Now we shall enumerate the names of the peculiar diseases, which are originated by the deranged and expanded humours, incarcerated in the different parts of the body. These humours, confined in the abdomen, give rise to Gulma abdominal glands) tumours, internal abscesses (Vidradhi), abdominal dropsy, impaired digestion in the bowels, constipation (Anaha), cholera (Visu-chika) and dysentery.

Lodged in the bladder, these humours usher in Prameha (morbid urethral discharges), Ashman (stone in the bladder) Mutrakrichchhra (stricture of the urethra) and Mutraghata retention of urine), and diseases affecting the renal secretion, etc. Restricted to the penis they tend to bring in syphilis, Nirudha-prakasha (phymosis and the local inflammatory diseases known as the Shuka-dosha, etc.

Similarly, lodged in the region of the anus, these deranged and expanded humours beget fistula in ano, haemorrhoids and polypus growths about that locality. Confined in the region of the scrotum, they give rise to hydrocele and other types of scrotal tumours, etc. Restricted to the region above the clavicles, these humours originate diseases peculiar to that locality, while erysipelas, cutaneous affections (Kushtha) and other minor diseases supervene, when they restrict themselves to the flesh and the skin (lymph-chyle) and blood. Affecting only the fat, these humours tend to originate Granthi (Aneurism), Apachi (scrofula), Arvuda (tumour , Galaganda (goitre) and Alaji (inflammation of the eye at the edge of the cornea .*

Lodged in the lower extremities, they bring on elephantisis, Vata-Rakta (a kind of leprosy), Vata-Kantaka, etc. Permeating the whole organism, they give rise to such diseases as fever, Sarvangaroga, etc. which invade the entire system.

Additional Text

Reaching down and confined in the bone-systems of the body, they produce Vidradhi (abscesses), Anushayi, ete.

The aggravated and expanded humours, thus firmly ensconced in the different parts of the body, exhibit the premonitory symptoms of diseases which will be fully dealt with under their respective heads. The manifestation of these premonitory symptoms should be considered as the fourth occasion for medical treatment.

Disease - Its Development

Now we shall deal with the full development or manifestation of a disease. The full manifestation of a disease, such as a swelling, tumour, aneurism (Granthi), Vidradhi (abscess) and erysipelas (Visarpa) etc., fever or dysentery, signifies the complete development of the characteristic symptoms, which should be regarded as the fifth occasion for medical treatment.

The sixth occasion for the calling in of medical aid should be considered to have arisen when a swelling (abscess, tumour, etc.) would burst and exhibit the characteristic symptoms of an open ulcer. A persistent lingering or continuance of a fever or dysentery, etc., should be considered as marking, or forming one of its particular stages, and which may run into one of an incurable type, if neglected or not sufficiently cared for at the outset.

Authoritative Verse On The Subject

The physician, who fully knows about the accumulation (Sanchaya), disturbance or aggravation (Prakopa), expansion (Prasaram), and differentiating traits of the deranged humours (Bheda), and is well conversant with the specific localities in which they are respectively confined in the course of their expansion (Sthana-samshrayam), and with the symptoms which they respectively exhibit in connection with the incidental disease (Vyakti), is alone worthy of that epithet.

The deranged humours, checked or subdued in their accumulating stage, fail to exhibit any further or subsequent development, but, if left unremedied, they gain in strength and intensity in the course of their further development. The humours, deranged either singly, or in couples, or in a triple combination as regards one or two of their virtues, push on, follow and blend with humours similarly deranged as regards their qualities and combinative numbers.

The medical treatment in a case, where two or all (three) of the deranged humours are involved, consists in conquering the strongest one in the combination, but so as not to enrage or aggravate the minor or the weaker humours in the group and specially so in a case of Sannipata. *

* The combination of any two of the bodily humours with the vitiated blood may likewise he interpreted to signify a Sannipatika (trihumoural) combination, A concourse of deranged humours, affecting and appearing in a particular part of the body, is called a boil or an ulcer (Vrana) which "is derived from the root "Vri" to cover and is so called from the fact of its covering a particular part of the body or from its leaving a cicatrix which remains the whole life-time of the patient.

Thus ends the twenty-first chapter of the Sutrasthanam in the Sushruta Samhita which treats of investigation into the nature of the humours giving rise to an ulcer.