Hear now the account of visarpa and the many forms of leprosy, as revealed by the divine Dhanvantari. When visarpa arises due to the influence of wind, it presents with symptoms much like those of a fever caused by wind: swelling appears, the skin throbs and aches with piercing pain, the body grows weary, and yet there is a peculiar sense of exhilaration. If bile is the cause, visarpa spreads swiftly, accompanied by the signs of bile-fever, and the affected areas become intensely red. When phlegm is at fault, visarpa brings itchiness and an oily texture, along with symptoms reminiscent of a phlegm-fever. Sometimes, all these causes converge, and visarpa manifests with every sign: swelling, pain, and eruptions, each bearing its own particular qualities. Even when such eruptions are ignored, the skin releases sweat, and wounds appear, bearing the marks of their origin. Fever, vomiting, fainting, diarrhea, thirst, dizziness, swelling that ruptures, loss of appetite, a sense of darkness, and tastelessness—all these may accompany visarpa, especially when both wind and bile are involved. This affliction does not confine itself to one spot; it can spread to all limbs, like glowing embers scattered across the body. Wherever it spreads, it burns in that region. When these embers are finally extinguished, the skin may turn black, blue, or red, and the condition accumulates, as though the flesh had been burned by fire. Eruptions appear, moving quickly and fiercely. If visarpa follows the vital spots and the wind within is exceedingly strong, it causes pain throughout the limbs, may rob a person of consciousness, induce deep sleep, and bring about breathlessness. Hiccups arise, and the sufferer may collapse wherever he happens to be—on the ground, a bed, or a seat—struggling and tormented, beset by confusion of mind and body, difficult to awaken from sleep. This is known as the fiery spreading. When wind is blocked by phlegm, it breaks through the phlegm—or even the blood—in many ways. If blood is increased, the skin, veins, tendons, and flesh are all affected. These tissues, once corrupted, form long, thick, rough chains of nodules, causing intense pain and fever, all suffused with blood. Alongside these symptoms, breathlessness, cough, diarrhea, dryness of mouth, hiccups, vomiting, dizziness, confusion, discoloration, fainting, a sensation as if the limbs are breaking, and loss of appetite may occur. This is nodular spreading, arising from the combined aggravation of phlegm and wind. When phlegm and bile are both involved, fever, stiffness, sleepiness, drowsiness, headache, weakness, trembling of the limbs, delirium, loss of appetite, and dizziness are common. Fainting, loss of digestive fire, a feeling as if the bones are breaking, thirst, heaviness of the senses, accumulation of impurities, and a coating within the body are also seen, as the disease spreads through the channels. Most often, this form affects the stomach. It is not exceedingly painful in a single spot, but is covered with pustules and may appear extremely yellow, red, or pale. The eruptions are sticky, black like soot, dirty, swollen, and heavy. As the disease matures, it is mostly moist, and when touched by heat, it bursts open. The flesh appears ripened, exposing tendons and veins, and all parts of the body may be affected, spreading everywhere and emitting a foul odor like that of a corpse. This is known as 'muddy' spreading. Sometimes, visarpa is caused by external injury, where agitated blood and bile, stirred up by wind, produce spreading marked by nodules resembling horse gram seeds. Eruptions, swelling, fever, pain, burning, and the presence of dark blood are observed. The cases caused by the three bodily channels are curable, and those arising from two causes are generally without complications. But those arising from all three causes, or invading the vital spots, are incurable—especially when the tendons, veins, and flesh are ruptured, the wounds are moist, and the smell of a corpse pervades. Dhanvantari further explained: Such disorders often arise especially due to improper eating, improper living, and actions such as slandering the virtuous, neglect, fighting, and theft. Sinful deeds, both recent and from the past, drive impure substances into the veins; these impurities then reach the skin, flesh, blood, and fat. There, they corrupt the tissues, drying them out, and eventually emerge outward, causing discoloration of the skin. The remaining impurities manifest as leprosy and other skin diseases. If neglected, these impurities spread through all bodily channels, entering every tissue, both external and internal, disturbing and overflowing them. With sweat and moisture, and as the channels constrict, minute and harsh worms are produced. These worms successively invade the hair, skin, tendons, and vessels. Thus, external leprosy appears, as if the skin were covered with ash. Leprosy is said to be of seven main kinds, arising from the humors singly, in pairs, or all together. Among all the three humors and their combinations, leprosy from wind is known as Kāpāla, from bile as Udumbara, and from phlegm arise Maṇḍala, Vicarcū, Ṛṣya, and others, including those from combinations of wind and bile. Other types include Carma, Eka-kuṣṭha, Kiṭima, Sidhmā, Alasā, and Vipādikā. Leprosy from wind and phlegm, and from phlegm and bile, are called Dadru and Śatāruṣī. Puṇḍarīka, which presents with blisters, Pāmā, and Carmadala are also described. Of all these, Kākaṇa, Pūrvatrika, Dadru with Kākaṇa, Puṇḍarīka, and Ryajihvā are considered the seven major types of leprosy. The symptoms are many: the affected patches may be excessively smooth or rough, with sweating or dryness, discoloration, burning, itching, numbness, pricking pain, swelling, and darkness. The sores are painful, the disease may appear quickly and last long, and even when healed, the skin remains rough; a slight cause can make it flare up greatly. Goosebumps and blackness of the blood are early signs. When the leprosy is black, red, dry, rough, and thin like a skull, spread out in shape and scattered with corrupted hairs, it is called Kāpāla leprosy, marked by much pricking pain and considered irregular. Leprosy resembling the fruit of the Udumbara tree is called Audumbara; it is round, with thick edges, and marked by intense burning and pain. It is uncovered, does not spread, is sometimes worm-infested like the Udumbara fruit, firm, true, heavy, oily, white or red, and accompanied by impurities. Another type, Maṇḍala, has lesions with tails attached to each other, much itching, discharge, and worms; it is smooth and yellowish in appearance. Vicarcikā is dark, with itching and pimples, moist and rough, red inside, dark within, and raised above the skin. There is a form called 'carmākhya' leprosy, which has the appearance of a deer's tongue, with many worms, rough to the touch like elephant skin. Again, there is kiṭima, which does not sweat, resembles fish scales, is dry, fiery in color, unpleasant to touch, itchy, rough, and grayish-black. Thus are the many forms and symptoms of visarpa and leprosy, their origins, signs, and the suffering they bring, as taught by the divine physician Dhanvantari.