The wise treatise describes the many signs and sufferings that arise when the digestive fire is disturbed. First, there is swelling of the abdomen, vomiting, and sometimes a ringing in the ears. The afflicted become emaciated, plagued by nausea, fainting spells, and fever. Fainting recurs, and a heaviness settles in the head and thighs; the hands and feet swell, drowsiness arises from deranged wind, the palate becomes dry, darkness clouds the vision, and the ears ring again and again. Pain strikes the sides, groin, and neck, and severe colic torments the sick. All symptoms increase, and hunger and thirst become unquenchable companions. When the food is finally digested, flatulence follows; but after eating, a fleeting sense of well-being may return. Yet, when wind predominates, the risk of grave diseases increases—heart disease, abdominal tumors, hemorrhoids, disorders of the spleen, and anemia may all arise. Over time, the stool becomes thin, liquid, dry, hard, noisy, and frothy. The sufferer repeatedly passes stool with great difficulty and pain at the anus, often struggling with breathlessness and coughing. Sometimes the stool is yellow or tinged with blue, and liquid in nature. Belching is putrid and sour, burning sensations afflict the heart and throat, appetite is lost, thirst intensifies, and pain persists. When phlegm is at fault, digestion becomes painful, the mind is nauseated, vomiting occurs, and appetite wanes. Sticky saliva fills the mouth, spitting and coughing follow, the heart palpitates, and nasal discharge is common. The heart feels stiff, the abdomen becomes numb and heavy, belching is both foul and oddly sweet, weakness prevails, and, at times, a strange exhilaration arises. Even when the feces are mixed, sticky, heavy, or sour, and the person is not yet emaciated, weakness is present, and all manner of diseases and symptoms may manifest. The three impurities—thirst and the rest—which are described in the division of the body, are also caused by disorders of the grahaṇī (the digestive organ), and are ever-present as their cause. Among the most formidable diseases are those born of wind: urinary stones, leprosy, diabetes, abdominal swelling, foul odor, hemorrhoids, and grahaṇī itself—these eight are exceedingly difficult to conquer. Then Dhanvantari, the divine physician, spoke to Suśruta: “Now, listen as I explain the causes of urinary retention. The bladder, its neck, the penis, the loins, the testicles, and the anus—all these are supported by single channels, situated within the cavities of the rectum and the bones. The bladder itself faces downward, its urinary veins opening below. From the sides, fine streams of fluid constantly fill the bladder; entering through these channels, they give rise to twenty kinds of disorders. Among these, urinary retention and diabetes are especially severe, attacking the vital spots and causing pain in the bladder, groin, and penis—pain that is mild but frequent. In the wind-dominant type, urine is scanty. In the bile-dominant type, the urine is yellow and always causes burning. When phlegm prevails, the urine is bloody, and there is heaviness and swelling of the bladder and penis. The urine may become slimy, obstructed, and tainted by all impurities. When wind blocks the opening of the bladder and dries it out, the urine—mixed with bile, phlegm, or semen—gradually forms a dreadful stone, yellow like the bile of a cow. All these disorders are rooted in phlegm. The earliest sign is swelling of the bladder and intense pain in the affected region. Urine is retained in the bladder, urination is painful, fever and loss of appetite ensue, and common symptoms include pain in the navel, perineum, bladder, and head. When the passage is open, urine flows freely; when blocked, it is passed with difficulty, clear as the gemstone gomedaka. When agitation sets in, pain arises, accompanied by blood and flesh in the tract. The patient, afflicted by wind, bites his teeth and trembles, clutching his penis and navel in distress. Wind causes him to pass stool and urinate frequently, but only drop by drop. The stone may be dark and rough, sometimes sharp like thorns. When bile is involved, the bladder burns as if cooked by fire. The stone may resemble the seed of bhallātaka—red, yellow, or white. When phlegm presses on the bladder, it becomes cold and heavy. In children, a large, smooth stone, honey-colored or white, may form, and such cases are especially common among the young. Because the channel is small and the stone can be easily grasped and expelled, the person may remain comfortable; but if semen is retained, a large calculus of semen forms. If the semen is displaced or not expelled, wind enters between the testicles, dries the semen, and this dried semen becomes a stone. This causes pain in the bladder, difficulty in urination, and swelling; yet, as soon as it forms, it may also dry up and dissolve. When afflicted, the patient suffers fever and cough, and the stone may resemble gravel; or, broken by wind, it may move in the reverse direction. Sometimes it is expelled with urine; at other times, moving against the flow, it is digested. When wind is agitated at the mouth of the bladder, it causes retention of urine. Symptoms include retention, pain, itching, and sometimes swelling; the stone, covering the bladder, may rise up, large and displaced, toward the region near the anus. There, it causes pain, burning, throbbing, and twisting; when the bladder is pressed, urine passes only drop by drop. This obstruction is known as ‘wind in the bladder’—a condition most difficult to overcome, and the second, stronger wind is even more formidable. When wind occupies the space between the rectum and bladder, it produces a hard, knotty, elevated mass like a pestle. This is called ‘wind-pestle,’ produced by the wind of Vishnu’s channel. Defective, coiled, and intense, the wind in the bladder causes severe pain. Binding up the urine, the wind moves about, causing stiffness, twisting, and heaviness; urine is passed little by little, or only occasionally. This is called ‘wind-coil.’ When urine is retained for a short time and does not come out, or is obstructed, and after urination there is little pain, this too is a sign of disorder. When, due to retention, the wind is obstructed and whirls within, the lower abdomen below the navel fills with urine. This brings intense pain, distension, inability, and accumulation of waste. Such urine retention arises from a defect in the opening of the stomach or by the action of wind. Thus, the ancient sages carefully described the signs, causes, and sufferings of digestive and urinary disorders, so that the wise may recognize and address them with knowledge and compassion.