Listen, O seeker, to the teachings revealed by the ancient sages regarding the many forms of skin afflictions and the origins of disease, as spoken by Dhanvantari and preserved in sacred scripture. There exists a particular type of skin disorder which is dry within but oily on the surface. When rubbed from inside, it sheds dust, yet it feels smooth to the touch and is thin, oily, and clear, bearing a resemblance to the fresh bloom of sweat. This is but one among many varieties. Often, such conditions manifest with a wasting away from above, clusters of intense itching, and red, thread-like lines appearing on the hands and feet—these are the signs of vipādikā. This affliction brings with it severe pain and unbearable itching. The skin becomes dotted with red pimples that spread widely, their color reminiscent of the green dūrvā grass or the blue atasi flower. Sometimes, a raised, circular lesion appears, known as dadru. It is intensely itchy, with a thick base, persistent burning pain, red discharge, and numerous sores. Such lesions may also be pale and circular, tinged with red, and accompanied by itching, burning, and pain. They often return in every birth, bringing with them moisture and discomfort. Another form, called puṇḍarīka, is raised and filled with redness, like a lotus leaf glistening with water. It is marked by blisters that are both white and reddish. There is also pāmā, characterized by blisters and pimples, along with itching, moisture, and pain. These are fine, dark-reddish, and dry, most commonly found on the buttocks, hands, and elbows. Another condition, kākaṇa, presents with blisters that are painful to touch, with itching, redness, and intense burning. This red patch or lesion is marked by severe pain and burning, first appearing red and then turning black, resembling the fruit of triphalā. Each variant arises from its own particular cause, displaying all the features of darkness. To distinguish the underlying humors—vāta, pitta, and kapha—one must observe the signs and actions as prescribed by the wise. Yet, when leprosy arises from a disturbance of all three humors, it is to be abandoned, for it is most difficult to cure. Leprosy that resides in the bone, marrow, or semen is especially hard to treat; if it is found in the fat, it can be managed, but if it affects the skin, flesh, or bone, it tends to become chronic. However, when the condition is not severe, arising from kapha and vāta, and remains limited to the skin or is impure, there is discoloration and dryness throughout the body. When the blood and flesh are affected, symptoms such as sweating, heat, swelling, and blisters on the hands and feet—especially at the joints—arise. If the humors combine frequently, there is destruction in the fat, though no clear signs appear in the marrow, bone, eyes, or voice. Sometimes, wounds may form, worms may be found in the semen, or even one’s wife and children may be afflicted. All the signs described before can appear in animals and others as well. Vitiligo (śvitra), when it arises solely from contact with wood (kaṣṭha), is severe and dreadful. It is known to ooze and is associated with the disturbance of all three humors. If wind is the cause, the lesion is dry and reddish; if bile, it appears coppery, like a lotus petal, always burning and leading to hair loss; if phlegm, the spot is white, dense, and heavy. With itching, the lesion gradually turns red, affecting both flesh and fat. By observing its color, the type and severity can be recognized, and it worsens over time. If the patch is not white, has abundant hair, is unattached, is newly arisen, and has not been burned by fire, then the leukoderma may be cured. Otherwise, it should be avoided. If leukoderma arises recently in the genital area, palm, or lips, it should especially be avoided by those who seek success. Diseases generally arise from contact, sharing food, and other forms of interaction, such as sharing beds, seats, clothes, garlands, and ointments. Dhanvantari, the divine physician, further expounded: Worms are of two main types—external and internal. The external worms are of four kinds, originating from dirt, phlegm, blood, and feces. There are twenty named types of external worms. Those arising from dirt are the size and shape of sesame seeds, dwelling in hair and clothing. These many-legged, subtle creatures are known as lice and nits. They are of two types, reside on the body, and cause itching and swelling. Yet, the sole cause of leprosy is internal worms. These arise from phlegm externally, and internally from the consumption of sweet foods, molasses, milk, curd, fish, and fresh rice. Born in the stomach from phlegm, they grow and spread throughout the body. Some resemble broad threads, others appear as swelling lumps. Some are shaped like sprouted grains—thin, long, and small—white or coppery in color, and are classified into seven kinds. Some worms originate in the intestines, encircling the abdomen; some arise from the heart, and others from the anus. When expelled, they resemble grass flowers, are fragrant, and produce various effects. Their presence brings about nausea, mouth discharge, indigestion, loss of appetite, fainting, vomiting, fever, abdominal swelling, emaciation, sneezing, and nasal congestion. Worms born in the blood vessels are minute, without legs, round and coppery, and sometimes invisible due to their subtlety. Those arising from hair destroy the hair, forming islands of baldness, and are like figs in appearance. These six types, together with Sausura and Samatara, are considered the sole cause of leprosy. Worms born in the large intestine from feces may also spread, and as they grow, they move toward the stomach. They cause foul breath, wheezing, and a smell of feces. These worms are broad, round, thick, and may be dark, yellow, white, or black. They are known by five names: Kakeruka, Makeruka, Sausura, Sashula, and Lelihā, and they produce offspring as well. Their effects include splitting of speech, piercing pain, stiffness, emaciation, roughness, pallor, horripilation, a burning sensation in the rectum, itching of the anus, and abnormal passage of stool. Dhanvantari then spoke again, addressing Suśruta: “Hear now the origin of diseases caused by wind. In every case of misfortune, obstruction is indeed the root cause. The unseen, corrupted wind moves through the body indiscriminately. He is the universal creator, the soul of all, the one who takes the form of the universe, the lord of all creatures. He is the creator, the sustainer, the pervader—Viṣṇu himself—the destroyer, death, and the end. Thus, what is spoken here must always be followed with effort. Upon understanding these faults, one should carefully discern both natural and altered actions, and, both in summary and in detail, ascertain the varieties of faults. Each agent acts in five ways, manifesting in altered forms. Their divisions, together with their causes and characteristics, have thus been explained.” Thus ends the sacred account of the various skin diseases, their signs, causes, and the origins of worms and wind-borne maladies, as taught by Dhanvantari to Suśruta, for the benefit of all who seek health and understanding.