Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

According to Ayurveda, there are three roga margas i.e. pathways in which a disease manifests. They are called Roga Margas. They are – Bahya Roga Marga – external pathway, Madhyama Roga Marga – intermediate pathway and Abhyantara Roga Marga – internal pathway.

In this article, we will try to understand ‘Bahya Roga Marga’.

Meaning of Bahya Roga Marga

–        Bahya = external

–        Roga = disease

–        Marga = pathway / tract

Bahya Roga Margas are those which form the external pathways for manifestation of diseases.

Ref – Ashtanga Hridaya Sutra Sthana, Chapter 12, Verses 44 ½ – 45 (A.Hr.Su.12/44b-45)

Bahya Roga Marga: The external pathway of diseases

शाखारक्तादयस्त्वक् च बाह्यरोगायनं हि तत्॥४४॥
तदाश्रया मषव्यङ्गगण्डालज्यर्बुदादयः।
बहिर्भागाश्च दुर्नामगुल्मशोफादयो गदाः॥४५॥

Bahya Roga Marga comprises Shakha. Therefore, these diseases are also called as ‘Sakhagata Rogas’ i.e. diseases manifesting in the Sakhas.

Sakha means branches. In medical terms we can consider it as ‘structures in the periphery’ or in the outer part of the body. In Ayurveda language, Sakhas are the dhatus i.e. tissues of the body. It is defined as ‘raktadayah twak cha’ i.e. blood and other tissues and skin comprise Sakhas. Here, twak or skin represents ‘rasa dhatu’. So, the sakhas are –

–        Twak – skin (represents rasa dhatu),

–        Rakta – blood

–        Mamsa – muscles

–        Meda – fat

–        Asthi – bones

–        Majja – bone marrow and

–        Shukra – semen / sperms

Are all dhatus present in the periphery or outer part of the body?

Technically no. But from Ayurveda perspective, all these tissues are present in the periphery i.e. outside the body which covers the internal organs. We get doubts about shukra dhatu in this context. But Ayurveda has mentioned ‘Sarva Shariragata Shukra’ which means the shukra present all through the body, which also makes it a component of sakha. Even among these dhatus, asthi i.e. bones are considered amongst the Madhyama roga marga. Here, only the end portions of the bones which contribute towards formation of bony joints should be considered as Madhyama roga marga. The rest of the bone counts in Sakha.

Another way of understanding is from the perspective of Abhyantara Roga Marga. This pathway of diseases comprises internal pathway and includes the kostha – visceral organs. The periphery of these pathways is also made up of or comprises one or the other tissues. Since the tissues appear to be branching out of the koshta or forming the outer boundary of the same, they are called as sakhas.

So, the bahya roga margas and sakhagata rogas are one and the same and describe the external pathway of diseases.

Shakha Gati

Here, we need to understand one more term i.e. Sakha Gati, which means movement of doshas into the sakhas. Gati is the movement of doshas. When the vitiated doshas move in bahya roga marga, they move into the sakhas i.e. tissues and affect them. This is the mechanism before the diseases are manifested in the sakhas or bahya roga marga. Thus, the doshas in sakha gati, move in the external pathways i.e. twak, rakta and other tissues and cause diseases in that pathway.

Bahya Roga Margagata / Sakhagata Rogas

The diseases occurring in the bahya roga marga or Sakha are called as ‘Bahya Roga Margagata Roga’ or ‘Sakhagata Roga’.

These are the diseases which occur in the tissues making up the Sakhas or Bahya Roga Marga i.e. from twak to shukra dhatu. In a way, they are the diseases manifesting in and expressed through one or the other tissues.

Some examples for diseases manifesting in bahya roga marga or sakha are –

–        Masa – elevated mole

–        Vyanga – melasma

–        Ganda – goiter

–        Alaji – skin disease, boils

–        Arbuda – tumor

–        Durnama – piles / hemorrhoids

–        Gulma – abdominal tumors

–        Sopha – swelling etc.

Other diseases can be considered tissue-wise in this context

–        Twak – Kustha – skin diseases etc.

–        Rakta – blood – diseases of blood, anemia etc.

–        Mamsa – muscles – Galaganda – goiter, Gandamala – lymphadenitis, Arsha – piles etc.

–        Meda – fat – medoroga – obesity, diseases caused due to disturbance in fat metabolism, prameha – diabetes etc.

–        Asthi – bones – bone disorders

–        Majja – bone marrow – bone marrow disorders

–        Shukra – semen, sperms, reproductive tissue – impotence, premature ejaculation etc.

Other diseases –

–        Pidaka – eruptions, boils

–        Charmakila – warts

–        Adhimamsa – muscular sprouts or over-growth

–        Mashaka – gum swelling od disorder

–        Visarpa – external types of herpes

–        Vidradhi – abscess

Important points to remember about Bahya Roga Marga

Most of the structures of Bahya Roga Marga i.e. Sakha, make up the exterior of the body, though they may also be present inside the body. The superficial tissues can be considered as sakha and the internal tissues as part of koshta or marma.

Seeing the diseases mentioned in the context of bahya roga marga, it is clear that most of them occur on the surface of the body, superficial tissues, can be seen, felt and addressed with external therapies and measures.

Shakhas or tissues making the bahya roga marga are prone to external injuries.

Diseases occurring in the sakha or bahya roga marga are easy to diagnose since they are visible.

Diseases of bahy roga marga carry a good and favorable prognosis, if identified and addressed at the quickest and hence easy to treat.

Bahya Roga Marga is the seat of Dhatu Agni. This is responsible for formation of dhatus. This fire is influenced by the fire in the belly, the central-core jatharagni or kayagni. The diseases of kayagni can be reflected through hypo or hyper functioning of these dhatu agnis which lead to increase or decrease of the tissues and their functioning respectively.

Structures related to the tissues making the bahya roga marga i.e. hairs, nails, etc. and the diseases occurring therein (appendages of the body) can also be considered as related to bahya roga marga.

Excessive production of dhatu malas too shall be considered as pathological manifestations of these pathways i.e. bahya roga marga.

Dhatu agni mandya i.e. hypo-functioning of the tissue fire, is an important pathological event in diseases of bahya roga marga. Snehana – oleation and Swedana – sudation will be the best treatments which can be done in these diseases. These measures will help in digesting the ama in the tissues, kindle the dhatu agni, remove the tissue blocks and enable the movement of morbid doshas which had been localized in the tissues towards the kostha. From there, the doshas can be expelled through vamana or virechana. As far as shodhana is concerned, vamana, virechana and raktamokshana are the best treatments for diseases of bahya roga marga. Vasti will be the best therapy for diseases localized in asthi, majja and shukra dhatus. Ksharakarma and Agnikarma are also ideal treatments for sakhagata rogas and can be skillfully chosen as and when required.