Dhanvantari, the divine physician, addressed Suśruta with compassion and clarity, intent on imparting the causes and nature of abscesses and the condition known as gulma. He began by explaining that such diseases arise chiefly from the consumption of foods that are stale, excessively hot, dry, rough, or burning. Furthermore, lying on uneven beds, improper movements, and various disturbances in the blood contribute to the corruption of flesh, fat, marrow, and bone, which then become the seats of disease within the abdomen. These conditions manifest as swelling, both external and internal, accompanied by severe pain and great suffering. The swelling may be round or elongated, and is recognized as the disease called abscess. The disorder may be formed by the separate or combined actions of the doṣas—wind, pitta, and kapha—and blood, moving throughout various parts of the body. It is often hard, knotted, and does not discharge easily. Internally, the affliction is especially severe and deep, increasing like a tumor. Sometimes, it discharges in a manner reminiscent of an anthill and leads to weakness of digestion. The swelling can occur in several locations: the navel, bladder, liver, spleen, heart, abdomen, and groin. When present in the heart, it causes trembling and intense pain in those regions. The signs of abscess are distinctive: a dark-red head, irregular maturation, and uneven shape. The disease is accompanied by loss of consciousness, confusion, distension, oozing, creeping sensations, and internal noise. When the disorder is dominated by pitta, the swelling appears red, coppery, or blackish, and is marked by delirium, fever, and burning sensations. If kapha predominates, the swelling arises suddenly, matures quickly, is pale, and is itchy. When all three doṣas are disturbed together, mixed symptoms arise: distress, chills, stiffness, yawning, loss of appetite, heaviness, delayed onset, and poor digestion. The strength of the disorder manifests in abnormal stools, with both external and internal signs such as black eruptions, dark discoloration, intense burning, pain, and fever. In women, the signs of pitta are also evident in cases of external bleeding. Disease may also be caused by blood resulting from injuries by weapons or similar causes. When a wound is aggravated by wind, the blood provokes pitta, producing symptoms of both pitta and blood, and causing abscesses with many complications. The variations in complications are recognized according to the site of affliction. For example, if swelling occurs at the navel or bladder, difficulty in urination arises. Obstruction of breathing and exhalation, spleen disorder, excessive thirst, and throat obstruction are seen in the kloma, along with pain throughout the body and in the heart. Fainting, darkness before the eyes, cough, palpitations of the heart, and pain in the sides of the abdomen may also occur, as well as the generation of doṣas within the abdomen. Pain may arise in the thigh-joints, groin, hips, back, and sides, and there is often pain in the anus and obstruction of wind. One should carefully recognize whether the swelling is raw, ripe, or suppurated. Some swellings discharge upward from the navel when ripe, others downward from the anus. Abscesses arising from the anus, breast, or navel are caused by the moistening of the doṣas. The combined disturbance of the doṣas brings about changes at their respective sites. When mature, an abscess located at the navel or bladder may rupture either internally or externally. If the abscess is depleted and complications arise, suppuration occurs within. Abscess may also develop in wicked women and sinners; if a fetus dies in the womb, a hard swelling may arise. Pain in the breast, whether present or not, is a sign of external abscess; due to the subtlety of blood in women, it does not occur in maidens. When wind is enraged or its movement is obstructed, swelling arises at the root of the penis. Reaching the scrotum and groin, it causes excessive swelling of the testicular sac. By compressing, it enlarges the veins in the sac, and the doṣa accumulates in the fat, manifesting the disease in seven forms with swelling. Due to wind, swelling may occur at the ends of the urinary tract, either externally or internally. It is filled with air, rough to the touch, dry, and causes burning. When ripe, and dominated by pitta, the swelling resembles a fig, with burning, heat, and suppuration. When kapha is predominant, the swelling is severe, heavy, unctuous, itchy, hard, and causes little pain. Swelling caused by blood is black, covered with eruptions, and shows signs of growth. When kapha and fat are involved, the swelling increases, becoming soft and resembling a ripe palmyra fruit. In those who habitually retain urine, as the urine moves there, the absence of greed and full steadiness are disturbed, and the gentle flow becomes agitated. Difficulty in urination arises below, with swelling of the scrotum and testicles, aggravated by wind and by immersions in cold water. Also, by retaining feces and urine, and by irregular movements of the limbs, when vital energies are disturbed and depleted within the body, wind becomes disordered and drives the blood downward. At the joint, it produces swelling resembling a knot. If neglected, the lump grows, causing distension, pain, and various diseases. When greatly afflicted, there is internal noise, and the swelling moves upward, causing swelling again at the head. This increase of blood is incurable, having the appearance of wind increase, with dry, black, or reddish veins, covered like a window with wool. Wind, in eight ways, when combined with various faulty humors, accumulates. Due to menstrual disorders, the eighth type arises in women. Those afflicted by fever, fainting, diarrhea, vomiting, and other actions, even if emaciated but strong, become cold and hungry. Whoever consumes food and drink, undertakes fasting, swimming, and similar activities, is afflicted by weak perceptions and provokes the disorder further. If one applies oil and sweat therapies, or instead undertakes drying therapies, or if purification is lost or not achieved, or if there are spasms, the excretions become dominated by wind. They may be separate or all mixed with blood, following the course of wind throughout the body. Wind, blocking the upward and downward channels, causes pain. A lump arises, hot to the touch, with the form of swelling. By wasting, by obstruction from phlegm and feces, or by blockage of the channels, wind, taking refuge in the abdomen, becomes hard due to dryness. When independent, wind is corrupted in its own abode; when dependent, it is corrupted in another's abode. Then, like a mass, phlegm mixes with excretions, completing the manifestation of these complex and painful diseases.