In those who have grown thin and emaciated, a troubling array of symptoms arises: blood may appear in the urine, breathing becomes labored, and a stiffness settles in the back and loins. When these afflictions intensify, they mark the onset of consumption, or wasting disease. Within the very seat of this wasting, a cough emerges, soon followed by the spitting up of phlegm. This expelled substance is foul, resembling decaying pus, and is often tinged with yellow and red. The sufferer’s sleep is restless, as if struck by unseen forces, and the heart burns with an inner heat. Sudden and strange desires come—sometimes for warmth, sometimes for cold—alongside an urge to eat excessively, yet all the while, strength slips away. The face takes on a peculiar sheen, appearing oily yet clear, and its contours curve oddly. The eyes become radiant and lustrous, but these are signs that all the marks of wasting disease have taken hold. This cough, born of wasting, destroys the bodies of those already weakened. In those who are strong, wasting and injury may also appear, but in them, these conditions are newly arisen rather than deeply rooted. Both forms, however, can be cured if the patient’s strength allows, especially when the disease is still young and its course distinct. But when different types mingle and linger, especially in the aged, they become chronic and harder to treat. Cough, breathlessness, wasting, vomiting, hoarseness, and other such diseases often arise from neglect; thus, one should strive to overcome them swiftly. Dhanvantari, the divine physician, then spoke further: “Now, I shall explain the origins of breathlessness. It arises when cough increases or when the bodily humors have previously become aggravated. Other causes include indigestion, diarrhea, vomiting, poisoning, anemia, fever, exposure to dust or smoke, strong winds, injury to vital spots, or even the intake of cold water. There are five types of breathlessness: minor, darkness, broken, great, and upward. In each, the wind within the body, obstructed by phlegm, moves erratically and becomes established throughout the system. This disturbed wind corrupts the channels that carry breath, water, and food, and when it settles in the chest, it produces breathlessness, especially when undigested food remains in the stomach. At the onset, pain is felt in the heart and sides, breathing becomes irregular, the abdomen swells, and there is a splitting pain in the temples. Exertion and overeating only make matters worse. The impure wind, both driven and driving, moves in reverse, ascending the channels and expelling phlegm. It seizes the head, neck, chest, and sides, causing cough, rattling sounds, fainting, loss of appetite, and severe nasal congestion. The breathlessness becomes intense and rapid, tormenting the life-breath itself. The patient may faint from its force, but after spitting, finds a brief moment of relief. Lying down becomes difficult; sitting brings some comfort. The eyes are wide, the forehead sweats, and the affliction is great. The mouth is dry, breathing is frequent, and there is a longing for warmth, accompanied by trembling. The condition worsens with cold clouds, water, east winds, and phlegmatic states. This chronic ‘darkness’ type of breathlessness can be cured in a strong person, but if fever, fainting, or chills are present, it does not subside easily. The afflicted one suffers pain from injured vital spots, sweats, faints, has abdominal swelling, burning in the bladder, and disturbed sleep. His gaze falls downward; his eyes are sunken, with red-tinged whites. The mouth is parched, speech becomes incoherent, the complexion fades, and consciousness slips away. He breathes with a deep, pitiable sound, snorting and gasping, agitated like a maddened bull, never ceasing. Knowledge and discernment are lost, the eyes and face bewildered. The eyes draw together, urine and stool are retained, and speech is broken. The throat grows dry again and again, with severe pain in the ears, temples, and head. Breathing is long and upward, but he cannot draw breath back down. Phlegm blocks the mouth and ears, the sense of smell is disturbed, and the eyes wander restlessly. When the vital spots are injured, he laments with suppressed speech. These symptoms, even when not yet fully manifest, will surely appear, and when they do, they herald death. Dhanvantari then continued: “Now, O Suśruta, let me explain the origin of hiccup. Hiccup has a single cause but various preliminary signs and types, each depending on the individual’s constitution. Hiccups arise from food, and may be minor, paired, or great; there is also a deep type, caused by improper, hurried, or excessive eating and drinking. When one consumes food and drink that is dry, sharp, rough, or excessive, the breath produces a mild hiccup, with a soft sound, often following hunger. A hiccup that arises with food and drink at twilight is called ‘paired’; when wind is disturbed by exertion, it produces a minor hiccup. This type starts at the root of the neck, moves slowly, worsens with exertion, but becomes mild after eating. A hiccup that comes after a long interval, with paired impulses, grows in the mouth as it progresses, intensifying with each episode. When it causes trembling of the head and neck, it is recognized as the ‘paired’ type, often accompanied by delirium, vomiting, diarrhea, and rolling of the eyes. The paired, forceful hiccup, as it advances, causes the brows and temples to droop, disturbing hearing and sight. It stiffens the body and speech, erases memory and consciousness, strikes the vital channels, and causes pain along their paths. When the body bends backward and trembles, the great hiccup arises, bringing severe pain, a loud sound, great force, and immense strength. This type may also arise from the stomach or navel, as previously described. It produces great yawning and stretching of the jaw; when the cause is deep, the deep hiccup is difficult to cure. In the first two types, one should avoid the others; the forceful type displays all symptoms, especially in those who are old or sexually active. For one whose body is already weakened by disease and emaciated from lack of food, other ailments may be cured, but not so for one who acts rashly. For when hiccup and breathlessness are established at the time of death, they remain fixed and unyielding.