In the course of his teachings, Dhanvantari spoke to Sushruta of the complex and troubling diseases that can arise within the abdomen, especially in women. He described how certain conditions, beginning with dryness in the womb, can reveal themselves through the exposure of the sexual organs, persistent nausea, strange cravings, the appearance of milk, and behaviors driven by desire. As time passes, the mingling of bodily winds leads to a buildup of bile within the womb, giving rise to tumors—growths that are caused by the disturbed interplay of wind and bile. These tumors bring severe pain, particularly in the womb and blood vessels. The suffering woman may experience vaginal discharge, a foul odor, and an increasing burning sensation. At times, the swelling may even mimic the signs of pregnancy, but all these troubles stem from sexual intercourse. As the tumors mature, they often develop into abscesses—painful, quickly ripening sores rooted in impure blood. Because they swiftly cause burning and tissue destruction, they are known as abscesses. When such a tumor is deep within, it brings burning in the bladder, pain in the spleen, loss of digestive power and strength, and abnormal urges. If it is located in the outer abdominal wall, there may be less pain, but discoloration, cough, or swelling may be seen. Sometimes, the abdomen becomes markedly distended with severe pain and tension, especially when the movement of wind is blocked; this condition is known as tympanites. The swelling may take on various shapes—like a sack of wealth, nodular, or raised like a pestle—and when all these signs are present, it is called a pestle-shaped tumor. Should the origin be in the colon, the pain from trapped wind becomes severe, accompanied by frequent belching, constipation, early fullness, inability to digest food, and a gurgling of the bowels. The abdomen may become distended like a sack, and digestive power wanes—these are the signs that a tumor is forming. Turning to the broader causes of abdominal diseases, Dhanvantari continued: “Listen, O Sushruta. All diseases, but especially those of the abdomen, arise when the digestive fire is weak. Other ailments, not yet fully understood, also emerge from the accumulation of impurities. When the vital airs—those that move upward and downward—are obstructed, they become agitated and flow irregularly, corrupting the vital breaths, prāṇa and apāna. This disturbance affects the joints of the flesh, causing swelling of the belly and abdomen in eight distinct ways. These disorders may arise from single or combined humors, or from fluids leaking from the spleen, groin, or wounds. The afflicted become parched in palate and lips, their limbs and abdomen swollen. They are deprived of movement, strength, and appetite, their bellies distended by wind, and their forms become ghost-like. Loss of hunger, aversion to all food, and burning pain ensue. Unable to distinguish between digested and undigested food, they consume what is unwholesome, further weakening the body. As strength diminishes, breathing grows shallow, and activity ceases. The mind turns away from sense objects, sorrow and wasting set in. There is constant pain in the bladder and joints, even after light meals. In abdominal disease, old age and indigestion further sap one’s strength. Lethargy, laziness, and drowsiness come unbidden, with scanty excretion and a weakened digestive fire. Burning, swelling, and bloating become especially pronounced when water is present in the body. Death may occur in watery places, and lamentation there is of no avail. The abdomen, like a window with a net of veins, makes gurgling sounds. The navel becomes obstructed and, under pressure, may be destroyed. Pain arises in the heart, waist, navel, anus, and groin as wind moves through these regions. Wind may pass out with sound, urine becomes scant, and excessive cravings disappear; the mouth loses its sense of taste. When abdominal disease is caused by wind, swelling appears in the hands, feet, face, and belly. Pain radiates to the groin, sides, abdomen, waist, back, and joints. There may be a dry cough, body aches, heaviness in the lower body, and accumulation of impurities. The skin turns dark or reddish, and the mouth remains tasteless. When pain splits the abdomen, blue-black veins spread across the belly, and bloating produces strange noises. Here, wind causes pain and noise, moving in all directions. When bile is the cause, fever, fainting, burning, and bitterness in the mouth arise. Dizziness, diarrhea, and a yellow hue to the skin and veins follow, accompanied by sweating, heat, and a burning sensation. The abdomen may appear smoky, feel soft, and decay rapidly. When phlegm is the culprit, heaviness, sweating, and swelling predominate, along with sleepiness, discomfort, loss of appetite, shortness of breath, cough, and pallor. The abdomen takes on a cloudy, oily appearance, with white and black veins visible. If the disorder increases greatly, the abdomen becomes hard, cold to the touch, heavy, and firm. This provokes all three doṣas, and impurities from each mingle and accumulate. Reaching the abdomen, they transform the body, causing wasting, fainting, and dizziness. Thus arise the threefold types of abdominal disease—each maturing quickly and proving extremely severe, especially when exposed to cold and wind. These ailments may be brought on by overeating, agitation, improper food and drink, unsuitable beverages, or the strain of vomiting and other illnesses. The spleen, which lies on the left side, becomes enlarged, hardened as a stone, and raised like the back of a tortoise. Gradually, it spreads across the abdomen, bringing shortness of breath, cough, thirst, foul taste in the mouth, bloating, fever, pallor, fainting, vomiting, burning, and confusion. The swelling may appear reddish or variegated, tinged with blue and yellow, and is often accompanied by upward movement of wind, nausea, fainting, intense thirst, and persistent fever. Due to heaviness, loss of appetite, hardness, obstruction, and dizziness, the spleen may even shift from the left side to the right. When the liver is affected and feces are retained in the rectum, distressing symptoms with difficult names appear, and the sufferer endures other painful upward movements as well. Thus, Dhanvantari revealed to Sushruta the many faces and causes of abdominal disease, so that the wise may recognize, understand, and seek to heal them.