# Roga-marga (the three pathways of disease) > Canonical version of this page: https://nighantu.ageayurveda.com/concept/roga-marga/ ## How much weight this concept bears Roga-marga is the best-anchored of the concepts in this cluster textually and the thinnest empirically. The classical footing is solid and now verified in three texts rather than one. Ca.Su.11/48 defines all three pathways; Ca.Su.11/49, a single aphorism, populates each with named diseases and names five of them twice, once as following shakha and once as following koshtha, which is the dual-pathway group; Ca.Su.28/31-33 supplies the doshagati mechanism by which doshas move outward from koshtha to shakha and back, with Chakrapani glossing the shakha of that chapter as the dhatus. Vagbhata states the same scheme independently at A.H.Su.12/44-49, defining shakha in Charaka's own words, agreeing with Charaka on koshtha, naming the madhyama rogamarga in the text, and splitting the dual-pathway diseases into outer-part and inner-part varieties instead of assigning them twice. Sushruta's koshtha at Su.Ci.2/12-13 is wider than either and includes the seat of blood along with the heart, unduka and lungs, which leaves the koshtha-shakha boundary genuinely unsettled rather than merely unclear, since rakta itself is assigned to shakha. What the texts do not contain, so far as this record could retrieve them, is the prognostic ranking the tradition is most often quoted for. Ca.Su.11/48-49 states membership and says nothing about difficulty of cure; A.H.Su.12/44-49 likewise. Ca.Ci.28/72-74 does attribute poor prognosis to depth of seat for a list of vata disorders that overlaps the madhyama list, but it never uses the word rogamarga and does not rank the pathways. The attributions of the ranking run to commentators, Chakrapani for the general claim that roga-marga serves prognosis and Gangadhara for the specific ruling that madhyama-marga disease is krichhra-sadhya or yapya, and neither commentary was retrieved in the original here, so neither is cited. The modern position is close to empty. A PubMed E-utilities search on 2026-10-06 returned zero records for 'rogamarga', for 'roga marga ayurveda' and for 'roga-marga'; every modern reference in this record that bears on roga-marga directly sits in non-indexed Indian Ayurveda journals, and the two PubMed-indexed references bear on the concept only by implication. That literature is dominated by narrative reviews that restate the three lists and then propose an analogy, most often to physiological compartmentalisation, without testing it. One cross-sectional study of 100 outpatients was found, and it reports a pathway distribution with an age gradient that it has no design to distinguish from ordinary epidemiology. No study was found in this search that measures whether two clinicians assign the same patient to the same pathway, whether pathway assignment predicts outcome or difficulty of cure, or whether the therapeutic rule derived from doshagati improves anything. The concept as it stands is a classical topographic taxonomy, attested in three samhitas and in continued teaching use, whose central prognostic claim is commentarial rather than textual and which has no published test of either its prognostic or its therapeutic claims. Roga-marga is Charaka's division of the body into three pathways along which disease settles. Shakha, the outer pathway, is rakta and the other dhatus together with the skin, and is called the bahya marga. Marma and asthi-sandhi, the vital points, Charaka's Sanskrit names basti (bladder), hridaya and murdha, together with the junctions of the bones and the snayu and kandara bound to them, form the madhyama or middle pathway. Koshtha, the great internal cavity, named in Ca.Su.11/48 as the mahasrotas, the middle of the body, the mahanimna and the amashaya and pakvashaya, is the abhyantara or internal pathway. Diseases are assigned to a pathway by where they manifest: goitre, pustules, skin disease and superficial growths to shakha; hemiplegia, convulsive disorders, facial palsy, wasting, bone and joint pain, prolapse of the rectum and diseases of head, heart and bladder to the middle pathway; fever, diarrhoea, vomiting, cholera, cough, dyspnoea, hiccup, abdominal disease and spleen disease to koshtha. Five conditions, visarpa, shvayathu, gulma, arsha and vidradhi, are named twice in the same aphorism, once as following shakha and once as following koshtha, which is the ubhaya-marga or dual-pathway group. The scheme is presented in the commentarial and teaching tradition as prognostic and therapeutic rather than merely descriptive, and the convention that the middle pathway is the hardest to cure is repeated across the modern reviews; this record was unable to locate that ranking in any verse of Charaka, Vagbhata or Sushruta that it could retrieve, and records it as commentarial convention rather than as text (see contested[3] and notKnown). Its mechanism rests on doshagati, the movement of doshas between koshtha and shakha, stated at Ca.Su.28/31-33. ## At a glance | Field | Value | | --- | --- | | Subject area | How disease is held to arise | | Domain, as recorded | Ayurvedic theory of health and disease, topography of pathogenesis | | Contested questions | 5 | | Stated as not known | 12 | | Classical citations | 9, 8 quoting the text | | Research papers assessed | 6 | | Citations checked | 2026-10-08 | ## What is contested, and by whom These are the questions on which the sources genuinely disagree. Each position is given as its source states it. No position is presented as the settled answer, because none of them is. ### What exactly does shakha cover? This is contested. - The dhatus plus skin, i.e. a tissue compartment. This is what Ca.Su.11/48 states, 'shakha raktadayo dhatavas tvak ca', and what Kaviratna's footnote spells out, and Vagbhata gives the identical definition at A.H.Su.12/44, 'shakha raktadayas tvak ca'. Two texts, same words. - The limbs and periphery, in the ordinary sense of the word 'branch'. This is how the term is often used loosely in clinical teaching. No source consulted here states it as the definition of the bahya rogamarga, and both texts that do define it define it the other way. - Whether the shakha of the doshagati passages at Ca.Su.28/31-33 is the same shakha as Ca.Su.11/48 is a real question, but it cannot be settled from the English. The Sanskrit uses the same word in both places, and Chakrapani on 28/31 glosses the destination as rasa and the rest, 'rasadinam shakharupatvat', which identifies it with the dhatus. On the evidence retrieved here the two uses agree. ### What is the extent of koshtha? This is contested. - The alimentary cavity. Ca.Su.11/48 gives mahasrotas, sharira-madhya, mahanimna, amashaya and pakvashaya. A.H.Su.12/46 gives 'antah koshtho mahasrota ama-pakvashayashrayah', which agrees. Kaviratna's footnote extends it to the bladder, the aorta, the lungs and the juices of liver and spleen, but that extension is his, not the verse's. - A wider internal territory. Su.Ci.2/12-13, now quoted at classical[7] from Bhishagratna, lists the seats of ama, agni, pakva, mutra and rudhira, plus the heart, the unduka and the lungs, as koshtha. Four of those eight are not in Charaka's or Vagbhata's definition. - The two definitions are not reconcilable at the boundary. Charaka assigns rakta to shakha and Sushruta assigns the reservoir of blood to koshtha, so on the combined reading the same tissue falls on both sides. Nothing retrieved here resolves which definition the roga-marga scheme is supposed to use, and the roga-marga scheme is Charaka's. ### How should the dual-pathway (ubhaya marga) diseases be understood? This is contested. - Membership is a property of the episode, not of the disease. Ca.Su.11/49 names visarpa, shvayathu, gulma, arsha and vidradhi twice inside one aphorism, as shakhanusarinah and again as koshthanusarinah, with no qualifier distinguishing two kinds of each. - They are separate outer and inner varieties of conditions that share a name. This is Vagbhata's reading and he states it in the text: A.H.Su.12/45 assigns the 'bahirbhaga', outer-part, varieties of durnama, gulma and shopha to shakha, and A.H.Su.12/47 assigns the 'antarbhaga', inner-part, varieties of shopha, arsha, gulma, visarpa and vidradhi to koshtha. - The category is a residue of a taxonomy that does not partition cleanly, which weakens the claim that pathway assignment is informative. - Charaka and Vagbhata therefore disagree about the same five diseases, and the disagreement is in the Sanskrit rather than in anyone's translation. Whether Vagbhata is interpreting Charaka or departing from him is not addressed by any source consulted here. ### Is the middle pathway really the hardest to cure? This is contested. - The standard teaching position, repeated across the modern reviews, is that madhyama-marga diseases are the most difficult, often phrased as krichhra-sadhya or yapya. - No verse stating it was located. This revision searched the three places the audit named. Ca.Su.11/48 and 11/49 were retrieved in full in the Sanskrit and quoted at classical[0], [2], [3] and [4]; they state membership and contain no prognostic term. A.H.Su.12/44-49 was retrieved in full in the Sanskrit and quoted at classical[6]; it contains no prognostic term either. Ca.Ci.28/72-74 was retrieved and is quoted at classical[8]; it does say that a list of vata disorders overlapping the madhyama list 'may or may not be cured even with effort' because of the depth of the seat, but it never uses the word rogamarga and does not rank the three pathways. - The claim's provenance is commentarial. The modern critical edition at carakasamhitaonline.com reports Chakrapani on Ca.Su.11/48 as giving the purpose of the roga-marga section as knowing prognosis, which is weaker than a ranking; the reviews attribute the ranking itself to Gangadhara. Chakrapani's commentary on Su.11 is not in the GRETIL Caraka excerpt, which covers only Sutrasthana 1-3, 5, 6 and 26-28, and Gangadhara's Jalpakalpataru was not retrievable here. Neither is quoted, so neither is cited. - Its status in this record is therefore: conventional, attributed to commentators, not located in any samhita verse retrieved, and not tested. The searches that justify the words 'not located' are the four named above and nothing wider. ### Does roga-marga correspond to any modern physiological division? This is contested. - Yes, to compartmentalisation, alimentary, intravascular, interstitial, intracellular (AYUSHDHARA 2023, modern[1]). - No: the three pathways group diseases by manifest site, not by any single physiological axis, and the dual-pathway group shows the taxonomy crossing whatever boundary is proposed. - Any such mapping has to choose a definition of koshtha first, and the texts do not agree on one. Charaka's and Vagbhata's koshtha is alimentary; Sushruta's includes the blood reservoir, the heart and the lungs, which would land in a different compartment on the proposed scheme. - The mapping has never been tested, so all of the above are currently assertions. ## What is not known Stated rather than left out. Where a negative has actually been searched for rather than assumed, the entry says so. - No samhita verse ranking the three pathways by difficulty of cure was located. This is the single most-repeated clinical claim about the concept, and the searches run for it were: the full Sanskrit of Ca.Su.11/48 and 11/49, the full Sanskrit of A.H.Su.12/44-49, and Ca.Ci.28/72-74. None contains a prognostic term applied to a rogamarga. The claim is attributed in the modern literature to Chakrapani and to Gangadhara. Chakrapani's commentary on Ca.Su.11 is not in the only machine-readable Caraka commentary text available here, and Gangadhara was not retrievable at all, so whether either commentator states the ranking in the form the reviews give is unverified. A wider search of printed commentary editions would settle it and has not been run. - Whether Ca.Ci.28/74's principle, that depth of seat makes cure uncertain, was intended as the same doctrine as the roga-marga ranking is not stated by any source consulted. The verse is about vata-vyadhi sites, the overlap with the madhyama list is partial, and treating the two as one claim would be the record's inference and not a source's. - Whether two clinicians independently assign the same patient to the same roga-marga has not been measured in anything found in this search. No inter-rater agreement data for this classification were located. - Whether pathway assignment predicts prognosis, difficulty of cure, or response to a given therapy is untested in anything found. The tradition's central prognostic claim has neither a located verse nor supporting data. - Whether the therapeutic rule derived from doshagati, bring shakha-lodged doshas back to koshtha before shodhana, improves outcomes over shodhana without that step has not been trialled in anything found in this search. - The criteria by which the single cross-sectional study assigned its 100 patients to pathways are not stated in it, so what that study measured is unclear. - How a disease that occupies both pathways should be managed differently from one confined to a single pathway is not specified by the sources consulted. Vagbhata's outer-part and inner-part distinction implies that the two varieties are treated as two diseases, but he does not say so and no source consulted draws the therapeutic consequence. - Whether Charaka's double assignment of the five dual-pathway diseases and Vagbhata's bahirbhaga/antarbhaga split are the same doctrine in different words or two different doctrines is not addressed by any source consulted. - Where the boundary between koshtha and shakha actually falls is not settled. Charaka and Vagbhata give an alimentary koshtha and assign rakta to shakha; Sushruta's koshtha at Su.Ci.2/12-13 includes the reservoir of blood as well as the heart, unduka and lungs. Nothing consulted says which definition the roga-marga scheme is to be read with. - No source found reconciles the roga-marga topography with the srotas enumeration. Both are territorial schemes over the same body, and how they relate, whether a channel belongs to a pathway, or crosses several, is not addressed. - The Sanskrit text and verse number of the Sushruta koshtha definition at classical[7] were not confirmed against a primary edition. The English is quoted from Bhishagratna directly, but Bhishagratna prints no verse numbers, and the address 12-13 and the Devanagari come from two secondary web sources. This is a known gap in that citation, recorded on the citation itself. - Whether the English translation of the Ashtanga Hridaya that the modern reviews quote is a lawful source for this project is not settled, because no public-domain English translation of the text was identified. The A.H. citations here are Sanskrit only for that reason. ## The terms this concept is built from | Term | What it names | | --- | --- | | Shakha (bahya rogamarga) | The external pathway. Charaka defines it as 'raktadayo dhatavas tvak ca', rakta and the other dhatus together with the skin (Ca.Su.11/48). Vagbhata gives the same definition in the same words, 'shakha raktadayas tvak ca', and calls it the bahya-rogayana (A.H.Su.12/44). The word literally means 'branch'; both texts use it for a tissue compartment, not for the limbs. | | Marma, asthi and sandhi (madhyama rogamarga) | The middle pathway. Charaka's Sanskrit names the marmas as 'basti-hridaya-murdhadini', bladder, heart, head and the like, and adds the junctions of the bones and the snayu and kandara bound to them (Ca.Su.11/48). Vagbhata lists 'shiro-hridaya-vasty-adi-marmani' with the joints of the bones and the sira, snayu and kandara attached to them, and names this the madhyama rogamarga (A.H.Su.12/47-48). Kaviratna's English renders basti as 'the arms' and murdha as 'the brain' in both places where they occur; the Sanskrit does not support either rendering and the gloss here follows the Sanskrit. | | Koshtha (abhyantara rogamarga) | The internal pathway. Charaka gives it as a set of synonyms: mahasrotas, sharira-madhya (the middle of the body), mahanimna, and the amashaya and pakvashaya (Ca.Su.11/48). Vagbhata agrees almost exactly: 'antah koshtho mahasrota ama-pakvashayashrayah' (A.H.Su.12/46). Sushruta's definition is wider and does not coincide with either; see contested[1]. | | Ubhaya marga | The dual-pathway group. Ca.Su.11/49 names visarpa, shvayathu, gulma, arsha and vidradhi twice within one aphorism: first as 'shakhanusarino bhavanti rogah' (diseases following shakha) and again as 'koshthanusarino bhavanti rogah' (diseases following koshtha). The compound 'ubhaya-marga' is not in the verse; it is the category name used by the commentarial and teaching tradition for the repetition. Vagbhata handles the same five differently, assigning their 'bahirbhaga' (outer-part) varieties to shakha and their 'antarbhaga' (inner-part) varieties to koshtha (A.H.Su.12/45, 47), which is a different doctrine about the same list. See contested[2]. | | [Doshagati](https://nighantu.ageayurveda.com/lexicon/dosha-gati/) | The movement of doshas between pathways. Ca.Su.28/31: from koshtha to shakha through exercise, the sharpness of internal heat, and neglect of what is beneficial, driven by the quickness of vayu. Ca.Su.28/32: once there they may lie dormant, not stirred, awaiting a further cause. Ca.Su.28/33: they leave shakha and return to koshtha by increase, liquefaction, digestion, clearing of the channel mouths, and the restraining of vayu. Chakrapani's Ayurvedadipika on 28/31 glosses the destination as rasa and the rest, 'rasadinam shakharupatvat', which identifies shakha here with the dhatus, the same sense as Ca.Su.11/48. | | Prognostic and therapeutic use | The tradition uses the pathway to grade difficulty of cure and to choose therapy. This record could not locate a samhita verse that ranks the three pathways by difficulty. The attribution runs through commentators: the modern critical edition at carakasamhitaonline.com reports Chakrapani on Ca.Su.11/48 as saying the purpose of describing roga-marga is to know prognosis, and the reviews attribute the specific ruling that madhyama-marga disease is krichhra-sadhya or yapya to Gangadhara. Neither commentary was retrieved in the original, so neither is quoted here. See contested[3] and notKnown. | ## The classical passages Each citation gives its address so a reader can check it in a printed edition, our account of what it establishes, and the result of reading it against its source. ### Charaka Samhita Sutra Sthana 11 (Tistraishaniya):48, checked against the source > त्रयो रोगमार्गा इति- शाखा, मर्मास्थिसन्धयः, कोष्ठश्च| तत्र शाखा रक्तादयो धातवस्त्वक् च, स बाह्यो रोगमार्गः; मर्माणि पुनर्बस्तिहृदयमूर्धादीनि, अस्थिसन्धयोऽस्थिसंयोगास्तत्रोपनिबद्धाश्च स्नायुकण्डराः, स मध्यमो रोगमार्गः; कोष्ठः पुनरुच्यते महास्रोतः शरीरमध्यं महानिम्नमामपक्वाशयश्चेति पर्यायशब्दैस्तन्त्रे, स रोगमार्ग आभ्यन्तरः||४८|| Sanskrit mūla > The seats of disease are three. They are (1) Cakha, (2) vital parts and bone-joints, and (3) Koshtha. Amongst these, Cakha includes blood and the like, the humours known by the name of Dhatu, and skin. These constitute the External seat of disease. The Vital parts, again, are the arms, the heart, the brain, and the like. The Bone-joints are the joints of the different bones, and the arteries and veins attached to them. These two (viz., the vital parts and bone-joints) constitute what is called the second seat (in our enumeration) of disease. Koshtha is otherwise called the great Stream within the body. The great cavity below, the cavity containing undigested food, the cavity where digestion takes place, and other words occurring together in medical treatises and expressive of the same part of the human frame, are also used for Koshtha. Koshtha is the Internal seat of disease. tr. Avinash Chandra Kaviratna The definition of all three pathways and the contents assigned to each, in the Sanskrit, with a public-domain English alongside it whose limits are recorded above. This is the locus classicus for the concept. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutra Sthana 11:Kaviratna's footnote to his aphorism 47, i.e. to Ca.Su.11/48, checked against the source > The word 'Marga' literally means path or way. In medical treatises, as applied to disease, it implies seat or the parts subject to disease. 'Cakha' literally means branch. As a techinacal word in medical science, it implies, as explained in the text, blood and the like, the humours and the skin. Of course, it includes flesh, marrow, fat, bones, and seminal fluid. tr. Avinash Chandra Kaviratna That Kaviratna read marga as seat or territory rather than as conduit, and read shakha in this context as a tissue compartment rather than the limbs. His extension of shakha to flesh, marrow, fat, bone and shukra goes beyond the verse, which says rakta and the other dhatus and the skin; the extension is his, and that is part of what this entry records. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutra Sthana 11:49, first of its three clauses, checked against the source > तत्र, गण्डपिडकालज्यपचीचर्मकीलाधिमांसमषककुष्ठव्यङ्गादयो विकारा बहिर्मार्गजाश्च विसर्पश्वयथुगुल्मार्शोविद्रध्यादयः शाखानुसारिणो भवन्ति रोगाः Sanskrit mūla > Bronchocele, ulcers, tubercles, indolent tumours, warts, tumours, fleshy excrescences, soft corns, leprosy, dark spots on the cheek, and other ailments of this kind, are diseases that appertain to External seats. Erysepelas, abscesses, tumours (in the stomach and the arms), piles, deep-seated abscesses, and similar other maladies are diseases that appertain to External seats. tr. Avinash Chandra Kaviratna The bahya-marga disease list, and immediately after it the five diseases said to follow shakha, visarpa, shvayathu, gulma, arsha, vidradhi. The same five are named again in the third clause of the same aphorism as following koshtha (classical[4]), and that repetition inside one aphorism, in the Sanskrit, is what constitutes the dual-pathway group. No reconstruction of the English is needed or used. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutra Sthana 11:49, second of its three clauses, checked against the source > पक्षवधग्रहापतानकार्दितशोषराजयक्ष्मास्थिसन्धिशूलगुदभ्रंशादयः शिरोहृद्बस्तिरोगादयश्च मध्यममार्गानुसारिणो भवन्ति रोगाः Sanskrit mūla > Hemiplegia, pains (in different limbs), spasmodic contractions, facial paralysis, pulmonary consumption, phthisis, pains in bones and bone-joints, prolapsus ani, and other diseases of the head, of the heart, and of the arms, all appertain to the Second seat. tr. Avinash Chandra Kaviratna The madhyama-marga disease list: pakshavadha, graha, apatanaka, ardita, shosha, rajayakshma, asthi-sandhi-shula, guda-bhramsha, and diseases of head, heart and bladder. The verse states membership only. It says nothing about prognosis, severity or difficulty of cure, and must not be cited for the ranking discussed in contested[3]. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutra Sthana 11:49, third of its three clauses, checked against the source > ज्वरातीसारच्छर्द्यलसकविसूचिकाकासश्वासहिक्कानाहोदरप्लीहादयोऽन्तर्मार्गजाश्च विसर्पश्वयथुगुल्मार्शोविद्रध्यादयः कोष्ठानुसारिणो भवन्ति रोगाः||४९|| Sanskrit mūla > Fever with diarrhcea, nausea, tympanitis, cholera and choleraic diarrhoea, asthma, consumption, hiccup, epistisis (suppression of urine), spleen, and other diseases of the stomach appertain to that which has been called the Internal seat. Besides these, erysipelas, intumescence, internal tumours, piles, all deep-seated abscesses, and other diseases of a similar kind, are said to appertain to the seat known by the name of Koshtka (as explained before). tr. Avinash Chandra Kaviratna The abhyantara-marga disease list, and in its second sentence the second naming of visarpa, shvayathu, gulma, arsha and vidradhi, this time as koshthanusarinah. Together with classical[2] this is the whole basis of the ubhaya-marga category: the same five diseases named under both pathways within one aphorism of the Sanskrit. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Charaka Samhita Sutra Sthana 28 (Vividhashitapitiya):31-33, checked against the source > vyāyāmād ūṣmaṇas taikṣṇyāddhitasyānavacāraṇāt / koṣṭhācchākhā malā yānti drutatvānmarutasya ca // 31 // tatrasthāśca vilambante kadācin na samīritāḥ / nādeśakāle kupyanti bhūyo hetupratīkṣiṇaḥ // 32 // vṛddhyā viṣyandanāt pākāt srotomukhaviśodhanāt / śākhā muktvā malāḥ koṣṭhaṃ yānti vāyośca nigrahāt // 33 // Sanskrit mūla > Through physical exercise, through the keeness of (internal) heat, through neglect of beneficial acts and practices, the Malas pass from the Koshtha to the ducts, impelled thereto by the speed (or force) of the wind. Arrived at the ducts they sometimes stay there, unimpelled by any other force. Unless the region and the time be undisposed thereto, they do not become excited, for they await some cause of excitement. In consequence of aggravation, of escape (through liquefaction, &c.), of digestion, and of the clearance of the mouth of the duct, the Malas, leaving the ducts, return to the Koshtha, the force of the (impelling) wind having been subdued. tr. Avinash Chandra Kaviratna The mechanism underpinning roga-marga: doshas move outward from koshtha to shakha under named conditions, may lie dormant there awaiting a further cause, and return inward when the named reversals occur. This is the classical basis for the therapeutic rule that shakha-lodged doshas should first be drawn back to koshtha. Chakrapani's gloss additionally ties the shakha of this chapter to the dhatus of Ca.Su.11/48. Source: https://archive.org/stream/BIUSante_47357/BIUSante_47357_djvu.txt ### Ashtanga Hridaya Sutra Sthana 12:44-49, checked against the source > kurvanti vividhān vyādhīn śākhā-koṣṭhāsthi-saṃdhiṣu | śākhā raktādayas tvak ca bāhya-rogāyanaṃ hi tat || 44 || tad-āśrayā maṣa-vyaṅga-gaṇḍālajy-arbudādayaḥ | bahir-bhāgāś ca dur-nāma-gulma-śophādayo gadāḥ || 45 || antaḥ koṣṭho mahā-srota āma-pakvāśayāśrayaḥ | tat-sthānāḥ chardy-atīsāra-kāsa-śvāsodara-jvarāḥ || 46 || antar-bhāgaṃ ca śophārśo-gulma-visarpa-vidradhi | śiro-hṛdaya-vasty-ādi-marmāṇy asthnāṃ ca saṃdhayaḥ || 47 || tan-nibaddhāḥ sirā-snāyu-kaṇḍarādyāś ca madhyamaḥ | roga-mārgaḥ sthitās tatra yakṣma-pakṣa-vadhārditāḥ || 48 || mūrdhādi-rogāḥ saṃdhy-asthi-trika-śūla-grahādayaḥ | Sanskrit mūla Vagbhata's independent statement of the same three-pathway scheme, which this record previously carried as an unverified paraphrase taken from a review. Four things it settles. (1) Shakha is defined in the same words as Charaka: 'shakha raktadayas tvak ca', and is called the bahya-rogayana (12/44). (2) Koshtha is 'antah koshtho mahasrota ama-pakvashayashrayah' (12/46), which agrees with Charaka's definition and not with Sushruta's wider one. (3) The madhyama rogamarga is named as such in the text, 'madhyamah rogamargah', and consists of the marmas, given as shiro-hridaya-vasti and the rest, the joints of the bones, and the sira, snayu and kandara bound to them (12/47-48). (4) Vagbhata handles the dual-pathway diseases by splitting them: the 'bahirbhaga' or outer-part varieties of durnama (arsha), gulma and shopha go to shakha (12/45), and the 'antarbhaga' or inner-part varieties of shopha, arsha, gulma, visarpa and vidradhi go to koshtha (12/47). That is a different doctrine from Charaka's, and it is the textual basis of position 2 in contested[2]. Nothing in 12/44-49 ranks the three pathways by difficulty of cure. Source: https://gretil.sub.uni-goettingen.de/gretil/corpustei/transformations/plaintext/sa_vAgbhaTa-aSTAGgahRdayasUtra.txt ### Sushruta Samhita Chikitsa Sthana 2 (Sadyovrana Chikitsita):12-13 **Quotation withheld:** nobody has yet read this quotation against its printed source, and an unchecked quotation is not published here. The passage is at https://archive.org/download/englishtranslati02susr/englishtranslati02susr_djvu.txt Sushruta's definition of koshtha, which is wider than Charaka's and than Vagbhata's. It includes the seat of blood, and also the heart, the unduka and the lungs, none of which are in Ca.Su.11/48. This entry was marked 'located' and unquoted at gathering, and it is load-bearing: contested[1] and notKnown both turn on it. The boundary problem is now sourced rather than asserted, since rakta is assigned to shakha by Ca.Su.11/48 and its reservoir to koshtha here. ### Charaka Samhita Chikitsa Sthana 28 (Vatavyadhi):72-74, checked against the source > सन्धिच्युतिर्हनुस्तम्भः कुञ्चनं कुब्जताऽर्दितः ||७२|| पक्षाघातोऽङ्गसंशोषः पङ्गुत्वं खुडवातता | स्तम्भनं चाढ्यवातश्च रोगा मज्जास्थिगाश्च ये ||७३|| एते स्थानस्य गाम्भीर्याद्यत्नात् सिध्यन्ति वा न वा | नवान् बलवतस्त्वेतान् साधयेन्निरुपद्रवान् ||७४|| Sanskrit mūla Added in response to the thin finding, which asked whether Ca.Ci.28 supports the claim that the middle pathway is hardest to cure. It does not support that claim, and this entry records what it does say instead. Charaka here lists sandhi-chyuti, hanu-stambha, kunchana, kubjata, ardita, pakshaghata, anga-samshosha, pangutva, khuda-vatata, stambhana, adhyavata and the vata disorders seated in majja and asthi, and says of them 'ete sthanasya gambhiryad yatnat sidhyanti va na va', these, by reason of the depth of the seat, may or may not be cured even with effort, and are to be treated when recent, in a strong patient, and free of complications. The principle is depth of seat, and the disease list overlaps Charaka's own madhyama-marga list at ardita, pakshaghata and the bone and joint conditions. It is adjacent evidence, not the verse the tradition cites: it is a statement about vata-vyadhi sites, it never uses the word rogamarga, it does not mention the three pathways, and it does not rank them. It is recorded here so that the claim in contested[3] can be seen to have a textual neighbour and still no text. Source: https://www.carakasamhitaonline.com/index.php?title=Vatavyadhi_Chikitsa ## What the research actually shows Every paper located for this concept, with what it measured and what it does and does not establish. The assessment is ours. ### Untitled 2026 · doi:10.46607/iamj0614012026 (https://doi.org/10.46607/iamj0614012026) A single-centre cross-sectional study of 100 OPD patients classified by roga-marga. Reports abhyantara 38%, madhyama 36%, with internal-pathway disorders (amlapitta, ajirna) concentrated in the 21-30 age band and middle-pathway bone and joint disorders in the 31-50 band. **How much it shows.** The only study found in this search that counts anything about roga-marga in patients, and it is weak: n=100, one outpatient department, no comparison group, no stated criteria for assigning a patient to a pathway, no inter-rater check, and publication in a non-indexed Ayurveda journal. The age gradient it reports is consistent with the ordinary age distribution of dyspepsia and of osteoarthritis, so the study provides no test that would discriminate between the roga-marga scheme carrying information and the gradient arising from background epidemiology alone. This record holds no comparison data for that OPD population and has run no analysis against one, so it does not assert that the gradient is explained by background epidemiology; it asserts only that the study cannot tell the two apart. ### Untitled 2023 · doi:10.47070/ayushdhara.v10isuppl1.1132 (https://doi.org/10.47070/ayushdhara.v10isuppl1.1132) Critical analysis of roga-marga that proposes the physiological notion of compartmentalisation (alimentary, intravascular, interstitial, intracellular) as a modern analogue of the three pathways. **How much it shows.** Narrative review. The compartment analogy is offered as an interpretation and is not tested against anything; no patient data, no measurement. It is a plausible-sounding mapping with no evidence behind it. ### Untitled 2023 · doi:10.21760/jaims.8.3.15 (https://doi.org/10.21760/jaims.8.3.15) Review arguing that roga-marga functions as a clinical and therapeutic indicator, i.e. that knowing the pathway should guide prognosis and choice of therapy. **How much it shows.** Narrative review in a non-indexed journal. Asserts clinical utility; presents no outcome data demonstrating it. This is also one of the reviews that attributes the prognostic ranking of the three pathways to the commentators rather than quoting a verse. ### Untitled 2022 · doi:10.31032/ijbpas/2022/11.7.6244 (https://doi.org/10.31032/ijbpas/2022/11.7.6244) Analysis of the roga-marga concept and its claimed clinical importance. **How much it shows.** Narrative review, non-indexed journal. Adds textual restatement, not evidence. ### Myth and reality of "theory-driven individualised practice" in Ayurveda: Mapping physicians' approaches using case-based scenarios. Indian J Med Ethics · 2024 · PMID 39183608 (https://pubmed.ncbi.nlm.nih.gov/39183608/) Case-vignette survey of 141 experienced practitioners found significant lack of consensus on clinical diagnosis and on the pathophysiology assigned to the same case, and that theoretical constructs did not uniformly determine treatment choice. **How much it shows.** Empirical and directly relevant, since pathway assignment is part of the samprapti reasoning surveyed. Limitations: convenience sample, emailed self-report, hypothetical cases, no formal agreement statistic. It does not measure roga-marga assignment as such, so it bears on the concept by implication rather than directly. Still the only study in this cluster that tests rather than restates. ### Understanding the etiopathogenesis and diagnosis of malignancy in the framework of Ayurveda: A review based on experience of working in an institute of oncology. Ayu · 2020 · PMID 34566386 (https://pubmed.ncbi.nlm.nih.gov/34566386/) Review drawing on examination of 400 cancer patients at an oncology institute, proposing that udara, gulma and vidradhi correspond to abdominal tumours with cancerous potential, and stating plainly that there is no common agreement among experts on the Ayurvedic pathogenesis of malignancy. **How much it shows.** Framed as a review based on clinical observation rather than a designed study: no protocol, no comparison group, no reported classification criteria, findings arrived at by expert judgement. Its value here is mainly the author's own admission of disagreement among experts, and the fact that two of the three conditions it names (gulma, vidradhi) are among the five dual-pathway conditions of Ca.Su.11/49. ## Citation Age Ayurveda Nighantu, "Roga-marga (the three pathways of disease)", https://nighantu.ageayurveda.com/concept/roga-marga/, CC BY 4.0. Whole concept set: https://nighantu.ageayurveda.com/concepts.json and https://nighantu.ageayurveda.com/concepts.csv. Educational reference only. This page describes what a body of theory claims and how well it is evidenced. Nothing here is advice, and nothing here describes how any condition should be treated.