O Sushruta, listen with attention as the revered Dhanvantari expounds the nature of diseases caused by the derangement of wind (vāta) and blood (rakta), and how they manifest throughout the body. When the body becomes rough, painful, and dark, and the affliction involves the head, it is said to be incurable, for the wind, sinews, and the very body itself are all disturbed. If one wing or arm is rendered useless, this is known as wing paralysis; half the body becomes insensible and inactive. Sometimes, disease may affect a single limb, or pain may be felt in the armpit. When the wind pervades the entire body, complete immobility and stiffness result. Paralysis caused solely by the wind is extremely difficult to cure. When other humors join, the disease worsens, leading to wasting of the limbs. If the body’s channels are blocked by undigested matter and phlegm, the limbs become rigid, and this state, known as daṇḍāpatānaka, is deemed incurable. When the wind arises from the root of the shoulder and contracts the veins there, it causes external discharge and disease in the arm. Should the tendons at the base of the fingers and on the back of the arm be affected, the arms lose their function—this is called vipūcī. If the wind settles in the hip and damages the tendons of the thighs, the person becomes lame; if both thighs are afflicted, he is rendered crippled. Such a one trembles when beginning to walk and limps, for his joints and ligaments have become loose. This condition is known as kalāyakhañja. The consumption of foods that are cold, hot, liquid, dry, heavy, or oily—whether digested or not—along with exertion, agitation, indulgence in oily foods, and sleeplessness, all disturb the balance of the humors. When phlegm accumulates excessively at the proper time, it overpowers the other humors and spreads through the body. If phlegm fills and stiffens the bones of the thighs, both bone and sinew are affected, and the thigh becomes cold due to the wind. The limbs turn dark, stiffness and lethargy set in; fainting, pain, and fever arise. This is known as thigh stiffness, or by some, as external wind. If swelling arises in the knee from wind and blood, and is accompanied by severe pain, this is called kroṣṭukaśīrṣa, for it resembles the large head of a jackal. When pain and unevenness appear in the feet due to fatigue, and wind afflicts the ankle, it is called vātakaṇṭaka. Should the wind affect the heel, fingers, navel, or neck, it restricts movement, and this is known as gṛdhrasī. When a person’s feet become numb or tingling, this is pādaharṣa, arising from the aggravation of phlegm and wind. If wind, combined with bile and blood, causes burning in the feet, especially during walking, this burning should be recognized and treated accordingly. Now, O Sushruta, hear of vātarakta, the disease of wind and blood. Its causes are incompatible and excessive eating, anger, sleeping during the day, and staying awake at night. It generally afflicts those who are delicate, who eat and live improperly, who are obese, and those who dwell in comfort. When the blood becomes impure from heat or improper cleansing, and is disturbed by wind or cold, vāta increases, becomes agitated, and moves abnormally. Obstructed by such blood, vāta first corrupts it, then in the rectum causes pain or produces vātarakta. Stiffness comes first, then the symptoms spread throughout the body; heaviness and vomiting may appear as signs. In time, it may resemble leprosy, called sāmbuda, and affect the knees, calves, thighs, hips, shoulders, arms, hands, feet, and joints. Itching, twitching, pricking, splitting pain, heaviness, and numbness arise and subside, appearing again and again. Sometimes, starting at the soles of the feet or the hands, it rages through the whole body like a rat. At first, it is confined to the skin and flesh, but later, it invades all body tissues. In places like the hips, the skin may become coppery, dark, or red; there is swelling, hard lumps, and suppuration, as vāyu enters the bones and marrow. Internally, it moves as if cutting, making creaking sounds and moving swiftly; as it spreads, it causes lameness or crippling. When wind predominates, there is intense pain, twitching, breaking sensations, dryness of swelling, blackness, and changes in discoloration. The blood vessels and finger joints contract, limbs stiffen, crookedness appears, there is aversion to cold, relief from warmth, rigidity, shivering, and numbness. When blood predominates, there is swelling, pronounced redness, tingling, and the disease does not improve with oily or dry treatments; itching and moisture are present. When bile (pitta) is predominant, there is burning, fainting, a bitter taste, loss of consciousness, intoxication, thirst, intolerance to touch, severe pain, dryness, suppuration, and intense heat. When phlegm (kapha) prevails, there is stiffness, heaviness, sleepiness, oiliness, coldness, mild itching, dull pain; when all three are mixed, all symptoms appear together. If only one doṣa is involved, the disease can be managed; if two, it is controllable; but when all three doṣas are disturbed, it quickly destroys, causing severe bleeding disorders. Vāta swiftly attacks the blood in the limbs, especially in the joints, blocking the channels and bringing pain, even taking away life. When the fivefold vital air is disturbed by dryness, restlessness, excessive jumping, overeating, injury, or rapid movements, it becomes aggravated. In this state, it harms the eyes and other senses; ailments such as nasal congestion, burning, thirst, cough, and breathlessness arise. Obstruction of the throat, loss of mucus, vomiting, loss of appetite, and nasal disorders occur; swelling appears in the throat, jaw, and upper regions. The vyāna—one aspect of the vital air—is corrupted by excessive movement, bathing, play, indulgence in pleasures, and by influences that are incompatible, dry, frightening, exciting, or depressing. Thus, O Sushruta, are described the many ways that wind and blood, when disturbed, bring pain and disease to the body.