Listen closely, O Sushruta, as Dhanvantari imparts the sacred knowledge of abdominal diseases and their causes. Among the many afflictions that beset the human body, those arising in the abdomen are especially formidable, for they often originate when the digestive fire—so vital for health—is weakened or extinguished. When impurities accumulate and the vital airs, both upward and downward, are obstructed, the winds within become agitated, flowing irregularly and disturbing the harmony of the body. One such condition is known as ‘gulma,’ a lump or tumor that may appear in the bladder, navel, heart, or sides. When caused by the erratic movement of wind, it brings forth headache, fever, and unsettling noises from the spleen and intestines. The pain is sharp and piercing, like the prick of a needle, and there is difficulty in passing urine, loss of feces, and swelling of the limbs, face, and feet—accompanied by a loss of digestive power. The skin dries and darkens, restlessness prevails, and the pain takes on various forms, shifting and throbbing as if covered by ants. When bile predominates, burning sensations arise, with sourness, fainting, diarrhea, sweating, thirst, and fever. The body turns yellow, swelling and tumors appear, and phlegm either diminishes or flares up, burning its own seat. When phlegm is the chief culprit, heaviness, loss of taste, a sinking feeling, headache, fever, nasal congestion, lethargy, nausea, and changes in skin color—pallor or darkness—manifest. The tumor grows deep, hard, and heavy, resembling a fetus or a child within the womb. Those that remain fixed in their place move within, and such are considered fatal. Generally, tumors arising from the combination of two bodily humors, or from mixed causes, are severe. They cause intense pain and burning, mature quickly, and are dense and elevated. There exists a blood-tumor, incurable, seen only in women—especially those who suffer pain during menstruation or have 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 regularly established in the womb each month. 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 mingles with accumulating bile in the womb, tumors arise exhibiting symptoms caused by both wind and bile. Severe pain develops in the womb and blood-vessels, accompanied by vaginal discharge, foul odor, and increased burning. Sometimes, the tumor resembles a pregnancy, and all these arise from intercourse; as they mature, they may develop into abscesses. These abscesses ripen quickly, rooted in impure blood, and rapidly cause burning and destruction. When the tumor is located deep within, there is burning in the bladder, pain in the spleen, loss of digestive power and strength, or abnormal urges. Conversely, when it lies in the outer abdominal wall, pain is less, but discoloration, cough, or outward swelling may appear. With tension and severe pain, the abdomen becomes markedly distended; when wind is obstructed upward or downward, this condition is called tympanites. The tumor may resemble a sack of wealth, be nodular, or raised like a pestle. When all signs are present, it is known as a pestle-shaped tumor. When arising from the colon, severe pain from wind causes frequent belching, constipation, early satiety, inability to digest, and gurgling of the intestines. Distension resembling a sack and loss of digestive power are signs of an impending tumor. Dhanvantari continues: All diseases arise especially when the digestive fire is weak, but abdominal diseases do so even more. Other diseases, not yet determined, also arise from the accumulation of impurities; when the upward and downward airs are obstructed, they become agitated and flow irregularly. By corrupting the vital breaths—prāṇa and apāna—they affect the joints of the flesh, causing swelling of the belly and abdomen, manifesting in eight different ways. With distinct or combined humors, with fluids from the spleen, groin, or wounds, those afflicted become dry of palate and lips, with swelling of all limbs and abdomen. Deprived of movement, strength, and appetite, with bellies distended by wind, such people become ghost-like in form—these are the signs to be recognized. Loss of hunger, aversion to all food, and burning pain arise; one who cannot discern digested from undigested food consumes 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 ensue. There is constant pain in the bladder and joints, even with light and small meals; in abdominal disease, old age and indigestion bring about loss of strength. Lethargy, laziness, and independent drowsiness occur, with scanty excretion and weak digestive fire; there is burning, swelling, and bloating, especially when water is present. Death occurs in all watery places, and lamentation there is fruitless; the abdomen, like a window with a mesh of veins, makes gurgling sounds. The navel is obstructed and, creating pressure, is destroyed; with wind, there is pain in the heart, waist, navel, anus, and groin. The wind passes out with sound, and carries little urine; there is no excessive craving, and the mouth of the person becomes tasteless. In abdominal disease caused by wind, swelling appears in the hands, feet, face, and belly; pain arises in the groin, sides, abdomen, waist, back, and joints. Dry cough, body ache, heaviness below, and accumulation of impurities are seen; the skin becomes dark or reddish, and the mouth loses its sense of taste. When the abdomen is split with pain, the veins appear blue-black and spread; when bloated, the belly produces strange sounds. Here, the wind causes pain and noise, moving in all directions. In abdominal disease from bile, there is fever, fainting, burning, and bitterness in the mouth. Dizziness, diarrhea, yellowness of the skin and other areas occur; the veins become yellow or coppery, with sweating and heat, and the person feels burning. There is a smoky appearance, soft to the touch, and rapid decay; in diseases of the abdomen caused by phlegm, there is heaviness, sweating, and swelling. Sleepiness, discomfort, loss of appetite, shortness of breath, cough, and paleness of the skin are present; the abdomen is cloudy, oily, and covered with white and black veins. Thus, O Sushruta, the causes, signs, and manifestations of abdominal diseases are revealed, so that the wise may recognize and treat them with discernment and compassion.