Rogamarga

Roga marga means pathways of disease progression and manifestations. It is essential to know the path of progression and manifestation of the disease to plan the protocol for its management. Roga marga is a place of vitiation of body channels (kha vaigunya). The disease can be cured, if the exact site of vitiation is targeted. Through the applicability of roga marga, the recurrence of the disease may be reduced. [Cha.Sa.Chikitsa Sthana 15/36-37] The specific medicines for specific receptors can be developed. [Cha.Sa. Sutra Sthana 4/22]
Acharya Charaka has explained roga marga as under. [Cha.Sa.Sutra Sthana 11/48]

1. Three roga margas viz. external (bahya), middle (madhyama) and internal (abhyantara)
2. Each roga marga has set of structural / physiological entities.
3. List of diseases of roga marga

This article describes the physiological and pathological aspects of rogamarga with their importance in therapeutics.

Contributors

Section/Chapter/topic	Concepts/Rogamarga
Authors	Bhojani M. K. 1, Dwivedi Rambabu 2, Vyas Mahesh3, Bhatted Santoshkumar4
Reviewer	Basisht G.5,
Editor	Deole Y.S.6
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Former Dean, Institute of Post Graduate Teaching & Research in Ayurveda, Jamnagar, India 3 Department of Samhita Siddhanta, All India Institute of Ayurveda, New Delhi, India 4 Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India 5 Rheumatologist, Orlando, Florida, U.S.A. 6 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	March 30, 2023
DOI	10.47468/CSNE.2023.e01.s09.133

Significance

As an important phase of pathogenesis (samprapti), the vitiated dosha travel and settle at the suitable places. [Madhu Kosha commentary on Madhava Nidana Sarvaroga Nidana Adhyaya] This is termed as prasara and sthana samshraya. It can be said that for both of these phases, roga marga plays a vital role. Also, the movement of 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).
Roga marga also contributes to the prognosis of the diseases. [Chakrapani commentary on Cha. Su. 11/48]
Further, roga marga is explained for precise treatment. [Madhukosha Commentary on Madhava Nidana Sarvaroga Nidana Adhyaya]

Etymology

1. 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 (or dhatusamyata) – Homeostasis, which culminates into pain – physical or psychological. [Arundatta on A.H.Nidana Sthana 1/1]
2. Marga :
   The Sanskrit word marga means to go along, or path. [Shabda Kalpadrum] 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 pathogenesis is to take place. [Sir. M.M. Williams]

Rogamarga can be understood as the way of 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 disease, to discover how disease injures the patient, to describe the lesions produced, to follow how the lesions change as disease progresses, to understand how disease produces secondary effects in the patient, and to record how the lesions heal as the patient recovers.”

Definition

The external pathway of disease is called bahya roga marga. [Hemadri and Arunadatta on A.H. Sutra Sthana 12/45] By this meaning, abhyantara (internal) and madhyama (medial) roga marga will be interpreted as internal and medial pathway of disease respectively.
These definitions suggest the appearance of clinical features can be representing a particular roga marga. However, in some cases the 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 diseases which occur in bhaya roga marga. Hence, it can be interpreted that the dosha samprapti can travel to any roga marga during the process.

Movement of dosha and pathways of diseases (roga marga vis-a-vis dosha gati)

Three types of movements of dosha are mentioned. [Cha. Sa.Sutra Sthana 17/113] The same are termed as three types of roga marga viz. shakha, koshtha and marma asthi sandhi. [Cha.Sa.Sutra Sthana 11/48]
These are the different movements of dosha. As these gati are further classified into prakrita (normal) and vaikrita (abnormal), the healthy channels will render the passage for dosha and when the same channels are weaker/vulnerable, they act as ‘roga marga’.

Diseases observed in each roga marga

Diseases occurring in different rogamarga are tabulated as under:

Table 1: Diseases in different roga marga

Diseases occurring in bahya roga marga	Diseases occurring in madhyama roga marga	Diseases occurring in abhyantara roga marga	Diseases occurring in bahya and abhyantara roga marga
Diseases like goitre, pimples, boil, warts, granuloma etc. which are manifested on the body and can be accessed easily and palpable	Diseases involving the pathology of the vital organs like hemiplegia, facial paralysis etc., diseases of cardiovascular system, diseases of urinary system, diseases of joints	Diseases like fever, diarrhoea, vomiting, cholera, constipation, diseases of abdomen, splenic disorders, cough, dyspnoea, hiccough etc. which are caused due to indigestion	Skin diseases having acute spread like erysepelas, oedema, abdominal tumours, piles and abscess

Anatomical aspects

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

Bahya rogamarga (external pathway)

This includes body components like twak (skin), rakta dhatu (blood), and other similar body constituents. [Cha.Sa.Sutrasthana 11/48] It is similar to a branch of tree.
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 dhatu, yakrita gata rakta dhatu should come under abhyantara roga marga. The accessory appendages of skin like hair, nails, tactile cells, sebaceous glands etc. should be considered under bahya roga marga. Mammary glands, ext. ear, tonsils, adenoids should also be considered under bahya roga marga. Thus, looking to the structures and diseases allotted to bahya rogamarga, it is evident that this marga has entities, which are superficial (compared to the madhyama roga marga) 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 11/48]

Madhyama rogamarga (medial pathway)

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 body and any damage to them will give rise to serious consequences.

Abhyantara rogamarga (internal pathway)

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

Koshthanga are mainly responsible for nutrition and excretion of mala. Hridaya is considered a koshthanga for; it is responsible for nutrition and excretion of blood impurities. Same is the case with vrikka and basti. But the reason for not considering these organs under koshtha may be that the structural disorders of any of the organs may influence the material flowing through them but not the organs of mahasrotas. In case of the diseases related to abhyantara roga marga, there may be indirect influence on the vahana dravya of these organs. eg. rakta mutrata in pittaja jwara, hridaya ashuddhi in ama jwara, bahu mutrata in ajirna etc. Thus, being influenced by koshtha and their diseases, these might have been included in koshthanga. 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

Physiologically, the various organs occurring in a particular roga marga are inter-connected. This could be explained as under:

Table 2: Peculiarities of roga marga

Roga marga	Important physiological aspect	Other peculiarities
Abhyantara roga marga	It is the prime site of jatharagni and concerned with digestion, absorption and excretion,	It has the mula sthana of the dosha. [Su.Sa.Sutra Sthana 21/6] The koshthanga are in the abhyantara rogamarga
Bahya roga marga	It is the site of dhatwagni, responsible for the dhatu nirmana	As the nutrition is processed through abhyantara roga marga, at least two roga margas are functionally interlinked; and many cause and effect phenomena can be observed in these two margas.
Madhyam roga marga	It includes organs such as sira, hridaya and basti, other marmas, asthi-sandhi etc.	These organs have nothing in common either physiologically nor have anatomical continuity. They are the main seats of prana according to ayurveda They have large quantity of blood circulation. These organs are interlinked with each other pathologically, as the pathology of one affects the other.

Pathological understanding of roga marga vs. disease pathways

In a normal body, as such, there will be no rogamarga for the dosha to travel. The healthy srotas/organs are rendered weak by the intake of nidana sevana and this renders the srotas weak, which is termed as khavaigunya. This results in directing the samprapti and spread of disease. Such weak srotas/ organs becomes rogamarga.
Roga margas have crucial role to play in the samprapti of a disease. The very definition of samprapti brings forth two things. One is that, the accumulated and spreading dosha virtually reaches each and every part of the body and the general channel of flow is rasayani. [ A.H. Nidana Sthana 1/23]
Along with it, this subject has been emphasized for sadhyasahdyata i.e. prognosis, according to Chakrapani and for therapeutic application according to madhukoshakara. This points towards the pathological importance of roga marga.

Role of roga-marga in various stages of samprapti

• Sub clinical or formative stages :
  Of the six stages, accumulaton (chaya), aggravation (prakopa), spread (prasara) are sub-clinical. The symptoms manifested in chaya stage are imprecise, depending on invoved dosha. Prakopa avastha exhibits the symptomatology but not disease. In the prasara avastha, when the spread of the morbid doshas starts, the manifestation at roga marga comes into picture. Albeit, as the accumulation (chaya avastha) occurs at the root (mula / utpatti sthana) of the dosha, the involvement of roga marga maybe inferred from accumulation stage (chaya avastha) itself.
• Clinical stage :
  A list of diseases are mentioned under a particular roga marga. So, it can be said that roga marga plays significant role in the clinical stages viz. sthana samshraya and vyakti avastha.
  Roga marga is the site of kha-vaigunya which later on cultivates for interaction of dosh and dushya. [Su.Sa.Sutra Sthana 24/10] Kha-vaigunya plays directive role for the pathology to spread in different srotas (systems).
  Sthanasamshraya avastha is an important transition stage between the sub clinical and the clinical stages; wherein the structural lesions begin to occur alongwith the functional disturbances, which leads to localization of the pathology.
• In the vyakti avastha, the outcome of the interaction of dosha-dushya is revealed. According to respected Vaidya Shiva Charan Dhyani, in the book “Nidana Panchaka”, at this stage, (i) completion of dosha dushya sammurcchana (ii) Srotodusti and its features and (iii) lakshana sammuchaya of diseases, are manifested.
Though the dosha dushya sammurcchana is initiated in the previous stage, its completion is achieved in vyakti avastha. The sroto dushti occurs at roga-marga
• Complicated clinical (post clinical) stage :
  Bheda stage is considered as the advanced clinical stage. In this stage, the disease (vyadhi) may become chronic or progressive and leads to other diseases. In this phase, the roga vriddhi takes place. Advancement of disease (roga vriddhi) takes place by different modes, which are listed briefly as follows:
1. In the same organ, sthanantara swarupa roga vriddhi :
   In skin disorders and other contagious diseases, due to anatomical continuity in skin, the pathogens can travel in the same organ. E.g visarpa. [Cha.Sa.Chikitsa Sthana 21/15]
2. Dhatugata swarupa roga vriddhi :
   The transfer of disease or 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, it is explained in certain other contexts also. They are the following :
1. Dhatugatatva of jwara (the morbid dosha causing fever penetrates into deeper tissues) [Cha. Sa. Chikitsa sthana 3/ 70-83], [Su.Sa.Uttara Tantra 29/83-89]
2. Dhatugatatva of kushtha (the morbid dosha causing skin diseases penetrates into deeper tissues) [Su. Sa. Nidana Sthana 5/20-27]
3. Dhatugatatva of masurika (the morbid dosha causing chicken pox penetrates into deeper tissues) [Ma. Ni. 54 / 14-23]
4. Dhatugatatva of visha vega (the poison penetrates into deeper tissues) [A.Hr.Uttara tantra 19/26] [Su.Sa. Kalpa Sthana 4/39]
The examples of dhatugatatva given in skin diseases (kushtha) can be taken as a model for understanding the symptomatology of dhatugatatva of kapha dominant diseases. Likewise, dhatugatatva of jwara for pittaja vyadhis and dhatugatatva described in vatavyadhi for vata dominant disorders.
3. Nidanarthakara swarupa roga vriddhi :
   Sometimes one 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]
4. Vyadhisankara swarupa roga vriddhi :
   Vyadhi sankara means the occurance of 2-3 diseases at a time. Sometimes, the disease itself subsides after producing some other disease and sometimes it persists and becomes more troublesome.
   e.g. Pratishyaya and kasa (coryza and coughing together),. [Cha.Sa.Nidana Sthana 8/22]
5. Upadrava swarupa roga vriddhi : [Cha.Sa. 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 diseases including ascites) are chhardi (vomiting), atisara (diarrhoea), shwasa (dyspnoea), kasa (cough), trishna (morbid thirst), hikka (hiccup), aruchi (anorexia) etc. [Cha.Sa.Chikitsa Sthana 13/49]
6. Roga vriddhi 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.
7. Roga vriddhi according to 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]
   • Satata jwara in amashaya (In continuous fever, the morbid doshas are in the stomach)
   • Anyedhyushka in hridaya (In intermittent fever, the morbid doshas are in the heart / heart region)
   • Trutiyaka in kantha (In tertian fever, the morbid doshas are in the throat / throat region)
   • Chaturthaka in sandhi (In quartan type of fever the morbid doshas are in the joints)
   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.

The inter-connectedness of the different roga marga

Dosha can move from one marga to another. The movement of the dosha from internal pathway towards other marga will be clear in most of the diseases. But in the case of external pathways, the movement of dosha from shakha towards koshtha is not so easy. The reason may be that the diseases of the internal pathway produce many symptoms externally. But the 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.

1. 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 doshas from koshtha to shakha have been mentioned by acharya Charak. [Cha.Sa.Sutra Sthana 28/31]
2. The same case is not found in the diseases of external pathways. Because the morbid dosha will not be able to move back to koshtha easily. This is because the viloma gati of 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 doshas from shakha to koshtha, mentioned by acharya Charak, plays role for this. [Cha.Sa.Sutra Sthana 28/32] Thus, compared to abhyantar rogamarga, the diseases of bahya roga marga takes longer duration.

The movement of the morbid factors in the diseases of medial pathways will be of different type. In these diseases, the movement of the dosha will be from one organ to the other organ of the same roga marga. In 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 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 diseases of external pathway originate from colon (pakwashayottha). In the 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 diseases are treated successfully.

Virechana have special influence on colon (pakwashaya). Thus, the disorders, which subside by means of virechana, the diseases of external pathways may be said to originate from colon (pakwashayottha).

Rogamarga related to prognosis

The purpose for describing roga-marga is to know prognosis (sukha sadhyatvadi jnanartham). [Chakrapani on Cha.Sa.Sutra Sthana 11/48] [Chakrapani on Cha.Sa.Sutra Sthana 10/12] [Chakrapani on Cha.Sa.Sutra Sthana 10/15,16] [Cha.Sa.Sutra Sthana 10/18,19] The contribution of roga marga to prognosis depends on the robustness of the site.[Chakrapani on Cha.Sa. Chikitsa Sthana 30/327]

Rogamarga for precise treatment

Roga marga is explained in view of precise treatment for diseases occurring in a particulat rogamarga. [Madhukosha on Madhava Nidana, Sarvaroga Nidana Adhyaya Shloka No.10]
As koshtha/abhyantar roga-marga is the place of jatharagni, all its 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 diseases occurring here, depending on the classification of origin from stomach (amashaya samuttha) and colon (pakwashaya samuttha vyadhi).
In the diseases of external pathways, dhatwagnimandya will be prominent. Snehana-swedana will be of use for bringing the dosha from shakha to koshtha and removal through the nearby orifice. Virechana and raktamokshana are one of the best shodhana measures for the diseases of external patways. In addition, kshara, and agnikarma can also be applied for the diseases.
For the diseases of medial pathway, prana and vyana vayu are found to be involved. Basti and nasya maybe more beneficial. As the 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 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.

Roga marga : a special type of classification of diseases

Some of the expert ayurvedic physicians believe that the description of roga marga denotes special type of disease classification. Such a classification is exceptional in comparison to systemic classification of disease. The systemic classification does not give any contribution in the field of prognosis and management. Whereas it is not so in the case of ayurvedic classification of diseases in terms of roga marga. The systemic classification is based on the anatomical and physiological continuity, whereas not always the organs of a particular roga marga have anatomical attachment. e.g. madhyama roga marga. The connection between the organs of a particular marga is evident pathologically, hence termed as roga marga.

Contemporary approach

The contemporary approach to understand the body and the pathogenesis of any disease is analytical. Whereas that of ayurveda is holistic and comprehensive. With this basic difference, it maybe said that such a concept of ‘rogamarga’ is also unique in Ayurveda, where different set of diseases are said to occur under a single rogamarga. Further, the prognostic approach of contemporary medical science is not based on the systems involved; whereas this concept of rogamarga is also having significance for the prognosis.

Current researches

Thesis

• Bhojani Meera et al: A study on Nirdesha Chatushka of Charaka Samhita and applied aspect of Trayo-Rogamarga, MD Thesis, 2003, IPGT&RA, Jamnagar : A detailed description on the concept of rogamarga and doshagati is explained. A clinical trial is done on the patients of tamaka shwasa and pravahika, based on the concept of rogamarga. It was found that the line of treatment for the diseases occurring in a single rogamarga maybe similar and for the abhyantara rogamarga, the treatment maybe focused on jatharagni centered (correction of the digestion).

Articles

• Vilas Kad, Tushar Auti. A review on trividha rogamarga & its role in manifestation of disease. Ayurpharm Int J Ayur Alli Sci. 2015;4(2):29-34
• 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
• Asharani Amitkumar Kore : Concept Of Dosha-Gati With Special Reference To Kshaya-Sthan-Vruddhi Gati; IAMJ: Volume 3; Issue 2; February- 2015
• Kore Asharani Amitkumar, Concept of Urdhav-Adho-Tiryak Gati of Dosha ; UJAHM 2015, 03 (05): Page 7-9;
• Dr. Kulkarni. Pratibha et al., Rogamarga and Dosha Gati ; wjpmr, 2016,2(6), 97-99;
• Pushpa Tuppad. Conceptual study of Rogamarga. J Ayurveda Integr Med Sci 2022;3:53-58;
These studies have derived the important role played by roga marga in the pathogenesis of the disease, its prognosis and the line of management. The dosha gati in its vikrita avastha is through the roga marga.

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