia: China section.
  9. Microsoft Encarta 98 encyclopedia: China section.
  10. Taylor, VM, et al. Cervical cancer screening Among Chinese American Women, submitted manuscript
  11. Taylor, VM, et al. Cervical cancer screening Among Chinese American Women, submitted manuscript
  12. Microsoft Encarta 98 encyclopedia: China section.
  13. Microsoft Encarta 98 encyclopedia: China section.
  14. Microsoft Encarta 98 encyclopedia: China section.
  15. Microsoft Encarta 98 encyclopedia: China section.
  16. Microsoft Encarta 98 encyclopedia: China section.