Hear now the words of the ancient sages, as Dhanvantari himself explains the nature and progression of certain grave ailments. First, consider the affliction of hiccup. When a hiccup arises after a long interval, it comes with paired impulses, beginning subtly in the mouth and growing stronger with each occurrence. This particular type, known as “paired,” brings with it trembling of the head and neck, and is often accompanied by delirium, vomiting, diarrhea, and the rolling of the eyes. As it intensifies, the forceful hiccup causes the brows and temples to droop, disturbing both hearing and sight. The body becomes stiff, speech is impaired, memory and consciousness may be lost, and pain follows the vital channels throughout the body. When the body bends backward and trembles, the great hiccup arises—marked by severe pain, loud sounds, and immense force. This powerful hiccup may originate from the stomach or the navel, just as described before. It brings with it great yawning and stretching of the jaw, and when its cause is deep-seated, the resulting deep hiccup is difficult to cure. In the first two varieties, one should be cautious and avoid the others, for the forceful type displays all symptoms, especially in those who are aged or sexually active. If a person’s 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. Now, Dhanvantari turns to the origin of another formidable disease—yakṣma. This affliction, accompanied by many other ailments and preceded by numerous disorders, is known by several names: rājayakṣmā, kṣaya, śoṣa, and the lord of diseases. In ancient times, this disease befell the king among stars and the twice-born ones. It is called rājayakṣma because both “king” and “yakṣma” are present; kṣaya, due to the wasting of the body and vital substances from which it arises; and śoṣa, because of the drying up of bodily fluids. As the lord of diseases, it rules over all others, arising from rash actions, suppression of natural urges, and the depletion of semen, strength, and unctuousness. The abandonment of proper rules regarding food and drink are its fourfold cause. These provoke the wind and disturb pitta throughout the body. Entering the joints, they 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. Severe nasal catarrh and fever appear as symptoms, along with excessive salivation, a sweet taste in the mouth, softness, impaired digestion, cravings for food and drink, and a failure to distinguish between pure and impure things. Food and drink become contaminated with flies, grass, hair, and similar impurities. Nausea, vomiting, loss of taste, and weakness persist even after bathing. The hands, thighs, chest, feet, mouth, abdomen, and eyes grow excessively pale; whip-like pain strikes the arms, the tongue burns, and the body takes on a repulsive appearance. There is a fondness for women, wine, and meat, yet also aversion and the desire to cover the head. Nails, hair, and bones grow, and oppression is felt even in dreams. In sleep, one may dream of falling, of jackals, snakes, demons, wild animals, and birds, or 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, wildfires, and burning trees. Nasal congestion, breathlessness, cough, hoarseness, headache, loss of appetite, drying of the upward breath, and vomiting from the stomach all manifest. When pain is felt in the side, fever arises in the joints—these eleven symptoms are characteristic of rājayakṣma. Among the complications are pain that destroys the throat, yawning, body aches, spitting, weakness of digestion, and foulness of the mouth. According to the disturbed humor, further symptoms appear: with wind (vāta), there is pain in the head and sides, body aches, obstruction of the throat, and loss of voice; with bile (pitta), pain arises in the feet, shoulders, and hands, along with burning, diarrhea, vomiting of blood, foul breath, fever, and delirium; with phlegm (kapha), there is loss of appetite, vomiting, cough, heaviness in the chest, and a sense of weight above. Excessive salivation, nasal discharge, shortness of breath, hoarseness, and weak digestion follow. The digestive fire is diminished, and swelling, coating, and excess phlegm appear. When the channels are blocked and the tissues depleted, burning arises in the mind, and other complications present themselves. Food, instead of nourishing, is digested in the gut itself, mixed with sour juices; in those afflicted by wasting, food no longer strengthens the limbs. The vital essence does not become blood or flesh, but remains as a wasting condition, obstructed on all sides. When the signs are few, the disease is not severe, and the six senses are not exhausted, one should avoid treatment; otherwise, treatment should be undertaken. When all the humors are disturbed and all the fat is wasted, the voice becomes hoarse—thin, dry, and unsteady. The throat turns white, and relief is found in oily and warm things due to wind; with bile, there is constant burning and dryness in the palate and throat. The throat feels smeared with phlegm, and the mouth gurgles; when all these signs are present together, wasting occurs. It rises greatly, as if filled with smoke, displaying phlegmatic symptoms. Such wasting, when all signs are present, is difficult to cure and should be avoided. Thus ends this teaching from the Śrī Garuḍa Mahāpurāṇa. Finally, Dhanvantari explains the causes of loss of appetite, as taught by Suśruta. Loss of appetite arises when the humors settle in the tongue and heart. When all the humors combine, and when mental distress is present, a fifth type occurs. In disorders of wind and the other humors, the mouth successively tastes astringent, bitter, and sweet. Such are the teachings of the sages, passed down through the ages, for the understanding of those who seek the truth of the body and its ailments.