As life ebbs away, the afflicted man breathes with a deep, pitiable sound, snorting and gasping in distress, his body agitated like a maddened bull, his breath unceasing. His knowledge and discernment vanish; confusion clouds his eyes and face. He squints, unable to relieve himself, and his speech becomes broken and incoherent. His throat dries again and again, while severe pain seizes his ears, temples, and head. He exhales long and upward but cannot draw breath back down. Phlegm blocks his mouth and ears, his sense of smell is disturbed, and as his eyes wander, he gazes upward, casting glances all around. When the vital spots are injured, he laments in suppressed speech. These unmanifest symptoms may become manifest and, when they do, they certainly bring death. At this point, Dhanvantari spoke to Suśruta, saying, “Now I will explain the origin of the disease of hiccup. Listen carefully. Hiccup has a single cause, but its preliminary signs, types, and dependence on constitution must be understood. Hiccups arise from food and are classified as minor, paired, great, or deep. The deep type, O Marut, is caused by improper, hurried, or excessive consumption. “When one consumes dry, sharp, rough, or excessive food and drink, the breath produces a mild hiccup, with a soft sound, often following hunger. The hiccup that arises together with food and drink at twilight is called ‘paired’; when wind is disturbed by exertion, it produces a minor hiccup. A hiccup that spreads from the root of the neck, moving slowly, increases with exertion and becomes mild immediately after eating. The hiccup that arises after a long time, with paired impulses, increases in the mouth as it progresses and grows with each episode. The type that causes trembling of the head and neck is identified as the ‘paired’ type, accompanied by delirium, vomiting, diarrhea, and rolling of the eyes. The paired, forceful hiccup, which comes with progression, causes the brows and temples to droop, and disturbs hearing and sight. It stiffens the body and speech, robs memory and consciousness, strikes the vital channels, and causes pain along their course. “When there is bending backward and trembling, the great hiccup arises. It brings severe pain, a loud sound, great force, and immense strength. This type also arises from the stomach or navel, just as previously described. It produces great yawning and stretching of the jaw; and 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 weakened by disease and emaciated from lack of food, all other ailments may be cured, but not so for one who acts rashly. Just as hiccup and breathlessness, when established at the time of death, remain fixed.” Then Dhanvantari continued: “Now, I shall explain the origin of the disease known as yakṣma, which is accompanied by many other ailments and is preceded by numerous disorders. It is called rājayakṣmā, kṣaya, śoṣa, and the lord of diseases. In ancient times, this affliction befell the king among stars and twice-born ones. Because both ‘king’ and ‘yakṣma’ are present, it is known as rājayakṣmā; it is called kṣaya due to the wasting of the body and vital substances, and arises from that cause. It is called śoṣa because of the drying up of fluids and so forth; it is the lord of diseases, like a king. It arises from rash actions, suppression of natural urges, and the depletion of semen, strength, and unctuousness. Abandonment of proper rules regarding food and drink—these four are its causes. By them, wind is provoked, and pitta is disturbed everywhere in vain. “These disturbed humors enter the joints of the body, press upon the veins, block the channels, or cause excessive discharge. Pain arises in the middle, upper, lower, and transverse parts of the body, and in the heart. The symptoms that follow are severe nasal catarrh and fever. There is excessive salivation, sweetness in the mouth, softness, impairment of digestive fire, craving for food and drink, and confusion between pure and impure things. Food and drink are often contaminated by flies, grass, hair, and the like; there is nausea, vomiting, loss of taste, and weakness even after bathing. The hands, thighs, chest, feet, mouth, abdomen, and eyes become excessively pale; there is whip-like pain in the arms, burning of the tongue, and a repulsive appearance of the body. “One develops fondness for women, wine, and meat, aversion, a tendency to cover the head, and growth of nails, hair, and bones, along with oppression in dreams. There are dreams of falling, of jackals, snakes, demons, wild animals, and birds; and of ascending heaps of hair, bones, husks, and ashes. There are visions of deserted villages and regions, of drying up water, of light in the sky, of wildfires, and of burning trees. There is nasal congestion, breathlessness, cough, hoarseness, pain in the head, loss of appetite, drying up of upward breath, and vomiting from the stomach. When pain is felt in the side, fever arises in the joints; these eleven symptoms manifest in rājayakṣma. “Among their complications are to be known: pain that destroys the throat, yawning, body aches, spitting, weakness of digestive fire, and foulness of the mouth. When wind (vāta) is involved, there is head and side pain, body aches, obstruction of the throat, and loss of voice; when bile (pitta) is disturbed, pain occurs in the feet, shoulders, and hands, with burning, diarrhea, vomiting of blood, foul breath, fever, and delirium. When phlegm (kapha) is involved, there is loss of appetite, vomiting, cough, heaviness in the chest, and a sense of weight above. There is excessive salivation, nasal discharge, shortness of breath, hoarseness, and weak digestive fire; because of the humors, the digestive fire is diminished, and there is swelling, coating, and excess phlegm. When the channels are blocked and the tissues are depleted, burning arises in the mind; other complications also occur in such a state.” Thus, Dhanvantari revealed the grave nature of these diseases, their signs, and their manifold complications, so that their recognition and understanding might guide the wise in their care and treatment.