Dhanvantari, the divine physician, began to speak: “Now, I shall explain the origin of the disease known as yakṣma, a malady that brings with it a host of other afflictions and is itself preceded by many disorders. This illness is called by various names—rājayakṣmā, kṣaya, śoṣa, and is even known as the lord of diseases. In ancient times, it struck not only the king among stars but also the twice-born, the brāhmaṇas. The disease is termed rājayakṣmā because it is like a king among illnesses, both in severity and in its sovereign nature. It is called kṣaya because it brings about the wasting away of the body and the vital essences. The name śoṣa is given due to the drying up of bodily fluids. It is the lord of diseases, ruling over others as a king rules his subjects. Its origins lie in rash actions, the suppression of natural urges, and the depletion of vital substances such as semen, strength, and unctuousness. Neglecting proper rules regarding food and drink—these are the four main causes. Through them, the wind (vāta) is provoked, and pitta (bile) is disturbed without purpose. Once disturbed, these humors enter the joints, pressing upon the veins, blocking the bodily channels, or causing excessive discharges. The result is pain throughout the body—whether in the middle, upper, or lower regions, and even in the heart. Severe symptoms manifest: persistent nasal catarrh, fever, excessive salivation, a sweet taste in the mouth, a strange softness, the impairment of digestive fire, intense cravings for food and drink, and a blurring of perception between what is pure and impure. Food and drink become tainted, often contaminated by flies, grass, or hair. Nausea, vomiting, loss of taste, and weakness persist even after bathing. The hands, thighs, chest, feet, mouth, abdomen, and eyes become unnaturally pale. There is whip-like pain in the arms, burning of the tongue, and the body takes on a repulsive appearance. The afflicted person develops an unusual fondness for women, wine, and meat, yet simultaneously experiences aversion, a tendency to cover the head, and abnormal growth of nails, hair, and bones, accompanied by oppression in dreams. In sleep, they dream of falling, of jackals, snakes, demons, wild animals, and birds; they see themselves climbing heaps of hair, bones, husks, and ashes. They witness deserted villages and lands, drying rivers, lights in the sky, wildfires, and burning trees. Other symptoms include nasal congestion, breathlessness, cough, hoarseness, headache, loss of appetite, drying up of the upward breath, and vomiting from the stomach. Pain in the sides is followed by fever in the joints—these eleven symptoms mark rājayakṣma. Further complications may arise: pain that destroys the throat, yawning, body aches, spitting, weakness of digestive fire, and foulness of the mouth. When vāta predominates, there is pain in the head and sides, body aches, throat obstruction, and loss of voice. With pitta, pain arises in the feet, shoulders, and hands, accompanied by burning, diarrhea, vomiting of blood, foul breath, fever, and delirium. When kapha is disturbed, there is loss of appetite, vomiting, cough, heaviness in the chest, and a sensation of weight above. Excessive salivation, nasal discharge, shortness of breath, hoarseness, and a weak digestive fire also occur. The humors diminish the digestive fire, leading to swelling, coating, and excess phlegm. As the channels become blocked and the tissues are depleted, a burning sensation arises in the mind, and further complications ensue. Food, though digested in the gut and mixed with sour juices, fails to nourish or strengthen the limbs. The essence of nourishment does not transform into blood or flesh, but remains trapped, resulting only in wasting. When the signs are few, the disease is not severe, and the six senses remain unimpaired, treatment should be avoided; otherwise, in all cases, one should proceed with treatment. When all the humors are disturbed and bodily fat is wasted, the voice becomes hoarse—thin, dry, and unsteady. The throat turns white, and relief comes from oily and warm substances if vāta is at fault. With pitta, there is constant burning and dryness in the palate and throat. With kapha, the throat seems smeared with phlegm, and gurgling sounds emerge from the mouth. When all these signs are present together, wasting is at its peak. The disease rises greatly, as if the body is filled with smoke, and phlegmatic symptoms dominate. This form of wasting is difficult to cure and should be avoided, especially when all signs are present. Thus concludes this section of the Śrī Garuḍa Mahāpurāṇa. Dhanvantari continued: “Now, I will explain the causes of loss of appetite, as taught by Suśruta. Loss of appetite arises when the humors reside in the tongue and heart. When all the humors combine, or when mental distress is present, a fifth type of loss of appetite occurs. In vāta and other disorders, the mouth successively tastes astringent, bitter, and sweet. Just as the mind loses all taste in times of grief or anger, so too, the humors and other corruptions can produce this fifth type. When the upward-moving air is afflicted by all the humors, it expels everything that is fit for digestion. This quickly leads to distress, loss of luster, excessive salivation, and loss of appetite. Pain arises in the navel and back, and food is expelled to the side. Then, with interruptions, astringent, frothy matter is vomited bit by bit. The belching is noisy, difficult, and forceful. Due to vāta, there is cough, dryness of the mouth, and affliction of the voice. When pitta is involved, the vomit is like saline water, smoky, greenish-yellow, mixed with blood, sour, sharp, bitter, with a smell of grass, and causes burning and ripening. With kapha, it is unctuous, thick, yellow, or like honey—sweet, salty, abundant, and excessive, causing horripilation. When these symptoms are joined by swelling, sweetness, drowsiness, nausea, exhilaration, and cough, and all signs are present together, the condition must certainly be discarded as incurable. When everything about a person becomes repulsive to the senses—by sight, hearing, and so on—due to the humors or from food corrupted by worms, the disease manifests with pain, trembling, and exhilaration, especially in worm-induced cases. Dhanvantari then said: “Now, O learned one, I will explain the causes of heart disease and related conditions, including those caused by worms. Five types located in the heart are recognized by their signs. When caused by vāta, there is excessive emptiness; the person eats and cries out, the heart feels broken, dried, stiff, and empty, and there is dizziness.” Thus, in his compassion and wisdom, Dhanvantari revealed the nature, causes, and symptoms of these grave diseases, so that the learned might recognize them and act wisely.