In the depths of the ocean, where powerful currents swirl and crocodiles lurk, one must act swiftly to rescue someone sinking into unconsciousness. Likewise, in life, when a person is swept away by intoxication, pride, anger, or pleasure, their actions become erratic; especially under the influence of wine, proper reasoning falters, and discernment between right and wrong is lost. To avoid such pitfalls, one should carefully consider their own strength, health, environment, vessel, constitution, and age before consuming anything intoxicating. By drinking according to one’s capacity, it is as if one partakes of nectar, ensuring well-being rather than harm. Then, Dhanvantari addressed Suśruta, saying, “Now, I shall explain the causes of hemorrhoids, which arise in the flesh of living beings like stakes. These are called 'arśas' because they obstruct the anal passage, and the corrupted skin, flesh, and fat give rise to them in various forms. Hemorrhoids are produced by the sprouting of flesh, excessive drinking, and other causes. Broadly, they are divided into two types: those present from birth and those that develop later. The dry, pointed, and unbroken ones are situated in the anal region—three at one and a half finger-breadths, and the rest at half a finger-breadth from the opening. Among these, the one that has flowed since childhood lies in the middle, discharging. When its outer covering is absent, it appears at the very start of the anus, externally, at a finger’s breadth. Some measure half a finger-breadth and have hair growing on them, caused by the heating of the seed in childhood. The origin of hemorrhoids is traced to the seed, cooked by the influence of both mother and father. They may also arise from the anger of deities or from the disturbance of all three doṣas—vāta, pitta, and śleṣman (kapha). Diseases inherited from the family, especially those congenital ones that are dry and difficult to see, are declared incurable. These congenital hemorrhoids are inward-facing, pale, and accompanied by severe complications. Those arising from the combination or accumulation of individual doṣas must be treated separately: dry ones are due to vāta and śleṣman, while moist ones stem from pitta. The causes of doṣa aggravation have already been explained in the section on wounds. When fire and waste accumulate excessively, delayed elimination, excessive drinking, irritation, eating unwholesome or hard foods, and persistent coughing can all contribute. Injury to the bladder, rectum, throat, lips, palate, frequent exposure to very cold water, and continuous strain further aggravate the condition. Holding back urine or stool, or forcibly expelling them; disgust, diarrhea, and grahaṇī (digestive disorders) also play a role. Pulling, uneven movements, and exertions by women, the descent of an unripe embryo, and distress caused by the growth of the embryo are additional causes. By such means, or others, the apāna wind becomes disturbed, producing waste in the folds of the anus, especially in those with liquid stools or a full body. Symptoms begin to arise: diminished digestive fire, obstruction, pain in the seat of bones, cramping of the limbs, twisting, and dizziness. Dense swelling may occur in the eyes, constipation or retention of stool follows, and the wind, blocked ahead, generally moves below the navel. Mixed with blood, breathing becomes difficult and contracted; rumbling in the intestines, bloating, excessive belching, and frequent expulsion are common. Urine becomes abundant, stool scanty, appetite weak, and the abdomen dusky. 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 appear. These symptoms intensify in those whose digestion is impaired; as the wind turns back, it is obstructed in the lower path. This agitation disturbs the other winds, all the senses, and the body; it dries up urine, stool, bile, phlegm, and wind. The digestive fire is destroyed, leading to emaciation—thinness, lack of enthusiasm, dejection, wasting, and dullness. The person becomes devoid of essence and luster, like a tree scorched by insects, afflicted by severe, fast-flowing humors and pains described as consumption, tormenting the vital points. Cough, thirst, dryness of mouth, tastelessness, breathlessness, nasal congestion, fatigue, breaking of limbs, grinding, sneezing, swelling, and fever arise. Impotence, deafness, stiffness, gravel, wasting, altered voice, meditation, repeated spitting, and lack of appetite follow. Pain afflicts all joints, bones, heart, navel, anus, and groin; bile flows from the rectum, resembling the belly of a crane. Dry, expelled at the tip, ripe or unripe in between; pale bile, colored like turmeric, sticky, and passed while seated. Rectal sprouts appear, accompanied by many winds, dryness, itching, fat, dark red, stiffness, unevenness, and roughness to the touch. They are mutually dissimilar, crooked, sharp, with split faces, resembling the fruits of jujube, date, karkandhu, and cotton. Some look like kadamba flowers, others like siddhartha seeds; excessive pain is felt in the head, sides, calves, thighs, groin, and other areas. These sprouts cause sneezing, belching, obstruction, heart pain, nausea, coughing, shortness of breath, irregular digestion, ringing in the ears, and dizziness. Afflicted by these, the person passes stool that is lumpy, scanty, noisy, and comes out in a stream, accompanied by pain and mucus, and is difficult to expel. Darkening of the skin, retention of urine and stool, and discoloration of the eyes and mouth occur. Tumors, spleen disorders, abdominal swelling, and hard masses arise. When bile predominates, the mouth turns blue, and the masses appear red, yellow, or black; they are thin, sharp, oozing, foul-smelling, slender, soft, and loose. Their tongues resemble that of a parrot, their mouths like a piece of liver or the mouth of a leech. They cause burning, fever, sweating, thirst, fainting, loss of appetite, and confusion. These masses are hot, fluid, blue, warm, yellow, or red in color; their middles are like barley, and their skin, nails, and other parts are greenish-yellow. Thus, Dhanvantari revealed to Suśruta the intricate nature, causes, symptoms, and manifestations of hemorrhoids, guiding him with wisdom for the healing of all beings.