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Rogamarga (view source)

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== Significance ==

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As an important phase of [[Samprapti|pathogenesis (samprapti)]], the vitiated [[Dosha|dosha]] travel and settle at the suitable places. [Madhu Kosha commentary on Madhava Nidana Sarvaroga Nidana Adhyaya]<ref name="ref2">Madhavakara ,Madhav Nidana with Madhukosha commentary by Vijayrakshita and Shreekanthadatta revised and edited by Prof. Yadunanda Upadhyaya ,Sarvaroganidana Adhyaya , 1/10 , Page No. 60 </ref> This is termed as prasara (sthana samshraya). It can be said that for both of these phases, roga-marga plays a vital role. Also, the movement of [[Dosha|dosha]] (dosha gati) mentioned as normal (prakriti) and abnormal (vaikrita) are with the same nomenclature viz. koshtha, shakha, marma-asthi-sandhi. This shows the significance of roga marga from physiological view point (prakrita gati of [[Dosha|dosha]]). Roga marga also contributes to the prognosis of the [[Vyadhi|diseases]]. [Chakrapani commentary on Cha. Su. 11/48]<ref name="ref3">Chakrapani commentary on Charaka istraishSamhita Sutrasthana , Tistraishaniya Adhyaya, 11/48reprinted 2020 , Chaukhamba Surbharati Prakashana , Varanasi , Page No. </ref> Further, rogamarga is explained for precise treatment. [Madhukosha Commentary on Madhava Nidana Sarvaroga Nidana Adhyaya]<ref name="ref4">Madhavakara ,Madhav Nidana with Madhukosha commentary by Vijayrakshita and Shreekanthadatta revised and edited by Prof. Yadunanda Upadhyaya ,Sarvaroganidana Adhyaya , 1/4 , Page No. 21 </ref>

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As an important phase of [[Samprapti|pathogenesis (samprapti)]], the vitiated [[Dosha|dosha]] travel and settle at the suitable places. [Madhu Kosha commentary on Madhava Nidana Sarvaroga Nidana Adhyaya]<ref name="ref2">Madhavakara ,Madhav Nidana with Madhukosha commentary by Vijayrakshita and Shreekanthadatta revised and edited by Prof. Yadunanda Upadhyaya ,Sarvaroganidana Adhyaya , 1/10 , Page No. 60 </ref> This is termed as prasara (sthana samshraya). It can be said that for both of these phases, roga-marga plays a vital role. Also, the movement of [[Dosha|dosha]] (dosha gati) mentioned as normal ([[Prakriti|prakriti]]) and abnormal (vaikrita) are with the same nomenclature viz. [[Koshtha|koshtha]], shakha, [[Marma|marma]]-[[Asthi|asthi]]-sandhi. This shows the significance of roga marga from physiological view point (prakrita gati of [[Dosha|dosha]]). Roga marga also contributes to the prognosis of the [[Vyadhi|diseases]]. [Chakrapani commentary on Cha. Su. 11/48]<ref name="ref3">Chakrapani commentary on Charaka istraishSamhita Sutrasthana , Tistraishaniya Adhyaya, 11/48reprinted 2020 , Chaukhamba Surbharati Prakashana , Varanasi , Page No. </ref> Further, rogamarga is explained for precise treatment. [Madhukosha Commentary on Madhava Nidana Sarvaroga Nidana Adhyaya]<ref name="ref4">Madhavakara ,Madhav Nidana with Madhukosha commentary by Vijayrakshita and Shreekanthadatta revised and edited by Prof. Yadunanda Upadhyaya ,Sarvaroganidana Adhyaya , 1/4 , Page No. 21 </ref>

== Etymology ==

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<ol type="A" style='text-align:justify;'><li style="font-weight: bold;">Roga : The word roga is derived from the root ‘ruj’ which means unpleasant, discomfort or pain, to break or disintegrate. It is evident that roga is the outcome of the disintegration of equilibrium of [[Dosha|dosha]] (or dhatusamyata) – Homeostasis, which culminates into pain – physical or psychological. [Arundatta on A.H.Nidana Sthana 1/1]<ref name="ref5">Arundatta commentary on Ashtang Hridaya edited by Pt. Hari Sadashiv Sastri Paradkar , Nidanasthana , Sarvaroganidana , 1/1 , reprinted 2018, Chaukhamba Sanskrit Sansthan , Varanasi , Page No. 440 </ref></li>

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<ol type="A" style='text-align:justify;'><li style="font-weight: bold;">[[Vyadhi|Roga]] : The word [[Vyadhi|roga]] is derived from the root ‘ruj’ which means unpleasant, discomfort or pain, to break or disintegrate. It is evident that [[Vyadhi|roga]] is the outcome of the disintegration of equilibrium of [[Dosha|dosha]] (or dhatusamyata) – Homeostasis, which culminates into pain – physical or psychological. [Arundatta on A.H.[[Nidana Sthana|Nidana Sthana]] 1/1]<ref name="ref5">Arundatta commentary on Ashtang Hridaya edited by Pt. Hari Sadashiv Sastri Paradkar , Nidanasthana , Sarvaroganidana , 1/1 , reprinted 2018, Chaukhamba Sanskrit Sansthan , Varanasi , Page No. 440 </ref></li>

<li style="font-weight: bold;">Marga : The Sanskrit word marga means to go along, or path. [Shabda Kalpadrum]<ref name="ref6">Radhakantadeva, Vasu, v. and Vasu, h. (1886).Shabdakalpadrumah , Page No. 708 </ref> Marga is derived from the Sanskrit verb ‘mruj’ that means purified channel or route. The dictionary meanings of the word marga are path, way, manner, mode, methods, process, indicative of how [[Samprapti|pathogenesis]] is to take place. [Sir. M.M. Williams]<ref name="ref7">Monier-Williams, m. (1899). A Sanskrit-English dictionary , Page. No. 812</ref></li></ol>

Rogamarga can be understood as the way of [[Vyadhi|disease]] occurrence, progression and recurrence as well. The word Roga marga maybe understood as ‘A weak spot’ or ‘Costus specious’. Textbook of Pathology by Boyd quotes “The science of pathology seeks to determine the cause of [[Vyadhi|disease]], to discover how [[Vyadhi|disease]] injures the patient, to describe the lesions produced, to follow how the lesions change as [[Vyadhi|disease]] progresses, to understand how [[Vyadhi|disease]] produces secondary effects in the patient, and to record how the lesions heal as the patient recovers.” -<ref name="ref8">Boyd, William. "Text-book of Pathology." (1953). </ref>

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The external pathway of [[Vyadhi|disease]] is called bahya rogamarga.<ref name="ref9">Hemadri commentary on Ashtang Hridaya edited by Pt. Hari Sadashiv Sastri Paradkar , Sutrasthana , Doshabhediya Adhyaya, 12/45 , reprinted 2018, Chaukhamba Sanskrit Sansthan , Varanasi , Page No. 200 </ref> [Hemadri and Arunadatta on A.H. Su. 12/45] By this meaning, abhyantara (internal) and madhyama (medial) roga marga will be interpreted as internal and medial pathway of [[Vyadhi|disease]] respectively.

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These definitions suggest the appearance of clinical features can be representing a particular roga marga. However, in some cases the [[Samprapti|pathogenesis]] can be different with different pathways. For example, carbuncles due to diabetes (prameha pitika) appearing in the bahya roga marga, needs additional treatments besides other [[Vyadhi|diseases]] which occur in bhaya roga marga.<ref name="ref10">Bhojani Meera Et Al: A study on Nirdesha Chatushka of Charaka Samhita and applied aspect of Trayo-Rogamarga, MD Thesis, 2003, IPGT&RA, Jamnagar </ref> Hence, it can be interpreted that the [[Dosha|dosha]] [[Samprapti|samprapti]] can travel to any roga marga during the process.

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These definitions suggest the appearance of clinical features can be representing a particular roga marga. However, in some cases the [[Samprapti|pathogenesis]] can be different with different pathways. For example, carbuncles due to diabetes ([[Prameha Nidana|prameha]] pitika) appearing in the bahya roga marga, needs additional treatments besides other [[Vyadhi|diseases]] which occur in bhaya roga marga.<ref name="ref10">Bhojani Meera Et Al: A study on Nirdesha Chatushka of Charaka Samhita and applied aspect of Trayo-Rogamarga, MD Thesis, 2003, IPGT&RA, Jamnagar </ref> Hence, it can be interpreted that the [[Dosha|dosha]] [[Samprapti|samprapti]] can travel to any roga marga during the process.

== Movement of [[Dosha|dosha]] and pathways of [[Vyadhi|diseases]] (roga marga vis-a-vis [[Dosha|dosha]] gati) ==

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Three types of movements of [[Dosha|dosha]] are mentioned. [Cha. Sa.[[Sutra Sthana|Sutra Sthana]] 17/113] The same are termed as three types of roga marga viz. shakha, koshtha and marmasthi sandhi.<ref name="ref11">Agnivesha , Dridhbala , Charaka , Charaka Samhita , Sutrasthana , Kiyantashirasiya Adhyaya, 17/112-113 , reprinted 2020 , Chaukhamba Surbharati Prakashana , Varanasi , Page No. 105 </ref> [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 11/48]

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Three types of movements of [[Dosha|dosha]] are mentioned. [Cha. Sa.[[Sutra Sthana|Sutra Sthana]] 17/113] The same are termed as three types of roga marga viz. shakha, [[Koshtha|koshtha]] and marmasthi sandhi.<ref name="ref11">Agnivesha , Dridhbala , Charaka , Charaka Samhita , Sutrasthana , Kiyantashirasiya Adhyaya, 17/112-113 , reprinted 2020 , Chaukhamba Surbharati Prakashana , Varanasi , Page No. 105 </ref> [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 11/48]

These are the different movements of [[Dosha|dosha]]. As these gati are further classified into prakrita (normal) and vaikrita (abnormal), the healthy channels will render the passage for [[Dosha|dosha]] and when the same channels are weaker/vulnerable, they act as ‘roga marga’.

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| [[Vyadhi|Diseases]] like Goitre, pimples, boil, warts, granuloma etc. which are manifested on the [[Sharira|body]] and can be accessed easily and palpable

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| [[Vyadhi|Diseases]] involving the pathology of the vital organs like hemiplegia, facial paralysis etc., [[Vyadhi|diseases]] of cardiovascular system , [[Vyadhi|diseases]] of urinary system, [[Vyadhi|diseases]] of joints

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| [[Vyadhi|Diseases]] involving the pathology of the vital organs like hemiplegia, facial paralysis etc., [[Vyadhi|diseases]] of cardiovascular system, [[Vyadhi|diseases]] of urinary system, [[Vyadhi|diseases]] of joints

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| [[Vyadhi|Diseases]] like fever, diarrhoea, vomiting, cholera, constipation, [[Vyadhi|diseases]] of abdomen, splenic disorders, cough, dyspnoea, hiccough etc. which are caused due to indigestion

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| [[Vyadhi|Diseases]] like [[Jwara|fever]], diarrhoea, vomiting, cholera, constipation, [[Vyadhi|diseases]] of abdomen, splenic disorders, cough, dyspnoea, hiccough etc. which are caused due to indigestion

| Skin [[Vyadhi|diseases]] having acute spread like erysepelas, oedema, abdominal tumours, piles and abscess

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Certain exemplary organs are grouped under different roga margas. The organic implications of each rogamarga can be discussed as follows.

=== Bahya rogamarga: ===

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This includes [[Sharira|body]] components like twak (skin), rakta dhatu (blood), and other similar [[Sharira|body]] consituents. [Cha.Sa.[[Sutra Sthana|Sutrasthana]] 11/48] It is similar to a branch of tree.<ref name="ref13">Jyoti Devangamath Et Al: Crucial Role Of Rogamarga To Understand Vyadhi. International Ayurvedic medical Journal {online} 2016 {cited 2016 July} Available from: http://www.iamj.in/posts/images/upload/1291_1296.pdf </ref>

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This includes [[Sharira|body]] components like twak (skin), [[Rakta dhatu|rakta dhatu]] (blood), and other similar [[Sharira|body]] consituents. [Cha.Sa.[[Sutra Sthana|Sutrasthana]] 11/48] It is similar to a branch of tree.<ref name="ref13">Jyoti Devangamath Et Al: Crucial Role Of Rogamarga To Understand Vyadhi. International Ayurvedic medical Journal {online} 2016 {cited 2016 July} Available from: http://www.iamj.in/posts/images/upload/1291_1296.pdf </ref>

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Thus, to show the remoteness of these structures, they have been termed as shakha. These are the structures seen one after another in a sequence. Rasa, rakta, mamsa, meda, majja pertaining to the internal structures like liver, spleen, brain etc. should not come under bahya roga marga. For example, hrdayagata rasa, yakrita gata rakta should come under abhyantara roga marga. The accessory appendages of skin like hair, nails, tactile cells, sebaceous glands etc. should be considered under bahya rogamarga. Mammary glands, ext. ear, tonsils, adenoids should also be considered under bahya rogamarga. Thus, looking to the structures and [[Vyadhi|diseases]] allotted to bahya rogamarga, it is evident that this marga has entities, which are superficial (compared to the madhyama rogamarga) and these entities are the first line of contact with the external stimulus and hence the pathology occurring is easily diagnosed and approachable. The madhyama roga marga includes marma (vital organs) like heart, brain, kidneys, bones, joints, ligaments, tendons. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 11/48]

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Thus, to show the remoteness of these structures, they have been termed as shakha. These are the structures seen one after another in a sequence. [[Rasa|Rasa]], [[Rakta dhatu|rakta]], [[Mamsa dhatu|mamsa]], [[Meda|meda]], [[Majja dhatu|majja]] pertaining to the internal structures like liver, spleen, brain etc. should not come under bahya roga marga. For example, hrdayagata rasa, yakrita gata rakta should come under abhyantara roga marga. The accessory appendages of skin like hair, nails, tactile cells, sebaceous glands etc. should be considered under bahya rogamarga. Mammary glands, ext. ear, tonsils, adenoids should also be considered under bahya rogamarga. Thus, looking to the structures and [[Vyadhi|diseases]] allotted to bahya rogamarga, it is evident that this marga has entities, which are superficial (compared to the madhyama rogamarga) and these entities are the first line of contact with the external stimulus and hence the pathology occurring is easily diagnosed and approachable. The madhyama roga marga includes [[Marma|marma]] (vital organs) like heart, brain, kidneys, bones, joints, ligaments, tendons. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 11/48]

The grouping of structures of madhyama roga marga is quite different from that of other roga-marga. Although these organs are not connected with each other, they perform vital functions of the [[Sharira|body]] and any damage to them will give rise to serious consequences.

The abhyantara roga marga is termed as kostha. It includes the gastrointestinal tract and all visceral organs. While enumerating koshtangas basti, hridaya and vrikka included in them will be included in abhyantara rogamarga. But in text these organs and [[Vyadhi|diseases]] related to them are ascribed to madhyama roga marga, which maybe explained as under

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Kosthanga are mainly responsible for nutrition and excretion of mala. Hridaya is considered a kosthanga for; it is responsible for nutrition and excretion of blood impurities. Same is the case with vikka and basti. But the reason for not considering these organs under kostha may be that the structural disorders of any of the organs may influence the material flowing through them but not the organs of mahasrotas (A.Rm.) In case of the [[Vyadhi|diseases]] related to abhyantara rogamarga, there may be indirect influence on the vahana dravya of these organs. eg. rakta mutrata in pittaja jwara, hrdaya asuddhi in ama jwara , bahu mutrata in ajirna etc. Thus, being influenced by kostha and their [[Vyadhi|diseases]], these might have been included in kosthanga. But when the point of roga marga comes, these organs are to be studied under madhyama roga marga as is in the texts.

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Kosthanga are mainly responsible for nutrition and excretion of mala. Hridaya is considered a kosthanga for; it is responsible for nutrition and excretion of blood impurities. Same is the case with vikka and basti. But the reason for not considering these organs under kostha may be that the structural disorders of any of the organs may influence the material flowing through them but not the organs of mahasrotas (A.Rm.) In case of the [[Vyadhi|diseases]] related to abhyantara rogamarga, there may be indirect influence on the vahana dravya of these organs. eg. rakta mutrata in pittaja [[Jwara|jwara]], hrdaya asuddhi in ama [[Jwara|jwara]], bahu mutrata in ajirna etc. Thus, being influenced by kostha and their [[Vyadhi|diseases]], these might have been included in kosthanga. But when the point of roga marga comes, these organs are to be studied under madhyama roga marga as is in the texts.

== Physiological aspect of roga-marga ==

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| Madhyam rogamarga

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| It includes organs such as sira, hridaya and basti, other marmas, asthi-sandhi etc.

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| It includes organs such as sira, hridaya and basti, other [[Marma|marmas]], asthi-sandhi etc.

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* These organs have nothing in common either physiologically nor have anatomical continuity.

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<ol><li style="font-weight: bold;">In the same organ, sthanantara swarupa roga vriddhi : In skin disorders and other contagious [[Vyadhi|diseases]], due to anatomical continuity in skin, the pathogens can travel in the same organ. E.g visarpa. [Cha.Sa.[[Chikitsa Sthana|Chikitsa Sthana]] 21/15] </li>

<li style="font-weight: bold;">Dhatugata swarupa roga vriddhi : The transfer of [[Vyadhi|disease]] or [[Samprapti|samprapti]] from one dhatu to another is also the manifestation of roga vriddhi (dhatu gatatva). Dhatugata vyadhi and dhatugata vata are explained to get a clear idea. Apart from the dhatugatatva of [[Dosha|dosha]], it is explained in certain other contexts also. They are the following : </li>

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<ol type="i"><li>Dhatugatatva of jwara (the morbid [[Dosha|dosha]] causing fever penetrates into deeper tissues) [Cha. Sa. [[Chikitsa Sthana|Chikitsa sthana]] 3/ 70-83], [Su.Sa.Uttara Tantra 29/83-89]</li>

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<ol type="i"><li>Dhatugatatva of [[Jwara|jwara]] (the morbid [[Dosha|dosha]] causing [[Jwara|fever]] penetrates into deeper tissues) [Cha. Sa. [[Chikitsa Sthana|Chikitsa sthana]] 3/ 70-83], [Su.Sa.Uttara Tantra 29/83-89]</li>

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<li>Dhatugatatva of kushtha (the morbid [[Dosha|dosha]] causing skin [[Vyadhi|diseases]] penetrates into deeper tissues) [Su. Sa. Nidana Sthana 5/20-27] </li>

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<li>Dhatugatatva of kushtha (the morbid [[Dosha|dosha]] causing skin [[Vyadhi|diseases]] penetrates into deeper tissues) [Su. Sa. [[Nidana Sthana|Nidana Sthana]] 5/20-27] </li>

<li>Dhatugatatva of masurika (the morbid [[Dosha|dosha]] causing chicken pox penetrates into deeper tissues) [Ma. Ni. 54 / 14-23] </li>

<li>Dhatugatatva of visha vega (the poison penetrates into deeper tissues) [A.Hr.Uttara tantra 19/26] [Su.Sa. Kalpa Sthana 4/39] </li>

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The examples of dhatugatatva given in skin diseases (kushtha) can be taken as a model for understanding the symptomatology of dhatugatatva of kapha dominant [[Vyadhi|diseases]]. Likewise, dhatugatatva of jwara for pittaja vyadhis and dhatugatatva described in vatavyadhi for vata dominant disorders.</ol>

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The examples of dhatugatatva given in skin diseases (kushtha) can be taken as a model for understanding the symptomatology of dhatugatatva of kapha dominant [[Vyadhi|diseases]]. Likewise, dhatugatatva of [[Jwara|jwara]] for pittaja vyadhis and dhatugatatva described in vatavyadhi for vata dominant disorders.</ol>

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<li style="font-weight: bold;">Nidanarthakara swarupa roga vriddhi : Sometimes one [[Vyadhi|disease]] may become nidana for the other disease. This is also a kind of roga-vriddhi. Eg., Jwara to raktapitta (the heat of the fever causes bleeding disorders), pratishyaya to kasa (coryza causes coughing), kasa to swasha (Coughing may lead to asthama kind of breathlessness), atisara to grahani (Diarrhoea causes sprue syndrome), grahani to arsha (Sprue syndrome may cause piles), etc. [Cha.Sa.Nidana Sthana 8/17-19] </li>

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<li style="font-weight: bold;">Nidanarthakara swarupa roga vriddhi : Sometimes one [[Vyadhi|disease]] may become nidana for the other disease. This is also a kind of roga-vriddhi. Eg., [[Jwara|Jwara]] to raktapitta (the heat of the [[Jwara|fever]] causes bleeding disorders), pratishyaya to kasa (coryza causes coughing), kasa to swasha (Coughing may lead to asthama kind of breathlessness), atisara to grahani (Diarrhoea causes sprue syndrome), grahani to arsha (Sprue syndrome may cause piles), etc. [Cha.Sa.[[Nidana Sthana|Nidana Sthana]] 8/17-19] </li>

<li style="font-weight: bold;">Vyadhisankara swarupa roga vriddhi : Vyadhi sankara means the occurance of 2-3 [[Vyadhi|diseases]] at a time. Sometimes, the [[Vyadhi|disease]] itself subsides after producing some other [[Vyadhi|disease]] and sometimes it persists and becomes more troublesome.

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e.g. Pratishyaya and kasa (coryza and coughing together),. [Cha.Sa.Nidana Sthana 8/22] </li>

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e.g. Pratishyaya and kasa (coryza and coughing together),. [Cha.Sa.[[Nidana Sthana|Nidana Sthana]] 8/22] </li>

<li style="font-weight: bold;">Upadrava swarupa roga vriddhi : [Cha.Sa.[[Chikitsa Sthana|Chikitsa Sthana]]21/40] Upadrava also signifies roga vrddhi. In a vigunita sthana, dosha dushya sammurcchana takes place. If it is not treated at early stage and nidana sevana continued then this dosha dushya melaka becomes more virulent and travels to other places and produces upadrava. eg. Upadrava of udara roga (obstinate abdominal [[Vyadhi|diseases]] including ascites) are chhardi (vomiting), atisara (diarrhoea), shwasa (dyspnoea), kasa (cough), trishna (morbid thirst), hikka (hiccup), aruchi (anorexia) etc. [Cha.Sa.[[Chikitsa Sthana|Chikitsa Sthana]] 13/49] </li>

<li style="font-weight: bold;">Roga vrddhi in same srotas in a sequential order : Roga initiates from sroto mula or a part of srotas and spreads to whole srotas, if nidana parivarjana is not done and chikitsa not applied. eg. Nasal Polyp leads to Bronchitis, which in turn may lead to asthma. </li>

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<li style="font-weight: bold;">Roga vrddhi according to [[Dosha|dosha]] sthana : The best example given to study this is in Jwara Prakarana of Sushruta Uttara Sthana. [Nibandha Sangraha commentary by Dalhana on Su.Sa. Uttara tantra 39/ 51-52]

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<li style="font-weight: bold;">Roga vrddhi according to [[Dosha|dosha]] sthana : The best example given to study this is in [[Jwara|Jwara]] Prakarana of Sushruta Uttara Sthana. [Nibandha Sangraha commentary by Dalhana on Su.Sa. Uttara tantra 39/ 51-52]

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* Satata jwara in amashaya (In continuous fever, the morbid [[Dosha|doshas]] are in the stomach)

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* Satata [[Jwara|jwara]] in amashaya (In continuous [[Jwara|fever]], the morbid [[Dosha|doshas]] are in the stomach)

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* Anyedhyushka in hridaya (In intermittent fever, the morbid [[Dosha|doshas]] are in the heart / heart region)

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* Anyedhyushka in hridaya (In intermittent [[Jwara|fever]], the morbid [[Dosha|doshas]] are in the heart / heart region)

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* Trutiyaka in kantha (In tertian fever, the morbid [[Dosha|doshas]] are in the throat / throat region)

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* Trutiyaka in kantha (In tertian [[Jwara|fever]], the morbid [[Dosha|doshas]] are in the throat / throat region)

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* Chaturthaka in sandhi (In quartan type of fever the morbid [[Dosha|doshas]] are in the joints) </li>

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* Chaturthaka in sandhi (In quartan type of [[Jwara|fever]] the morbid [[Dosha|doshas]] are in the joints) </li>

In this way, looking at the different procedures of roga vriddhi, it is evident that roga marga plays a definite role in the roga vriddhi, which may take place in the same roga marga or in other roga marga. </ol></ul>

== The inter-connectedness of the different roga marga ==

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[[Dosha|Dosha]] can move from one marga to another. The movement of the [[Dosha|dosha]] from internal pathway towards other marga will be clear in most of the [[Vyadhi|diseases]]. But in the case of external pathways, the movement of [[Dosha|dosha]] from shakha towards koshtha is not so easy. The reason may be that the [[Vyadhi|diseases]] of the internal pathway produce many symptoms externally. But the [[Vyadhi|diseases]] of the external pathway generally may not have any serious symptoms and signs pertaining to internal or medial pathway. The reason for this can be given in the following paras. <ol type="a"><li>[[Sharira|Body]] due to its defense mechanism generally tries to push out the factors, which are not suitable to it. If the koshtha is filled with such morbid factors, in order to defend the organs of koshtha from any type of damage they are pushed to other margas if not expelled out. This is done preferably through the marga of poshana. The causes of movement of the [[Dosha|doshas]] from koshtha to shakha have been mentioned by acharya Charak. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 28/31] </li>

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[[Dosha|Dosha]] can move from one marga to another. The movement of the [[Dosha|dosha]] from internal pathway towards other marga will be clear in most of the [[Vyadhi|diseases]]. But in the case of external pathways, the movement of [[Dosha|dosha]] from shakha towards [[Koshtha|koshtha]] is not so easy. The reason may be that the [[Vyadhi|diseases]] of the internal pathway produce many symptoms externally. But the [[Vyadhi|diseases]] of the external pathway generally may not have any serious symptoms and signs pertaining to internal or medial pathway. The reason for this can be given in the following paras. <ol type="a"><li>[[Sharira|Body]] due to its defense mechanism generally tries to push out the factors, which are not suitable to it. If the [[Koshtha|koshtha]] is filled with such morbid factors, in order to defend the organs of [[Koshtha|koshtha]] from any type of damage they are pushed to other margas if not expelled out. This is done preferably through the marga of poshana. The causes of movement of the [[Dosha|doshas]] from [[Koshtha|koshtha]] to shakha have been mentioned by acharya Charak. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 28/31] </li>

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<li>The same case is not found in the [[Vyadhi|diseases]] of external pathways. Because the morbid [[Dosha|dosha]] will not be able to move back to koshtha easily. This is because the viloma gati of [[Dosha|dosha]] will have to take place here. This sort of movement is possible only with the co-operation of the srotas. The causes of movement of [[Dosha|doshas]] from shakha to koshtha , mentioned by acharya Charak, plays role for this. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 28/32] Thus, compared to abhyantar rogamarga, the [[Vyadhi|diseases]] of bahya roga marga takes longer duration. </li></ol>

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<li>The same case is not found in the [[Vyadhi|diseases]] of external pathways. Because the morbid [[Dosha|dosha]] will not be able to move back to [[Koshtha|koshtha]] easily. This is because the viloma gati of [[Dosha|dosha]] will have to take place here. This sort of movement is possible only with the co-operation of the srotas. The causes of movement of [[Dosha|doshas]] from shakha to [[Koshtha|koshtha]], mentioned by acharya Charak, plays role for this. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 28/32] Thus, compared to abhyantar rogamarga, the [[Vyadhi|diseases]] of bahya roga marga takes longer duration. </li></ol>

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The movement of the morbid factors in the [[Vyadhi|diseases]] of medial pathways will be of different type. In these [[Vyadhi|diseases]], the movement of the [[Dosha|dosha]] will be from one organ to the other organ of the same roga marga. In [[Vyadhi|diseases]] like amavata, vatarakta, etc. which are related with the joints coming under medial pathway, signs and symptoms of the malfunction of heart (hridaya) or bladder (basti) or both etc. will be present. In the same way, the involvement of the heart may produce signs and symptoms related with extrenal pathway in their premonitory stage (purvarupavastha). Prameha and rajayakshma, which are the [[Vyadhi|diseases]] of medial pathway, may be quoted as examples. In these disorders, excessive growth of hair, nails etc. are observed in premonitory stage.

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The movement of the morbid factors in the [[Vyadhi|diseases]] of medial pathways will be of different type. In these [[Vyadhi|diseases]], the movement of the [[Dosha|dosha]] will be from one organ to the other organ of the same roga marga. In [[Vyadhi|diseases]] like amavata, vatarakta, etc. which are related with the joints coming under medial pathway, signs and symptoms of the malfunction of heart (hridaya) or bladder (basti) or both etc. will be present. In the same way, the involvement of the heart may produce signs and symptoms related with extrenal pathway in their premonitory stage (purvarupavastha). [[Prameha Nidana|Prameha]] and rajayakshma, which are the [[Vyadhi|diseases]] of medial pathway, may be quoted as examples. In these disorders, excessive growth of hair, nails etc. are observed in premonitory stage.

It can be said that most of the [[Vyadhi|diseases]] of external pathway originate from colon (pakwashayottha). In the [[Vyadhi|diseases]] of external pathway apart from the external treatment (bahya chikitsa or bahirparimarjana chikitsa), virechana is preferred. It is only through suitable virechana dravyas, skin [[Vyadhi|diseases]] are treated successfully.

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Roga marga is explained in view of precise treatment for [[Vyadhi|diseases]] occurring in a particulat rogamarga. [Madhukosha on Madhava Nidana, Sarvaroga Nidana Adhyaya Shloka No.10]

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As koshtha/abhyantar roga-marga is the place of jatharagni, all its [[Vyadhi|diseases]] manifest due to poor agni (agnimandya or agni dushti), resulting into ama. Vamana and virechana maybe the line of treatment for shodhana purpose for the [[Vyadhi|diseases]] occurring here, depending on the classification of origin from stomach (amashaya samuttha) and colon (pakwashaya samuttha vyadhi).

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As [[Koshtha|koshtha]]/abhyantar roga-marga is the place of jatharagni, all its [[Vyadhi|diseases]] manifest due to poor agni (agnimandya or agni dushti), resulting into ama. Vamana and virechana maybe the line of treatment for shodhana purpose for the [[Vyadhi|diseases]] occurring here, depending on the classification of origin from stomach (amashaya samuttha) and colon (pakwashaya samuttha vyadhi).

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In the [[Vyadhi|diseases]] of external pathways, dhatwagnimandya will be prominent. Snehana-swedana will be of use for bringing the [[Dosha|dosha]] from shakha to koshtha and removal through the nearby orifice. Virechana and raktamokshana are one of the best shodhana measures for the [[Vyadhi|diseases]] of external patways. In addition, kshara, and agnikarma can also be applied for the [[Vyadhi|diseases]].

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In the [[Vyadhi|diseases]] of external pathways, dhatwagnimandya will be prominent. Snehana-swedana will be of use for bringing the [[Dosha|dosha]] from shakha to [[Koshtha|koshtha]] and removal through the nearby orifice. Virechana and raktamokshana are one of the best shodhana measures for the [[Vyadhi|diseases]] of external patways. In addition, kshara, and agnikarma can also be applied for the [[Vyadhi|diseases]].

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For the [[Vyadhi|diseases]] of medial pathway, prana and vyana vayu are found to be involved. Basti and nasya maybe more beneficial. As the [[Vyadhi|diseases]] of madhyama roga-marga are generally originated from colon (pakwashayottha) and due to obstructed vayu, basti maybe the first line of treatment. Basti is capable of preventing and overcoming the afflictions of marma, asthi sandhi etc. [Cha. Sa. Siddhi Sthana 9/ 7]. Additionally, the [[Vyadhi|diseases]] of head like facial paralysis (ardita), neck stiffness (manyastambha), hemiplegia (pakshaghata), etc. can be treated with nasya.

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For the [[Vyadhi|diseases]] of medial pathway, prana and vyana vayu are found to be involved. Basti and nasya maybe more beneficial. As the [[Vyadhi|diseases]] of madhyama roga-marga are generally originated from colon (pakwashayottha) and due to obstructed vayu, basti maybe the first line of treatment. Basti is capable of preventing and overcoming the afflictions of [[Marma|marma]], asthi sandhi etc. [Cha. Sa. Siddhi Sthana 9/ 7]. Additionally, the [[Vyadhi|diseases]] of head like facial paralysis (ardita), neck stiffness (manyastambha), hemiplegia (pakshaghata), etc. can be treated with nasya.

Similarly, shamana aushadha may also be categorized as acting specifically on a particular roga marga.

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