When disorders within the body are neglected, a subtle affliction begins to take root. First, a lump forms, followed by distension, pain, and the onset of various diseases. If the condition worsens, the afflicted person hears internal noises, and the disturbance rises upward, causing swelling at the head once again. This increase of blood, marked by signs resembling the aggravation of wind, is considered incurable. The veins become dry, black, or reddish, their appearance obscured as if covered with wool. Wind, or vāta, accumulates in eight distinct ways, each combining with faulty humors within the body. In women, particularly, the eighth type emerges due to menstrual disorders. Those suffering from this affliction may experience fever, fainting, diarrhea, vomiting, and other disturbances. Even if their bodies are emaciated, if they possess some strength, they become cold and hungry. If, during this time, one eats or drinks, or engages in fasting, swimming, and similar activities, their perceptions weaken, and the disorder is further provoked. The situation worsens if the person applies oil and sweat therapies, undertakes drying treatments, or if purification is incomplete or lost, or if spasms occur. The excretions then become dominated by wind, sometimes separate, sometimes mixed with blood, following the erratic course of wind through the body. When wind blocks the upward and downward channels, pain arises. A lump forms, hot to the touch, swelling in appearance. Through wasting, or by obstruction from phlegm and feces, or by blockages in the channels, the wind settles in the abdomen, becoming hard and dry. If the wind is corrupted in its own abode, it acts independently; if corrupted elsewhere, it acts dependently, causing phlegm to mix with the excretions, forming a mass. This condition is known as gulma—a lump that may be found in the bladder, navel, heart, or side. When caused by wind, gulma brings headache, fever, and noises in the spleen and intestines. The pain is sharp, like a needle; there may be loss of feces, difficulty passing urine, swelling of the limbs, face, and feet, and a loss of digestive fire. The skin, under wind’s influence, becomes dry and black, and restlessness prevails. The lump itself is ever-changing, throbbing and shifting, as if covered by ants. When bile joins the disorder, burning, sourness, fainting, diarrhea, sweating, thirst, and fever arise. A yellowish color spreads over the body, with swelling and tumors. Phlegm, too, may either diminish or flare up, as though burning its own seat. When phlegm dominates, the person feels heaviness, loses the sense of taste, feels as if sinking, and suffers from headache, fever, nasal congestion, lethargy, nausea, and changes in the skin’s color—pallor or darkness. The tumor becomes deep, hard, and heavy, resembling a fetus or even a child in the womb. When such tumors remain in their place, moving within, they are considered fatal. Generally, tumors arising from a combination of two doshas, or from mixed causes, are particularly severe. They cause intense pain and burning, mature quickly, and are dense and elevated. Especially in women, a blood-tumor is considered incurable, arising in those who suffer menstrual pain or diseases of the womb. If a woman, in anger, engages in intercourse during her period, the wind in her body obstructs the menstrual flow, which is usually established monthly in the womb. This brings dryness to the womb, exposes the sexual organ, and causes nausea, cravings, the appearance of milk, and behavior driven by desire. Gradually, as wind and bile mingle, bile accumulates in the womb, producing the tumors described as caused by wind and bile. There is severe pain in the womb, especially in the blood vessels, accompanied by vaginal discharge, foul odor, and an increased burning sensation. Sometimes, the tumor may even resemble a pregnancy. All these arise from sexual intercourse, and as the tumors mature, they may develop into abscesses. Such abscesses ripen quickly, rooted in impure blood, and because they rapidly cause burning and destruction, they are called abscesses. When the tumor is deep within, there is burning in the bladder, pain in the spleen, loss of digestive power and strength, or abnormal urges. If the tumor lies in the outer abdominal wall, the pain is less, but there may be discoloration, cough, or greater swelling outwardly. With tension and severe pain, the abdomen becomes markedly distended. When wind is blocked either upward or downward, this condition is called tympanites. The swelling may resemble a sack of wealth, be nodular, or rise like a pestle; when all signs are present, it is known as a pestle-shaped tumor. If the disorder arises from the colon, severe pain from wind brings frequent belching, constipation, early satiety, inability to digest, and gurgling of the intestines. Distension like a sack and loss of digestive power are signs that a tumor is impending. At this point, Dhanvantari spoke to Sushruta: "I will now explain the causes of abdominal diseases. Listen well. All diseases, but especially abdominal ones, arise when the digestive fire is weak. Other diseases, not yet determined, also arise from the accumulation of impurities. When the upward and downward airs are blocked, they become agitated and flow irregularly. By corrupting the vital breaths—prāṇa and apāna—these disorders affect the joints of the flesh, causing swelling of the belly and abdomen, manifesting in eight different forms. Whether the humors are distinct or combined, whether fluids arise from the spleen, groin, or wounds, those afflicted become dry of palate and lips, with swelling of all limbs and the abdomen. Deprived of movement, strength, and appetite, with bellies distended by wind, these people come to resemble ghosts in form—these are the signs to be recognized. Loss of hunger, aversion to all food, and burning pain arise; unable to discern digested from undigested food, they consume what is unwholesome. The body’s strength diminishes, breathing becomes shallow, and there is little activity. The mind turns away from sense objects, and sorrow and wasting follow. There is constant pain in the bladder and joints, even with light and small meals. In abdominal disease, old age and indigestion bring about a loss of strength. Lethargy, laziness, and drowsiness arise independently, with scanty excretions and a weak digestive fire. Burning, swelling, and bloating occur, especially when water is present within the body." Thus, the wise physician recognizes these signs and understands the subtle interplay of wind, bile, and phlegm in the arising of abdominal diseases.