Aetiology and pathology: This syndrome usually occurs after rain, or it may be due to over-indulgence of raw or cold food. In both cases the pathogen cold and damp injure the pi-spleen impairing its function of transportation and transformation and resulting in a poor appetite, borborygmii, abdominal pain and loose stools. As pathogenic damp is sticky and stagnant, it is liable to block the flow of qi causing a sensation of epigastric fullness and distension.

Syndromes of the fei-lung

1. Invasion of the fei-lung by the pathogen wind
Clinical manifestations: An itchy throat and cough associated with fever and chills. If the wind is accompanied by cold then the patient usually feels cold and presents with nasal obstruction, a watery nasal discharge and mucoid sputum. The tongue coating is thin and white. If the wind is associated with heat, fever will be the most prominent symptom and will be associated with a red, swollen throat, a purulent nasal discharge and purulent sputum. The tongue coating will be yellow.

Aetiology and pathology: Invasion of the fei-lung by the pathogen wind disturbs its function of dispersal and descent. Normal respiration is affected producing the symptoms of cough and nasal obstruction. Cold is a yin pathogen and therefore liable to damage the yang qi. Consequently when wind is associated with cold, the sensation of cold will be more severe than that of fever and will be accompanied by a watery nasal discharge and white mucoid sputum. Heat is a yang pathogen, and if wind is accompanied by heat, fever will become the most prominent symptom and will be associated with a purulent nasal discharge and purulent sputum.

2. Retention of damp and/or phlegm in the fei-lung
Clinical manifestations: Cough, dyspnoea and white frothy Sputum The onset is generally precipitated by cold, and the tongue coating is white and sometimes sticky.

Aetiology and pathology: This syndrome is due to the disturbance of the normal circulation of body fluid, the body fluid accumulates and precipitates the formation of damp/or phlegm. When damp and phlegm remain in the fei-lung the passage of qi is blocked and the functions of the fei-lung are impaired, this results in the above symptoms.

3. Retention of phlegm and/or heat in the fei-lung

Clinical manifestations: Cough, dyspnoea, wheezing and thick yellow and/or green sputum (occasionally pus). This can be associated with rigors and a fever; the tongue proper is red with a yellow coating and there is a rapid pulse.

Aetiology and pathology: This syndrome is caused by invasion of exogenous wind and/or heat, or wind and/or cold, which later develops into heat. The heat mixes with phlegm, which remains in the fei-lung and blocks the circulation of qi; this impairs the functions of the fei-lung and causes cough, dyspnoea and wheeze. Heat exhausts body fluid causing purulent sputum. When phlegm and heat are found in the fei-lung, stagnation of blood results which in turn leads to purulent, bloody sputum.

4. Insufficiency of the yin of the fei-lung
Clinical manifestations: A dry, unproductive cough associated with sticky, scant, blood-stained sputum, fever, a malar flush, a feverish sensation in the palms and soles, a dry mouth and night sweats. A red tongue proper and a thready and rapid pulse will be found.

Aetiology and pathology: Such symptoms are usually caused by chronic disease of the fei-lung, which consumes the yin and results in insufficiency of body fluid. The fei-lung is deprived of nourishment, its functions are impaired and this produces a dry mouth. Xu (deficiency) of yin causes endogenous heat which drives out body fluid and injures blood vessels, this results in a fever, a malar flush, a feverish sensation in the palms and soles, night sweats and bloody sputum.

Syndromes of the Shen-kidney

1. Weakness of the qi of the shen-kidney
Clinical manifestations: A sore and weak sensation in the lumbar region and knee joints, urinary frequency, polyuria, dribbling, enuresis, urinary incontinence, dyspnoea, wheezing, and occasionally infertility. The pulse will be thready.

Aetiology and pathology: This syndrome is often caused by malaise after a prolonged chronic illness, or may be the result of senility or congenital deficiency. Weakness of the qi of the shen-kidney results in an inability of the urinary bladder to control urination; this causes enuresis, incontinence, frequency and urgency. Shen-kidney stores essence (shen), but when the qi of the shen-kidney is deficient, infertility can result. When the qi of the shen-kidney is weak, it fails to help the fei-lung perform its function of descent, qi therefore attacks the fei-lung resulting in dyspnoca and wheezing.

2. Insufficiency of the yang of the shen-kidney
Clinical manifestations: These are broadly similar to the syndrome described as 'Weakness of qi of the shen-kidney'. The major symptoms are a dull ache in the lumbar region and knee joints, cold, pallor, impotence, oliguria and oedema of the lower limbs. A pale, tooth-marked tongue and a deep thready pulse will be found.

Aetiology and pathology: This syndrome usually occurs after a prolonged chronic illness in which the yang of the shen-kidney is injured, it may occasionally be due to an excess of sexual activity which also injures the yang of the shen-kidney. In either instance, the yang of the shen-kidney fails to warm the body which results in cold aching sensations in the low back and knee joints, and impotence. Then shen-kidney controls water metabolism, and an insufficiency of the yang of the shen-kidney results in oliguria; the subsequent fluid excess presents with the symptom of oedema.

3. Insufficiency of the yin of the shen-kidney
Clinical manifestations: Blurred vision, tinnitus, amnesia, feverish sensation in the palms and soles, a malar flush, night sweats, hot yellow urine and constipation. The tongue proper will be red and the pulse thready and rapid.

Aetiology and pathology: This usually occurs after a prolonged chronic illness in which the yin of the shen-kidney is impaired, it may also be due to an over-indulgence in sexual activity, which consumes the shen-kidney. Either of these factors can result in the shen-kidney failing to produce marrow and maintaining normal cerebral function. The symptoms that result are dizziness, blurred of nourishment. Furthermore, pathogenic heat in the interior stirs up endogenous wind causing fever, convulsions and neck rigidity. Coma is due to pathogenic heat affecting the pericardium and disturbing the mind.

Syndromes of the Pericardium
The syndromes of the pericardium are seen clinically as the invasion of the pericardium by heat. The symptoms are a high fever, coma and delirium, these result from heat invading the interior of the belly, which in turn disturbs the mind.

Syndromes of the Small Intestine
Disturbance of the function of the small intestine is included in the syndromes of the pi-spleen, particularly with respect to its main function (transformation and transportation).

Syndromes of the Gall Bladder

Damp and heat in the gall bladder Clinical manifestations: Yellow sclera and skin, pain in the costal and hypochondrial region, pain in the right upper abdominal quadrant and a bitter taste in the mouth. Some patients may vomit sour and/or bitter fluid. The tongue coating is yellow and sticky.

Aetiology and pathology: The function of the gall bladder is to store and excrete bile, and this depends on the normal function of the gan-liver. Exogenous damp and/or heat (heat caused by depression of the gan-liver, damp and heat caused by overindulgence in alcohol and rich food) may accumulate in the gan-liver and gall bladder, thereby impairing the free flow of qi. Bile cannot therefore be secreted and freely excreted, and the subsequent biliary overflow causes jaundice, a bitter taste in the mouth and vomiting. Stagnation of the qi of the gan-liver and gall bladder also leads to stagnation of blood, causing right hypochondria! pain. This syndrome is closely related to the gan-liver, and is also known as 'damp and heat in the gan-liver and gall bladder'. Syndromes of the Stomach

1. Retention of food in the stomach
Clinical manifestations: Distension and pain in the epigastric region, anorexia, belching, heartburn and vomiting. The tongue has a thick sticky coating.

Aetiology and pathology: This syndrome is usually caused by over-eating, which leads to the retention of undigested food in the stomach; the qi of the stomach ascends rather than descending.

2. Retention of fluid in the stomach due to cold
Clinical manifestations: The sensation of fullness associated with a dull epigastric pain, aggravated by cold and alleviated by warmth. The tongue coating will be white and sticky and the pulse thready or slow.

Aetiology and pathology: This syndrome usually follows a cold after rain, or may be precipitated by the excessive ingestion of raw or cold food. Either of these factors result in cold in the stomach which causes stagnation of qi and pain. Prolonged damage injures the yang qi of the pi-spleen and stomach so that body fluid is retained in the stomach instead of being transported and transformed, this results in vomiting.

3. Hyperactivity of the fire of the stomach
Clinical manifestations: A burning in the epigastrium, thirst, a preference for cold drinks, vomiting of undigested food or sour fluid, gingival swelling pain and ulceration, halitosis. The tongue proper will be red with a dry yellow coating.

Aetiology and pathology: This syndrome is usually due to overeating rich food, which causes heat to accumulate in the stomach. The heat consumes body fluid and causes the qi of the stomach to ascend. This results in a burning epigastric pain, thirst, a preference for cold drinks and vomiting. Halitosis and gingival ulceration are due to the fire element in the stomach.