Listen as the ancient wisdom unfolds, describing the disturbances of the humors within the body and their consequences. When phlegm accumulates excessively at its proper time, it dominates the other humors and spreads throughout the body. If this phlegm fills and stiffens the bones of the thighs, both bone and sinew are affected, and the thigh becomes cold, influenced by wind. The limbs turn dark, stiffness arises, lethargy sets in, fainting may occur, accompanied by pain and fever. This condition is known as thigh stiffness; some refer to it as external wind. Swelling in the knee, caused by wind and blood and accompanied by severe pain, is called kroṣṭukaśīrṣa, and the swollen knee resembles the large head of a jackal. When pain and unevenness arise in the feet due to fatigue, and wind affects the ankle, this is called vātakaṇṭaka. If wind afflicts the heel, fingers, navel, or neck, restricting movement, this is known as gṛdhrasī. When the feet become thrilled or numb, this is pādaharṣa, arising from the aggravation of both phlegm and wind. If wind, together with bile and blood, causes burning in the feet, especially while walking, this burning is recognized as a distinct ailment. Then, Dhanvantari addressed Sushruta, saying, “I will explain to you the causes of vātarakta. Listen carefully. It arises from incompatible and excessive eating, anger, sleeping during the day, and staying awake at night. Vātaśoṇita generally afflicts those who are delicate, who eat and live improperly, who are obese, and those who live in comfort. When the blood becomes impure in people due to heat or improper cleansing, and is disturbed by vāta or cold winds, vāta increases, becomes agitated, and moves abnormally. Obstructed by such blood, vāta first corrupts it, and then, in the rectum, causes pain or produces vātarakta. Initially, it causes stiffness, then spreads everywhere; symptoms like heaviness and vomiting mark its presence. Later, it manifests like leprosy, called sāmbuda, affecting the knees, calves, thighs, hips, shoulders, arms, hands, feet, and joints. Itching, twitching, pricking, splitting pain, heaviness, and numbness arise and subside repeatedly, appearing again and again. Sometimes, starting at the soles of the feet or hands, it runs through the whole body in a rage, like a rat. At first, it is confined to the skin and flesh, but over time, it becomes deep and invades all the body tissues. In places like the hips, the skin becomes coppery, dark, or red; swelling, hard lumps, and suppuration develop, and vāyu enters the bones and marrow. Inside, it moves as if cutting, making a creaking sound, moving swiftly; as it spreads, it causes lameness or crippling. When vāta predominates, there is intense pain, twitching, breaking sensations, dryness of swelling, blackness, and fluctuating discoloration. There is contraction of blood vessels and finger joints, stiffness of limbs, crookedness, aversion to cold, relief from warmth, rigidity, shivering, and numbness. When blood is predominant, swelling, pronounced redness, tingling, and resistance to oily or dry treatments arise, accompanied by itching and moisture. When pitta dominates, burning, fainting, bitter taste, loss of consciousness, intoxication, thirst, intolerance to touch, severe pain, dryness, suppuration, and intense heat occur. When kapha predominates, stiffness, heaviness, sleepiness, oiliness, coldness, mild itching, dull pain arise; when all are mixed, all symptoms appear together. When only one doṣa is involved, it can be managed; when two doṣas are involved, it is controllable; but when all three doṣas are involved, it quickly destroys, causing severe raktapitta. Vāta quickly attacks the blood in the limbs, especially in the joints, blocking the channels, and with pain, takes away life. When the fivefold vital air is disturbed by dryness, restlessness, excessive jumping, overeating, injury, and rapid movements, it becomes aggravated. When agitated, 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; it also produces swelling in the throat, jaw, and upper regions. Vyāna is corrupted by excessive movement, bathing, play, indulgence in pleasures, and by incompatible, dry, frightening, exciting, and depressing influences. It causes loss of virility, enthusiasm, strength, sorrow, mental agitation, fever, various forms of pain, goosebumps, and deep sleep. It produces skin diseases, spreading eruptions, and other ailments causing weakness throughout the body. Samāna is disturbed by irregular digestion and eating cold, mixed foods. It causes disorders from improper sleep and wakefulness, such as colic, abdominal tumors, seizures, and diseases rooted in unfulfilled desires. Apāna is disturbed by dry, heavy foods, suppression of urges, excessive riding, frequent travel, and overindulgence in movement. When agitated, it produces diseases based in the lower abdomen, including disorders of urine, semen, piles, prolapse of the rectum, and many others. General malaise spreads throughout the body, accompanied by drowsiness, heaviness, and sluggishness; due to unctuousness and delayed awakening, coldness, swelling, and loss of digestive fire occur. By alleviating itching, dryness, and destruction, and through proper remedies, one attains freedom from these ailments; otherwise, drowsiness and related disorders persist. The obstruction of vāyu is said to have many forms. When covered by pitta symptoms, there is burning, thirst, pain, dizziness, and darkness. With pungent, hot, sour, and salty foods, burning and desire for cold arise; coldness, heaviness, pain, loss of digestive fire, bitterness, and excess of ghee and milk occur. Fasting, exertion, dryness, heat, and desire for warmth occur when covered by kapha; when kapha covers, there is body ache, heart fatigue, heaviness, and loss of appetite. Thus, the sages describe the interplay of humors and airs within the body, their disturbances, symptoms, and the path to relief, guiding the attentive toward understanding and healing.