When the first signs of bile disorder appear in a person, there is confusion about one’s own speech, trembling of the body, excessive sleep, and, above all, a deep fatigue that seems to draw upon all the bodily humors. By observing which symptoms are most prominent, one can discern the involvement of wind, bile, and other humors in the blood and tissues; when these humors enter the blood, the person may see visions tinged red, blue, or black, and is plunged into a state of darkness—fainting away. If wind is the main cause, the person quickly regains consciousness, but is left with pain in the heart, trembling, dizziness, coughing, and a dusky or reddish complexion—these are the marks of wind-induced fainting. When bile is dominant, the person perceives the sky as blood-colored or yellow, loses consciousness, and upon awakening, is drenched in sweat, tormented by burning sensations and intense thirst. If phlegm is the culprit, the sky seems clouded, broken, and tinged yellowish-blue; the eyes are bloodshot with a bluish hue. Such a person is unconscious for a long time and, upon returning, salivates heavily from the heart and chest, feels heaviness and dullness in the limbs, and is, as if, bound by the king’s law—powerless to move. When all three humors surge together, the person falls as if possessed, suddenly and without motion, showing no repulsive or convulsive movements. In such states—whether intoxication or fainting—once the humors’ force is spent in the body, they subside on their own or by means of abstinence and proper medicines. During these episodes, the powers of speech, body, and mind are seized by the humors, whether their force is strong or weak; together with loss of consciousness, these faculties collapse, and the person stands on the threshold of life’s destruction. Because of this, people become inert as wood, resembling the dead. If treatment is not swiftly given, death follows quickly. Just as one would hasten to rescue a man sinking in the deep ocean, surrounded by crocodiles and rushing waters, so too should one swiftly attend to someone slipping into unconsciousness. Intoxication, pride, anger, and pleasure all drive people to act in many ways, yet when overcome by wine, one loses the ability to apply right or wrong reasoning. Therefore, one should consider one’s own strength, presence of cough or illness, the place, the vessel, one’s constitution, and one’s age before drinking; then, by drinking within one’s capacity, the experience is like nectar. At this point, Dhanvantari addressed Suśruta and said, “Now I will explain the causes of hemorrhoids, those which arise in the flesh of living beings like stakes. They are called ‘arśas’ because they obstruct the anal passage; the fault, having corrupted the skin, flesh, and fat, produces them in various forms. Hemorrhoids are said to be produced by the sprouting of flesh, by drinking, and other causes. In summary, there is a twofold division: those present from birth and those that develop later. These growths are dry, pointed, and unbroken, situated in the anal region. Among them, three are found at one and a half finger-breadths from the anus, and the rest at half a finger-breadth. Of these, the one that discharges since childhood lies in the middle; when the outer covering is absent, it is found at the very beginning of the anus, externally, at a finger’s breadth. With a measure of half a finger and hair growing from it, those that arise together are caused by heating of the seed in childhood. The origin of hemorrhoids is from the seed, due to the ‘cooking’ by mother and father; they may also arise from the anger of deities or from the disturbance of all three doṣas—wind, bile, and phlegm. All diseases arising from the family line are considered incurable, especially those congenital ones, which are dry and difficult to see. These are inward-facing, pale, and accompanied by severe complications. Those arising from the combination or accumulation of individual doṣas must be treated separately. Dry hemorrhoids are due to wind and phlegm, while moist ones are from bile. The causes of doṣa aggravation have already been described in the section on wounds. When fire and waste accumulate excessively, or from delay, excessive drinking, irritation, eating unwholesome or hard foods, or coughing, hemorrhoids may arise. They can also be caused by injury to the bladder, rectum, throat, lips, palate, frequent contact with very cold water, or continuous excessive straining. Holding back urine or stool, or forcibly expelling them, disgust, diarrhea, and grahaṇī (digestive disorders)—all these are complications. Pulling, uneven movements, and exertions by women, descent of an unripe embryo, or distress from the growth of the embryo, can also be causes. By such or other causes, the apāna wind is disturbed, producing waste in the folds of the anus, especially in those with liquid stools or a full body. Symptoms begin to appear: first, there is diminished digestive fire, obstruction, pain at the seat of the bones, cramping of the limbs, twisting, and dizziness. The eyes may become densely swollen; constipation or retention of stool may occur; the wind, blocked above, moves below the navel. Mixed with blood, the breath becomes difficult and contracted; there is rumbling in the intestines, bloating, excessive belching, and frequent expulsion of wind. Urine becomes abundant, stool scanty, appetite weak, and the abdomen takes on a dusky hue; there is pain in the head, back, and chest, fatigue, and altered feces. Restlessness toward sense objects, anger from distress, suspicion, retention, swelling, and pallor in the abdomen are also seen. These symptoms worsen in those whose digestion is impaired; as the wind turns back, it is obstructed in the lower path. It agitates the other winds, all the senses, and the body; it dries up urine, stool, bile, phlegm, and wind. It destroys the digestive fire, and then all become emaciated—thin, greatly lacking enthusiasm, dejected, wasted, and dull. They are without essence or luster, like a tree scorched by insects, afflicted by severe, fast-flowing humors and pains that torment the vital points. There may be cough, thirst, dryness of mouth, tastelessness, breathlessness, nasal congestion, fatigue, breaking of limbs, grinding, sneezing, swelling, and fever. The person is afflicted by impotence, deafness, stiffness, gravel, is wasted, with altered voice, lost in thought, spitting repeatedly, and lacking appetite. There is pain in all joints, bones, heart, navel, anus, and groin. Sometimes bile flows from the rectum, resembling the belly of a crane. Such are the teachings of the sages regarding the humors, intoxication, and the painful arising of hemorrhoids, as revealed by the great Dhanvantari.