The Role of Pañcamahābhūta in the Pathogenesis and Pathways of Disease: A Literary Review in Ayurveda Samhita

Abstract Background: Ayurveda emphasizes the concept of Pañcamahābhūta (five great elements) as the foundational principle of the human body, health, and disease. Disease progression and manifestation occur through defined channels known as Roga-mārga (pathways of disease), as described in Bruhatrayī¹. Understanding the interplay between Pañcamahābhūta, Doṣa, and Roga-mārga enhances diagnostic precision and therapeutic decision-making. Objective: This review explores the role of Pañcamahābhūta in determining disease manifestation and Roga-mārga, through a literary analysis of classical Ayurvedic texts supplemented with contemporary perspectives. Methods: Classical references from Caraka Saṃhitā, Suśruta Saṃhitā, and Aṣṭāṅga Hṛdaya were critically reviewed²⁻⁷. Contemporary commentaries and modern scientific correlations were also analyzed⁸⁻¹⁰. Results: Each Mahābhūta exerts dominance over particular Doṣa, influencing disease site, manifestation, and progression through specific Roga-mārga (Koṣṭha, Śākhā, Marmāsthi-sandhi)³. This mapping not only reflects Ayurvedic nosology but also supports holistic management strategies. Conclusion: The Pañcamahābhūta theory provides a unique framework to understand disease pathways in Ayurveda. Its application in clinical research and practice could refine personalized approaches to prevention and treatment. Keywords: Ayurveda, Sthaulya, Atisthūlya, Insulin resistance, Medoroga, Metabolic syndrome, Ashta Doṣa