When the balance of the body’s elements is disturbed, a host of distressing symptoms and diseases can arise. There is a loosening of the tissues’ firmness, and the body’s natural qualities are lost because of undigested matter. As a result, blood, fat, and bone diminish, and the senses grow weak. The limbs begin to feel as though they are decaying, the heart seems to melt within, the mouth becomes parched and dry, and stiffness is accompanied by drooling. One afflicted in this way experiences little thirst, an aversion to cold, diminished desire, impaired digestion, and an overall sense of weakness. Fever comes, breathing grows short, pain arises in the ears, and dizziness prevails. This disease, which is fivefold in nature, can be caused by any one of the humors—wind, bile, or phlegm—either individually or together, and may also result from eating clay. In its early stages, one notices palpitations of the heart and dryness of the skin. Appetite fades, the urine turns yellow, sweating ceases, and urination becomes scant. When fat is affected by wind, the body becomes exceedingly dry, rough, and sometimes moist. The eyes, veins, nails, and urine all take on a blackish hue; swelling occurs, there is a distaste for smells and flavors, the stool becomes dry, and there may be fainting sensations along the sides of the body. When bile dominates, the fever appears yellowish-green in the head and elsewhere. Thirst and dryness intensify, fainting and foul odors come, and there is a longing for cold, a bitter and crooked taste in the mouth. Diarrhea, sourness, and burning sensations follow, while phlegm brings moistness to the heart, drowsiness, a salty and twisted taste, horripilation, and loss of voice. Cough and vomiting may also appear, and sometimes the symptoms vanish entirely—yet this absence is itself hard to bear. When both bile and wind are greatly aggravated, the phlegm may turn either bitter or sweet. As the disease progresses, it corrupts the fats and similar tissues, causing dryness and depletion of the channels. Bloodletting becomes necessary, yet the symptoms persist as before. In cases of anemia and consumption, the navel, feet, mouth, and urinary tract are affected. The stool resembles that of worms—broken and mixed with mucus. If a person already afflicted with excess bile consumes foods that further increase bile, jaundice arises. The bile, entering the intestines, burns and draws out blood and flesh. The urine and eyes become yellow, the mouth and stool turn red, and the person is beset with burning sensations, abnormal digestion, thirst, a frog-like appearance, and weakened senses. Swelling associated with bile may occur in one suffering from anemia. If neglected, such swellings and related conditions—like dropsy and severe jaundice—arise and are difficult to treat. When anemia is accompanied by greenish or dark bile, and when wind and bile are both involved, symptoms include dizziness, thirst, sexual excitement in women, and mild fever. If drowsiness or a loss of digestive fire appears, this is known as halīmaka, with excessive laziness as an early complication. Swelling is considered the primary disorder and is explained thus: when bile, blood, phlegm, and wind are corrupted, they carry their impurities into the external veins. There, they obstruct the flow and cause swelling to settle in the skin and flesh. This swelling, compact and raised, is sometimes called “accumulation.” Swelling can arise from all the humors, in various forms and natures, and also from injury or poison. When the swelling spreads throughout the body, it manifests as kāma-jaundice, recognized by its broad, raised, and knotted appearance, and is classified into three types. The general cause of swelling is the disturbance of the humors. Disease develops quickly in those weakened by actions like fasting. Overconsumption of heavy or extremely cold foods, salty, alkaline, pungent, or sour vegetables, water, or irregular sleep and wakefulness all contribute. Suppressing natural urges, eating tough meat, indigestion, fatigue, sexual activity, travel, or agitation from vehicles are also factors. As a result, symptoms such as shortness of breath, cough, diarrhea, hemorrhoids, abdominal diseases, fever, bloating, laziness, vomiting, hiccup, anemia, and spreading skin diseases may arise. When swelling occurs above, below, or in the middle of the bladder, and is centered in the body, it is called “sarvāṅgaga” if it affects the whole body, “sarvagata” if widespread, and “pratyapratyag” if localized. Early signs of swelling include sneezing, heaviness in the head and limbs, and swelling caused by wind that is mobile and dry, with rough hair, and reddish or dark coloration. Swelling may affect the bladder, joints, and fat tissue; numbness, upward movement of wind, exhaustion, and rapid aggravation cause great distress. If the swelling is oily, it decreases with massage, appearing smaller at night and larger during the day; when the skin is smeared with mustard oil, it tingles. If caused by bile, the swelling is yellowish-red, dry, persistent, and burns the body from within. There is thirst, burning, fever, sweating, dizziness, moistness, faintness, desire, diarrhea, a smell, tenderness, and softness. Other symptoms include itching, pale hair, hard and cold skin, heaviness, oiliness, smoothness, firmness, pain, sleepiness, vomiting, and weak digestion. Swelling may also result from trauma, cuts, wounds, exposure to cold or sour winds, or the effects of certain plants like bhallātaka and kapikacchu. Contact with pungent or dry substances can also cause swelling, which then spreads with inflammation, intense heat, a reddish appearance, and often shows signs of bile. Swelling from poison arises from bites, scratches, or contact with venomous creatures, and even from non-venomous animals. It may also result from contamination with feces, urine, semen, other impure substances, poisonous plants, winds, or toxic powders. Such swelling is soft, mobile, drooping, quick to cause burning and pain, recent, and without complications. According to tradition, it may be considered either curable or incurable. At this point, Dhanvantari spoke: “Now I will explain the causes of spreading diseases like visarpa. Listen well, O Suśruta. Visarpa arises from injury and from corrupted humors, much like swelling. Its location is said to be external, and in that place, due to fear or exhaustion, it becomes more severe. The difficulty of cure depends on which humor is involved. When aggravated by specific irritants, the humors quickly enter the body, either remaining within or manifesting externally. Excessive thirst, disturbances of the natural urges, irregular activity, and a sudden loss of digestive fire cause the disease to spread outward.” Thus, the origins and manifestations of these diseases are revealed, showing how the disturbance of the body’s elements leads to suffering, and how careful attention to one’s habits and constitution is essential for health.