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|title=Rogamarga

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|keywords=carakasamhitaonline, charak samhita, caraka samhita, ~~ayurved~~, Rogamarga, Rogamarga in ayurveda, Bhojani M. K., Dwivedi Rambabu, Vyas Mahesh, Bhatted Santoshkumar, Basisht G., Deole Y.S., Roga Etymology, pathways of diseases, Diseases observed in each roga marga, Bahya rogamarga, Physiological aspect of roga-marga,

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|keywords=carakasamhitaonline, charak samhita, caraka samhita, ayurveda, Rogamarga, Rogamarga in ayurveda, Bhojani M. K., Dwivedi Rambabu, Vyas Mahesh, Bhatted Santoshkumar, Basisht G., Deole Y.S., Roga Etymology, pathways of diseases, Diseases observed in each roga marga, Bahya rogamarga, Physiological aspect of roga-marga,disease pathways, how disease happens, ancient science

|description=Roga marga means pathways of disease progression and manifestations.

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|type=article

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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.<ref name="ref1">Agnivesha , Dridhbala , Charaka , Charaka Samhita , Sutrasthana , Taistraishaniya Adhyaya , 11/48 , reprinted 2020 , Chaukhamba Surbharati Prakashana , Varanasi , Page No. 77 </ref> [Cha.Sa.~~Sutrasthana~~ 11/48]

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Roga marga means pathways of [[Vyadhi|disease]] progression and manifestations. It is essential to know the path of progression and manifestation of the [[Vyadhi|disease]] to plan the protocol for its management. Roga marga is a place of vitiation of [[Sharira|body]] channels ([[Kha vaigunya|kha vaigunya]]). The [[Vyadhi|disease]] can be cured, if the exact site of vitiation is targeted. Through the applicability of roga marga, the recurrence of the [[Vyadhi|disease]] may be reduced. [Cha.Sa.[[Chikitsa Sthana|Chikitsa Sthana]] 15/36-37] The specific medicines for specific receptors can be developed. [Cha.Sa. [[Sutra Sthana|Sutra Sthana]] 4/22] Acharya Charaka has explained roga marga as under.<ref name="ref1">Agnivesha , Dridhbala , Charaka , Charaka Samhita , Sutrasthana , Taistraishaniya Adhyaya , 11/48 , reprinted 2020 , Chaukhamba Surbharati Prakashana , Varanasi , Page No. 77 </ref> [Cha.Sa.[[Sutra Sthana]] 11/48]

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# Three roga ~~maragas~~ viz. external (bahya), middle (madhyama) and internal (abhyantara)

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# Three roga margas viz. external (bahya), middle (madhyama) and internal (abhyantara)

# Each roga marga has set of structural / physiological entities.

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# List of diseases of roga marga

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# List of [[Vyadhi|diseases]] of roga marga

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

{{Infobox

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|data2 = Bhojani M. K. 1, Dwivedi Rambabu 2, Vyas Mahesh3, Bhatted Santoshkumar4

|label3 = Reviewer

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|data3 = Basisht G.5,

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|data3 = [[Gopal Basisht|Basisht G.]]5,

|label4 = Editor

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|data4 = Deole Y.S.6

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|data4 = [[Yogesh Deole|Deole Y.S.]]6

|label5 = Affiliations

|data5 = 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

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== Significance ==

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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]<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 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]<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 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]] (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, roga marga 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 (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>

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<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 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>

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<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>

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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.” -<ref name="ref8">Boyd, William. "Text-book of Pathology." (1953). </ref>

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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>

== Definition ==

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The external pathway of 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 disease respectively.

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The external pathway of [[Vyadhi|disease]] is called bahya roga marga.<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. Sutra Sthana 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 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.

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~~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~~.<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 ~~samprapti can travel to any roga marga during~~ the ~~process~~.

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== 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|koshtha]] and [[marma]] asthi 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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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]] observed in each roga marga ===

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[[Vyadhi|Diseases]] occurring in different rogamarga are tabulated as under:

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'''Table 1: Diseases in different roga marga'''

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{| class="wikitable" style="text-align:justify;"

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! Diseases occurring in bahya roga marga

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! Diseases occurring in madhyama roga marga

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! Diseases occurring in abhyantara roga marga

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! Diseases occurring in bahya and abhyantara roga marga

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|-

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

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|}

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== Anatomical aspects ==

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

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=== Bahya rogamarga (external pathway) ===

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This includes [[Sharira|body]] components like twak (skin), [[Rakta dhatu|rakta dhatu]] (blood), and other similar [[Sharira|body]] constituents. [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|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 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 [[Vyadhi|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|marma]] (vital organs) like heart, brain, kidneys, bones, joints, ligaments, tendons. [Cha.Sa.[[Sutra Sthana|Sutra Sthana]] 11/48]

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=== Madhyama rogamarga (medial pathway) ===

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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.

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=== Abhyantara rogamarga (internal pathway) ===

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The abhyantara roga marga is termed as [[koshtha]]. It includes the gastrointestinal tract and all visceral organs. While enumerating koshthangas [[Basti|basti]], [[Hridaya|hridaya]] and vrikka included in them. These will be included in abhyantara roga marga. 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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Koshthanga are mainly responsible for nutrition and excretion of [[Mala|mala]]. [[Hridaya|Hridaya]] is considered a koshthanga for; it is responsible for nutrition and excretion of blood impurities. Same is the case with vrikka and [[Basti|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 [[Vyadhi|diseases]] related to abhyantara roga marga, there may be indirect influence on the vahana [[Dravya|dravya]] of these organs. eg. rakta mutrata in pittaja [[Jwara|jwara]], hridaya ashuddhi in [[Ama|ama]] [[Jwara|jwara]], bahu mutrata in ajirna etc. Thus, being influenced by koshtha and their [[Vyadhi|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.

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== Physiological aspect of roga-marga ==

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

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'''Table 2: Peculiarities of roga marga'''

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{| class="wikitable"

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! Roga marga

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! Important physiological aspect

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! Other peculiarities

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|-

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| Abhyantara roga marga

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| It is the prime site of jatharagni and concerned with digestion, absorption and excretion,

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|

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* It has the mula sthana of the [[Dosha|dosha.]] [Su.Sa.Sutra Sthana 21/6]

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* The koshthanga are in the abhyantara rogamarga

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|-

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| Bahya roga marga

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| It is the site of dhatwagni, responsible for the [[dhatu]] nirmana

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|

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* 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.

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|-

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| Madhyam roga marga

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

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|

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

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* They are the main seats of [[prana]] according to [[ayurveda]]

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* They have large quantity of blood circulation.

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* These organs are interlinked with each other pathologically, as the pathology of one affects the other.

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|-

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|}

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== Pathological understanding of roga marga vs. [[Vyadhi|disease]] pathways ==

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In a normal [[Sharira|body]], as such, there will be no rogamarga for the [[Dosha|dosha]] to travel. The healthy [[Srotas|srotas]]/organs are rendered weak by the intake of nidana sevana and this renders the [[Srotas|srotas]] weak, which is termed as [[Kha vaigunya|khavaigunya]]. This results in directing the [[Samprapti|samprapti]] and spread of [[Vyadhi|disease]]. Such weak [[Srotas|srotas]]/ organs becomes rogamarga.

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Roga margas have crucial role to play in the [[Samprapti|samprapti]] of a [[Vyadhi|disease]]. The very definition of [[Samprapti|samprapti]] brings forth two things. One is that, the accumulated and spreading [[Dosha|dosha]] virtually reaches each and every part of the [[Sharira|body]] and the general channel of flow is rasayani. [ A.H. Nidana Sthana 1/23]

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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.

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== Role of roga-marga in various stages of [[Samprapti|samprapti]] ==

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<ul style='text-align:justify;'><li style="font-weight: bold;">Sub clinical or formative stages : Of the six stages, accumulaton (chaya), [[Prakopa|aggravation (prakopa)]], spread (prasara) are sub-clinical. The symptoms manifested in chaya stage are imprecise, depending on invoved [[Dosha|dosha]]. [[Prakopa|Prakopa]] avastha exhibits the symptomatology but not [[Vyadhi|disease]]. In the prasara avastha, when the spread of the morbid [[Dosha|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|dosha]], the involvement of roga marga maybe inferred from accumulation stage (chaya avastha) itself. </li>

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<li style="font-weight: bold;">Clinical stage : A list of [[Vyadhi|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.

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Roga marga is the site of [[Kha vaigunya|kha-vaigunya]] which later on cultivates for interaction of dosh and [[Dushya|dushya]]. [Su.Sa.[[Sutra Sthana]] 24/10] [[Kha vaigunya|Kha-vaigunya]] plays directive role for the pathology to spread in different [[Srotas|srotas]] (systems).

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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. </li>

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<li style="font-weight: bold;">In the vyakti avastha, the outcome of the interaction of [[Dosha|dosha]]-[[Dushya|dushya]] is revealed. According to respected Vaidya Shiva Charan Dhyani, in the book “Nidana Panchaka”, at this stage, (i) completion of [[Dosha|dosha]] [[Dushya|dushya]] sammurcchana (ii) Srotodusti and its features and (iii) [[Lakshana|lakshana]] sammuchaya of [[Vyadhi|diseases]], are manifested.<ref>Vaidya Shivacharana Dhyani.Nidana Panchaka. Chaukhambha Surabharati prakashana.Varanasi. 2022, 58.</ref> </li>

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Though the [[Dosha|dosha]] [[Dushya|dushya]] sammurcchana is initiated in the previous stage, its completion is achieved in vyakti avastha. The sroto dushti occurs at roga-marga

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<li style="font-weight: bold;">Complicated clinical (post clinical) stage : Bheda stage is considered as the advanced clinical stage. In this stage, the [[Vyadhi|disease (vyadhi)]] may become chronic or progressive and leads to other [[Vyadhi|diseases]]. In this phase, the [[Vyadhi|roga]] vriddhi takes place. Advancement of [[Vyadhi|disease]] ([[Vyadhi|roga]] vriddhi) takes place by different modes, which are listed briefly as follows: </li>

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<ol><li style="font-weight: bold;">In the same organ, sthanantara swarupa [[Vyadhi|roga]] vriddhi : In [[Skin diseases in Integrative Medicine|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>

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<li style="font-weight: bold;">Dhatugata swarupa [[Vyadhi|roga]] vriddhi : The transfer of [[Vyadhi|disease]] or [[Samprapti|samprapti]] from one [[Dhatu|dhatu]] to another is also the manifestation of [[Vyadhi|roga]] vriddhi ([[Dhatu|dhatu]] gatatva). Dhatugata vyadhi and dhatugata [[Vata dosha|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|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 Chikitsa|kushtha]] (the morbid [[Dosha|dosha]] causing skin [[Vyadhi|diseases]] penetrates into deeper tissues) [Su. Sa. [[Nidana Sthana|Nidana Sthana]] 5/20-27] </li>

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

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

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

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<li style="font-weight: bold;">Vyadhisankara swarupa [[Vyadhi|roga]] vriddhi : [[Vyadhi|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 Chikitsa|kasa]] (coryza and coughing together),. [Cha.Sa.[[Nidana Sthana|Nidana Sthana]] 8/22] </li>

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

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<li style="font-weight: bold;">[[Vyadhi|Roga]] vriddhi in same [[Srotas|srotas]] in a sequential order : [[Vyadhi|Roga]] initiates from sroto mula or a part of [[Srotas|srotas]] and spreads to whole [[Srotas|srotas]], if [[Nidana|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;">[[Vyadhi|Roga]] vriddhi 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|jwara]] in [[Amashaya|amashaya]] (In continuous [[Jwara|fever]], the morbid [[Dosha|doshas]] are in the stomach)

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* Anyedhyushka in [[Hridaya|hridaya]] (In intermittent [[Jwara|fever]], the morbid [[Dosha|doshas]] are in the heart / heart 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 [[Jwara|fever]] the morbid [[Dosha|doshas]] are in the joints) </li>

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

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== The inter-connectedness of the different [[Vyadhi|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|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|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|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|amavata]], [[Vatarakta Chikitsa|vatarakta]], etc. which are related with the joints coming under medial pathway, signs and symptoms of the malfunction of [[Hridaya|heart (hridaya)]] or bladder ([[Basti|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 Chikitsa|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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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|virechana]] is preferred. It is only through suitable [[Virechana|virechana]] [[Dravya|dravyas]], skin [[Vyadhi|diseases]] are treated successfully.

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

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== Rogamarga related to prognosis ==

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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|Chikitsa Sthana]] 30/327]

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== Rogamarga for precise treatment ==

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

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In the [[Vyadhi|diseases]] of external pathways, dhatwagnimandya will be prominent. [[Snehana (unction therapy)|Snehana]]-[[Swedana|swedana]] will be of use for bringing the [[Dosha|dosha]] from shakha to [[Koshtha|koshtha]] and removal through the nearby orifice. [[Virechana|Virechana]] and [[Raktamokshana|raktamokshana]] are one of the best [[Shodhana|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|prana]] and vyana vayu are found to be involved. [[Basti|Basti]] and [[Nasya|nasya]] maybe more beneficial. As the [[Vyadhi|diseases]] of madhyama roga marga are generally originated from colon (pakwashayottha) and due to obstructed vayu, [[Basti|basti]] maybe the first line of treatment. [[Basti|Basti]] is capable of preventing and overcoming the afflictions of [[Marma|marma]], asthi sandhi etc. [Cha. Sa. [[Siddhi Sthana|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|nasya]].

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Similarly, [[Shamana|shamana]] [[Aushadha|aushadha]] may also be categorized as acting specifically on a particular roga marga.

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== Roga marga : a special type of classification of [[Vyadhi|diseases]] ==

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Some of the expert ayurvedic physicians believe that the description of roga marga denotes special type of [[Vyadhi|disease]] classification. Such a classification is exceptional in comparison to systemic classification of [[Vyadhi|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 [[Vyadhi|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.

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== Contemporary approach ==

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The contemporary approach to understand the [[Sharira|body]] and the [[Samprapti|pathogenesis]] of any [[Vyadhi|disease]] is analytical. Whereas that of [[Ayurveda|ayurveda]] is holistic and comprehensive. With this basic difference, it maybe said that such a concept of ‘rogamarga’ is also unique in [[Ayurveda|Ayurveda]], where different set of [[Vyadhi|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.

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== Current researches ==

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=== Thesis ===

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<ul style='text-align:justify;'><li>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|shwasa]] and pravahika, based on the concept of rogamarga. It was found that the line of treatment for the [[Vyadhi|diseases]] occurring in a single rogamarga maybe similar and for the abhyantara rogamarga, the treatment maybe focused on jatharagni centered (correction of the digestion). </li></ul>

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=== Articles ===

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<ul style='text-align:justify;'><li>Vilas Kad, Tushar Auti. A review on trividha rogamarga & its role in manifestation of [[Vyadhi|disease]]. Ayurpharm Int J Ayur Alli Sci. 2015;4(2):29-34<ref name="ref12">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 </ref></li>

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<li>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 name="ref13"/></li>

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<li>Asharani Amitkumar Kore : Concept Of Dosha-Gati With Special Reference To Kshaya-Sthan-Vruddhi Gati; IAMJ: Volume 3; Issue 2; February- 2015<ref name="ref14">Asharani Amitkumar Kore Concept Of Dosha-Gati With Special Reference To Kshaya-Sthan-Vruddhi Gati IAMJ: Volume 3; Issue 2; Pages-628-6333 </ref></li>

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<li>Kore Asharani Amitkumar, Concept of Urdhav-Adho-Tiryak Gati of Dosha ; UJAHM 2015, 03 (05): Page 7-9;<ref name="ref15">Kore Ashrani , CONCEPT OF URDHAV-ADHO-TIRYAK GATI OF DOSHA, UJAHM 2015, 03 (05): Page 7-9 </ref></li>

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<li>Dr. Kulkarni. Pratibha et al., Rogamarga and Dosha Gati ; wjpmr, 2016,2(6), 97-99;<ref name="ref16">Kulkarni Pratibha et .al. Roga Marga and Dosha Gati , World Journal of Pharmaceutical and Medical Research , 2016,2(6), 97-99. </ref></li>

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<li>Pushpa Tuppad. Conceptual study of Rogamarga. J Ayurveda Integr Med Sci 2022;3:53-58;<ref name="ref17">Pushpa Tuppad, Conceptual study of Rogamarga. J Ayu Int Med Sci. 2022;7(3):53-58 Available From : https://jaims.in/jaims/article/view/1793 </ref></li>

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These studies have derived the important role played by roga marga in the [[Samprapti|pathogenesis]] of the [[Vyadhi|disease]], its prognosis and the line of management. The dosha gati in its vikrita avastha is through the roga marga. </ul>

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