In the ancient days, the sages observed the causes and manifestations of swelling and spreading diseases with great care. They saw that the general cause of swellings lay in the disturbance of the bodily humors. Especially, disease would arise swiftly in those weakened by strenuous actions such as fasting. They noted that when one excessively consumed heavy or extremely cold foods, or indulged in salty, alkaline, pungent, or sour vegetables and water, or lived with irregular patterns of sleep and wakefulness, the body’s balance was disturbed. The suppression of natural urges, eating tough meats, indigestion, fatigue, sexual activity, travel, or agitation from vehicles—all these contributed to the onset of swelling. From such imbalances, a host of ailments could arise: shortness of breath, cough, diarrhea, hemorrhoids, abdominal diseases, fever, bloating, laziness, vomiting, hiccup, anemia, and spreading skin diseases. When swelling appeared above, below, or in the middle of the bladder, and was situated at its center, it was named according to its extent: 'sarvāṅgaga' when it affected the whole body, 'sarvagata' when widespread, and 'pratyapratyag' when localized. The early signs of such swelling included sneezing, heaviness in the head and limbs, and swelling caused by wind—mobile, dry, with rough hair, reddish or dark in color. Swelling of the bladder, joints, and fat tissue would follow, accompanied by numbness, upward movement of wind, exhaustion, and rapid aggravation, causing distress to the afflicted. If the swelling was oily, it would subside with massage, being small at night and large during the day; when the skin was smeared with mustard oil, it would tingle. When caused by bile, the swelling appeared yellowish-red, produced dryness, did not subside quickly or at all, and burned the body from within. There would be thirst, burning, fever, sweating, dizziness, moistness, faintness, desire, diarrhea, a smell, tenderness to touch, and softness. Other signs included itching, pale hair, hard and cold skin, heaviness, oiliness, smoothness, firmness, pain, sleepiness, vomiting, and weak digestion. Swelling could also arise from trauma, cuts, wounds, cold wind, sour wind, or from the effects of the bhallātaka and kapikacchu plants. Contact with pungent or dry substances could cause swelling, accompanied by spreading inflammation, intense heat, a reddish appearance, and often symptoms of bile. Swelling caused by poison would arise from the bite, scratch, or contact with venomous creatures—and even from non-venomous animals. It could also result from contamination by feces, urine, semen, or other impure substances, from contact with poisonous plants or winds, or from the use of toxic powders. Such swelling was soft, mobile, drooping, quick to cause burning and pain, recent, without complications, and was considered either curable or incurable according to tradition. Dhanvantari, the divine physician, then spoke to Suśruta, saying, “Now I will explain the causes of spreading diseases like visarpa. Listen well. Visarpa arises from injury and corrupted humors, much like swelling. Its location is said to be external, and there, due to fear or exhaustion, it becomes more severe; its difficulty of cure depends on the specific humor involved. When aggravated by specific irritants, the humors quickly enter the body, either remaining inside or manifesting externally. Due to excessive thirst, disturbances of the urges, irregular activity, and sudden loss of digestive fire, the disease spreads outward. When caused by wind, visarpa is accompanied by symptoms similar to wind-fever: swelling, throbbing, piercing pain, fatigue, and a sense of exhilaration. When caused by bile, it spreads rapidly, has symptoms of bile-fever, and is intensely red. When caused by phlegm, it is itchy, oily, and has symptoms similar to phlegm-fever. Sometimes, arising from the convergence of factors and marked by all signs, these diseases accumulate with their own distinctive symptoms, disregarded by all eruptions; even so, they release sweat, bearing the characteristics of wounds. Accompanied by fever, vomiting, fainting, diarrhea, thirst, dizziness, rupture of swelling, loss of appetite, darkness, and tastelessness, caused by wind and bile, visarpa affects all limbs, like glowing embers scattered; wherever the spreading occurs, it spreads in that region. When the embers are extinguished, the affected area becomes black, blue, or red, and accumulates; as if burned by fire, with eruptions, it moves swiftly and rapidly. When the spreading follows the vital spots and wind is exceedingly strong, it causes pain in the limbs, takes away consciousness, induces sleep, and produces breathlessness. Hiccups arise, and the person attains such a condition; sometimes, afflicted in the vital spots, he lies on the ground, bed, or seat. Then, struggling, he is distressed, afflicted with confusion of mind and body, difficult to awaken from sleep; this is called fiery spreading. When wind is obstructed by phlegm, it breaks through the phlegm in many ways, or blood, and in the case of increased blood, it affects skin, veins, tendons, and flesh. Having corrupted them, it forms a long, thick, rough chain of nodules, with intense pain and fever, all suffused with blood. Accompanied by breathlessness, cough, diarrhea, dryness of mouth, hiccups, vomiting, dizziness, confusion, discoloration, fainting, limb-breaking, and loss of appetite, this is nodular spreading, arising from the aggravation of phlegm and wind. From phlegm and bile arise fever, stiffness, sleep, drowsiness, headache, weakness and trembling of limbs, delirium, loss of appetite, and dizziness. Fainting, loss of digestive fire, breaking of bones, thirst, heaviness of the senses, accumulation of impurities, and coating; it spreads through the channels. Usually affecting the stomach, not excessively painful in one place, covered with pustules, extremely yellow, red, or pale. Sticky, black, resembling soot, dirty, swollen, heavy; deep maturation, mostly moist when touched by heat, it bursts open. Like ripened flesh, with exposed tendons and veins, affecting all parts with all symptoms, spreading everywhere, emitting the smell of a corpse; this spreading is called 'muddy'. Due to external causes, from injury, agitated blood and bile, wind produces spreading, marked by nodules resembling horse gram. With eruptions, swelling, fever, pain, burning, and dark blood, the three pathologies caused by the channels are curable, and those arising from dual causes are without complications. But incurable are those arising from all causes, and those that invade the vital spots; with ruptured tendons, veins, flesh, moist, and emitting the smell of a corpse.” Thus, the sages recorded the wisdom of the ancients, that the causes and manifestations of swelling and spreading diseases must be understood in their subtlety and fullness, so that one may discern their nature and seek proper remedies.