Hear now, as the ancient sages describe the many forms and signs of disease that arise in the body, particularly those afflictions of the lower channels and the bowels. There are times when a person, seated and straining, passes stool that is dry and expelled only at the tip, while the rest remains ripe or unripe, stuck in between. The passage may be accompanied by pale bile, colored like turmeric, sticky in nature. At the rectum, small growths may sprout, and many winds disturb the channels, bringing dryness, itching, and discomfort. The stool may be fatty, dark red, stiff, rough, and uneven to the touch. Such discharges are mutually dissimilar, crooked, and sharp, sometimes splitting apart. Their appearance may remind one of the fruits of jujube, date, karkandhu, or even cotton. Some resemble the blossoms of the kadamba tree, others the tiny seeds of siddhartha. The afflicted suffer severe pain—not only in the head, but also in the sides, calves, thighs, groin, and other parts of the body. These ailments bring sneezing, belching, obstructions, pain in the heart, nausea, coughing, shortness of breath, irregular digestion, ringing in the ears, and dizziness. 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. Over time, the skin darkens, urine and stool are retained, and the eyes and mouth lose their natural color. From these arise tumors, disorders of the spleen, swelling of the abdomen, and hard masses within. When bile predominates, the mouth turns blue and the masses themselves appear red, yellow, or black. They are thin, sharp, oozing, foul-smelling, slender, soft, and loose. The tongue may resemble that of a parrot, the inside of the mouth like a piece of liver or the mouth of a leech. These conditions bring burning sensations, fever, sweating, thirst, fainting, loss of appetite, and confusion. The masses may be hot, fluid, blue, warm, yellow, or red, with centers like barley grains. The skin, nails, and other parts of the body take on a greenish-yellow hue. When phlegm is the cause, the masses are large, dense, only slightly painful, white, raised, swollen, oily, stiff, round, heavy, and firm. They are slimy and still, smooth, causing much itching, and pleasant to the touch. They may resemble the stem of the karira or jackfruit, or the udder of a cow. In some, these masses are found in the groin, snake-like in shape, filled with pus and causing pain in the bladder and navel. The person may experience shortness of breath, palpitations, excessive salivation, loss of appetite, and nasal congestion. These afflictions bring severe difficulty, heaviness of the head, coldness, and an astringent sensation. They may cause impotence, weak digestion, softness of the tissues, vomiting, diarrhea, and other disorders. The stools in such cases are rich in fat, mucus, and phlegm, and there may be a flow of blood. The stool neither flows freely nor breaks apart, and the skin and other parts are pale and oily. When all these symptoms are mixed together, all their features appear at once. When blood predominates, the masses at the anus are yellowish, resembling the fruit of the banyan tree, or like gunja berries or coral. They are extremely foul, hot, severely obstructed, and painful. Sometimes, blood is suddenly discharged from these masses, and with the excessive flow, the sufferer cries out in pain like a peacock, stricken by the consequences of blood loss. The person becomes deficient in color, strength, enthusiasm, and vitality, and the senses are impaired, especially after consuming foods such as mudga, kodrava, jambira, karira, chanaka, and similar substances. When wind is aggravated by dry, binding foods, it becomes strong in the rectum, blocking the downward channels and drying out the lower parts. As a result, the stool becomes hard, dry, and mixed with wind, causing severe pain in the abdomen, back, heart, and sides. There is bloating in the belly, hard stool, nausea, cutting pain, and especially severe pain in the bladder, along with swelling of the cheeks. Because of the upward movement of wind, vomiting, loss of appetite, fever, heart disease, digestive disorders, retention of urine, and diarrhea may arise. Deafness, severe headache, breathlessness, pain in the head, cough, nasal congestion, mental disturbances, thirst, difficulty breathing, disorders of bile, abdominal tumors, and similar conditions may also occur. These are the diseases caused by wind when it is greatly disturbed; among them, the most fearsome are those with dreadful names, leading even to death and severe complications. Yet even without such severe symptoms, those whose bowels are afflicted by wind develop inherent disorders, both internal and associated with the channels. Those diseases which are established and have become fixed are incurable, though they may be managed with the strength of digestive fire and other means. Diseases arising from the combination of two humors, and those dependent on the second channel, are also described. These are difficult to cure and may take years to resolve. Those arising in the external channel and dominated by a single humor are also known. Hemorrhoids are easily curable and do not take long to develop. Those that arise in the genitals and similar areas are described according to their type, but not those that are congenital. Forms of worm infestation are slimy and soft. When circulating wind gathers phlegm, it produces external hemorrhoids on the skin. Physicians recognize the hard, immovable, wart-like growths of the skin. Pain and roughness are caused by wind, while blackening of the mouth is due to bile. Oily texture, knotting, and normal color are attributed to phlegm. A wise person should quickly seek relief from hemorrhoids, for these diseases can soon cause obstruction of the anus and abdomen. Then Dhanvantari spoke to Suśruta, saying, “Now I will explain to you the causes of diarrhea and digestive disorders. These are of six kinds, arising from the disturbance of the humors—whether singly or together—and also from fear and grief. Diarrhea especially arises from excessive drinking of water, as well as from eating dry food, raw meat, unctuous substances, sesame flour, and improperly cooked grains. It may also result from too much alcohol, excessive or dry foods, confusion of tastes and unctuousness, and from the opposition of worms and improper combinations, which provoke wind. When wind is disturbed in this way, it disperses downward, destroying the digestive fire. Thus, food, feces, and the bowels are all affected, resulting in looseness of stool and other symptoms. The signs of impending diarrhea are these: disturbance in the heart, anus, and bowels, sweating of the limbs, and retention of impurities. The person may experience bloating and indigestion without fever; the stool is scanty, silent, and difficult to pass. The stool is dry, frothy, and clear, passed repeatedly or at intervals; it may appear burnt or poisoned, slimy, and cause cutting pain. With a dried and contracted anus, hair standing on end, and sighing, when bile is involved, the stool appears yellow, resembling turmeric or green grass. Thus are the forms, causes, and signs of these afflictions described by the wisdom of the sages.