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AN OPEN EXPLANATORY CLINICAL TRIAL WITH A PRE-TEST AND POSTTEST DESIGN EVALUATING THE COMBINED THERAPEUTIC EFFECT OF SHASHILEKHA VATI AND GOMUTRA GHAN VATI IN SHWITRA

Dr. BHAVIN KATHIRIYA Final Year, PG SCHOLAR Dept. of PG Studies in KAYA CHIKITSA

UNDER THE GUIDANCE OF Dr. SHRIDHARA HOLLA, M.D. (AYU)

Professor
DEPT. OF PG. STUDIES IN KAYACHIKITSA, S.D.M. COLLEGE OF AYURVEDA, UDUPI

UNDER THE CO-GUIDANCE OF Dr. G. SHRINIVASA ACHARYA, M.D.(Ayu), PROFESSOR AND H.O.D. DEPT. OF PG. STUDIES IN KAYACHIKITSA, S.D.M. COLLEGE OF AYURVEDA, UDUPI

INTRODUCTION
Skin - best revelation of general health, Amateur eye - any change in the skin, Colour and texture - personality at physical and psychological level. Organ of expression, Boundary B/w ourselves and the outer world. Shwitra - contoured by colour variation, dark skin people. Major cosmetic problem - subscript complex . Society - scornful opinion Feel marooned, gloomy psychologically - social stigma. Idiopathic hypopigmentation Vitiligo (1% of worlds population)

Methodology
Aims and Objectives of the Study:
To study nidana panchaka of Shwitra according to Ayurvedic texts in detail. To critical analyse literature for the different clinical aspects of Shwitra and study Vitiligo in Modern medicine in detail. To assess the role of Shashilekha vati along with Gomutra Ghana vati internally.

Source of data: 20 patients diagnosed as Shwitra were taken for the study, from the OPD & IPD of S.D.M. Ayurveda Hospital, Udupi. Drugs required for the study were Prepared in S.D.M. Pharmacy, Udupi Design of Study: It was an open explanatory clinical study with pre-test and post-test design.

Diagnostic Criteria:

Must have Pratyatma Lakshana of Shwitra i.e. visible depigmented lesion.


Inclusion Criteria: Patients fulfilling the criteria of diagnosis irrespective of sex or creed.

Patients between the ages of 16 to 70 years.


Exclusion Criteria:
Chronicity more than 10 years. Spread more than 50 % of the body involvement. Patient with any other systemic illness like diabetes mellitus, IHD etc.

ASSESSMENT CRITERIA
A) Subjective parameters:
Sympotms of Switra as well as Vitiligo explained in ayurvedic and modern texts respectively were the subjective parameters such as: 1) Twak shwethata whitish discolouration with complete dipigmented skin
Grade 0 normal normal skin colour Grade 1 mild less pigmentation and more pigmentation over a lesion Grade 2 - moderate depigmentation more than pigmentation or equal over lesion Grade 3 severe no pigmentation totally white colour over lesion

2) Arun varnata :
Grade 0 normal normal skin colour Grade 1 mild less aruna varnata and more pigmentation Grade 2 - moderate more aruna varnata than normal colour or equal over lesion Grade 3 severe totally aruna varna over the lesion

3) Tamra varnata :
Grade 0 normal normal skin colour Grade 1 mild less tamra varna and more pigmentation Grade 2 - moderate more tamra than normal colour or equal over lesion Grade 3 severe totally tamra varnata over the lesion

4) Twak rukshta :
Grade 0 normal no dryness Grade 1 mild dryness on exposure to cold and sunlight and other allergents Grade 2 - moderate dryness during exposure to cold environnment Grade 3 severe always dryness

5)

Daha :
Grade 0 normal no burning sensation Grade 1 mild burning sensation on expose to mid noon sunlight Grade 2 - moderate burning sensation morning sunlight exposure and other iritants Grade 3 severe always burning sensation

6)

Roma vivarnata :
Grade 0 normal normal hair colour Grade 1 mild less than 25% of hair over the lesion has vivarnata Grade 2 - moderate 25% - 75% of hair over the lesion has vivranata Grade 3 severe more than 75% of hair over the lesion has vivarnata

7)

Kandu :
Grade 0 normal no itching Grade 1 mild itching on exposure to cold and sunlight and other allergants Grade 2 - moderate itching on exposure to mild cold environment Grade 3 severe always itching

Vida score (Vitiligo disease activity score) : The Vitiligo Disease Activity (VIDA) Score is a 6-point scale for assessing Vitiligo activity. It helps in assessing effectiveness of interventions to halt and reverse the extention of depigmentation. Scoring: Based on the individual's own opinion of the present disease activity over time. Active Vitiligo involves either one of the following aspects: (1) Expansion of existing lesions or (2) Appearance of new lesions.
Vitiligo Activity Active Active Active Time Period 6 weeks or less 6 weeks to 3 months 3 - 6 months VIDA Score +4 +3 +2

Active
Stable Stable with spontaneous repigmentation

6 - 12 months
1 year or more 1 year or more

+1
0 -1

Assessment of the involved body surface area by the Rule of Nine was used with categorically looking to the nature of the disease followed with further specified to the organs.
Involved body part Head and neck Scalp Face Neck Thorax Dorsal Ventral Abdomen Trunk Percentage 2.0 5.0 2.0 9.0 9.0 9.0 18 18 Subtotal Total 9

Back
One Upper limbs Finger to elbow Dorsal Ventral

9.0
18 R 2.25 2.25 4.5 L 4.5 18

Elbow to shoulder
Dorsal Ventral One lower limb Finger to knee Dorsal Ventral Knee to leg 4.5 4.5 R L 9 9 2.25 2.25 R L 36 4.5 4.5

B) OBJECTIVE PARAMETERS: Special scoring pattern was adopted for scrutinizing the symptomatology. The score was given on the basis of size, color, number and percentage of area involvement.

1)

Percentage of Body region involvement:


Total % of area involved Score

3) Colour change in the observed Shvitra patches:


Color Normal Red Pinkish Redish white White Score 0 1 2 3 4

0 Less than 2 % 2-5% 5-20% 20-50%

0 1 2 3 4

4) Size of the observed Shvitra patch :


Size 0 cm Less than 2 cm 2 to 5 cm 5 to 10 cm More than 10 cm Score 0 1 2 3 4

2)

Number of patches:
Number of patches Score

0 1 to 3 4 to 6 7 to 10
More than 10 or Descrete lesion

0 1 2 3 4

5) Number of black spots in observed Shvitra patch :


Number of black spots If no black spots appear If less than three spots appear If three or more spots appear Score 2 1 0

INTERVENTION
Following oral medications are given for 56 days .

Shashilekha vati - 125 mg. tid (B.F.)


Along with Anupan- Bakuchi Taila 1 Karsha(12 ml) + Madhu

Gomutra ghan vati 1 gm tid (B.F.)


Duration of the Study: 28 days of medication followed by another 28 days of follow up with same medication.

ANALYTICAL STUDY
Analytical Study of Shashilekha vati :
For routine analysis and standardization of Shashilekha vati,

HPTLC finger print profile of Shashilekha vati has been obtained in comparison with Bakuchi in a suitable solvent system. When the plate viewed under 254 nm HPTLC finger prints of Bakuchi and Shahilekha vati showed 13 and 6 spots respectively. The Rf values of four spots (0.51, 0.69, 0.75, 0.82- all Green) of Shahilekha vati is comparable with that of Bakuchi. , Thus presence of Bakuchi in Shashilekha vati has been established by HPTLC fingerprinting.

Gas Chromatography Mass Spectrometry profile of Shashilekha vati has been obtained for amenable steroids or anti-nutritional value as per the library of the instruments. This analysis did not reveal presence of any of the pesticides as well as steroids.

Figure 1. TLC photo documentation of alcohol extract of Shashilekha vati 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

At 254 nm

At 366 nm

Under white light

Post derivatisation

Track 1- Bacuchi 5 l Track 2- Shashilekha vati 5l Track 3- Bacuchi 10 l Track 4- Shashilekha vati 10 l

Solvent system- Toluene: Ethyl acetate (7:3)

GS-MS of SLV

Analytical Study of Gomutra Ghana Vati: For routine analysis and standardization of Gomutra Ghana Vati, Microbial load analysis of Gomutra Ghana vati was carried out as Gomutra is used as main ingredient which had ruled out contamination. HPTLC finger print profile of Gomutra Ghana Vati (GGV) was done for comparing the sample to its ingredients viz. chitraka (C), Marica (M) and Shunthi (S). HPTLC of Photodocumentation revealed spots of the same Rf and color as that of ingredients in GGV. When chromatograms were obtained under UV 254 and 366 nm at equal concentration of ingredients and triple the concentration of GGV, the chromatogram of GGV was superimposable with each ingredient. Gas Chromatography Mass Spectrometry profile of Gomutra ghana Vati has been obtained for amenable pesticides as keeping eagle eye on Gomutra may contain pesticides as Cow usually eats farm crops which may be sprinkled with pesticides. This analysis did not reveal presence of any of the pesticides as well as steroids.

Figure 1. TLC PHOTODOCUMENTATION OF ALCOHOLIC EXTRACT OF GOMUTRAGHANA VATI AND ITS INGREDIENTS
1 2 3 4 1 2 3 4 1 2 3 4

At UV 254 nm

At UV 366 nm

Post derivatisation

Track 1 - Chitraka 10 l Track 2 - Maricha 10 l Track 3 - Sunthi10 l Track 4 - Gomutraghana vati 30 lSolvent system - Toluene : Ethyl acetate (9: 2)

GS-MS of GGV

OBSERVATION
AGE
16-20 21-30 31-40
5%

GENDER 51-60 61-70


MALE FEMALE

41-50
20%

15%

30% 15%

20%
25%

70%

RELIGION
HINDU 5% MUSLIM 10% CHRISTIAN PRIMARY

EDUCATION
HIGHER SECONDARY GRADUATE

5%

20%

85%

75%

HABITATE
URBAN RURAL
STUDENT

OCCUPATION
HOUSEWIFE EMPLOEE BUSINESS MAN

25% 30% 75%

15%

25%

30%

SOCIOECONOMIC STATUS
LOWER CLASS UPPER MIDDLE 20% LOWER MIDDLE UPPER CLASS 0% 5% MIDDLE

MARITAL STATUS
UNMARRIED 0% MARRIED

5%

45% 55% 70%

AHARA
VEGETARIAN MIXED

VYASANA
SMOKING ALCOHOL NONE

15% 40% 50% 50%

45%

PRAKRUTI
VATA
VATA PITTA

SAMHANANA
KAPHA
KAPHA VATA 10% 20% AVARA MADHYAMA PRAVARA 0%

PITTA
PITTA KAPHA 0% 0% 40% 5%

35%

90%

SATVA
PRAVARA MADHYAMA AVARA

SATMYA
MADHYAMA AVARA

10% 40%

25%

50%

75%

AHARA ABHYAVARANA AND JARANA SHAKTI


PRAVARA MADHYAMA AVARA 12
10 10% 35% 55%

Nidana of Shwitra identified

No. of Patients 6
4 2 0 AHARAJA VIHARAJAMANASIKA

Occurrence of symptoms of Shwitra


Symptamatalogy Twak Shwethata(TSw) Arun Varnata(AVr) Tamra Varnata(TVr) Twak Rukshta(TRuk) Daha(D) Roma Vivarnata(RVi) Kandu(K)
12 10

Manobhava identified in subject


Manobhava No. of Patients Chinta (C) 9 45% %

No. of Patients 12

% of Patients 60%

1 7

5% 35%

Bhaya (B) 12 60% Shoka (S) 2 3 10% 15% Krodha (K)

30%

40%

15%

15%
10 8

No. of Patients 6
4 2 0 TSw Avr TVr Truk D Rvi K

No. of Patients6
4 2

0 C B S K

incidence of Number of patches Shwitra


10 8

Incidence of Colour of patches Shwitra


10 8

No. of 6 Patients
4 2 0 1 -5 6 - 10 Above 10

No. of 6 Patients
4

2
0 Complete whiteDull white Reddish

Measurement of patches wise distribution (Sq cm)


14 12

Chronicity wise distribution


7

10

6
5

No. of 8 Patients 6
4

No. of 4 Patients 3
2 1 0-10 11 - 20 21 - 30 31 - 40 41 - 50 0 6 months 1 year 2 year 3 year 4 year 5 year 6 year

2
0

Affected side wise distribution of Subject


12

10

No. of Patients

VIDA SCORE wise distribution


VIDA SCORE No. of Patients +4 (Active: 6 weeks or less) +3(Active:6weeks to 3 months) +2 (Active:3 6 months ) +1 ( Active:6 12 months ) 9 4 45% 20% 2 10%
9 8 7 6

10%

No. of 5 Patients
4 3

0 (Stable: 1 year or more )

15%

2 1

-1 (Stable with spontaneous repigmentation)

0%

0 4 3 2 1 0 -1

RESULTS
Effect on Twaka Shwethata
Mean Twaka Shwethata BT (SE) 2.300 (0.2065) AT (SE) 0.6500 (0.1500) Difference in Means % Paired t Test S.D. 1.650 71.74% 0.8127 0.182 =9.079 P=<0.0001 S.E.M t P

3 2.5 2 1.5 1 0.5 0 Twaka Shwethata

BT
AT56

Effect on Aruna Varnata


Mean Arun varnata BT (SE) 0.200 (0.156) AT (SE) 0.0500 (0.0500) 0.150 75 % 0.489 0.109 =1.371 P=0.186 Difference in Means S.D. S.E.M t P % Paired t Test

0.25 0.2 0.15 BT 0.1 0.05 0 Aruna Varnata AT56

Effect on Tamra Varnata


Mean Tamra varnata Differenc e in Means
BT (SE) 0.8500 AT (SE) 0.25000 0.6000 70.58% 0.7539 0.169 =3.559 P=<0.002 1 S.D. S.E.M t P

Paired t Test

(0.2325) (0.1230)

0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Tamra Varnata

BT
AT56

Effect on Twak Rukshta


Mean Twaka Rukshta
BT (SE) 1.300 (0.2417) AT (SE) 0.2000 (0.09177) 1.100 84.62% 0.9119 0.204 =5.395 P=<0.0001

Difference in Means

Paired t Test
t

S.D.

S.E.M

1.4 1.2

1
0.8 0.6 0.4 0.2 0 Twaka Rukshta BT AT56

Effect on Daha
Mean Daha
BT (SE) 0.3000 (0.1638) AT (SE) 0.05000 (0.05000)
0.35 0.3 0.25 0.2 BT 0.15 0.1 0.05 0 Daha AT56

Difference in Means

Paired t Test
t

S.D. 0.2500 83.33% 0.6387

S.E.M

0.143

=1.751

P=0.0961

Effect on Roma Vivarnata


Mean Roma vivarnata Difference in Means % Paired t Test BT (SE) 0.4000 (0.1974) AT (SE) 0.3000 (0.1638) 0.1000 25% 0.3078 0.0688 =1.453 P=0.1625 S.D. S.E.M t P

1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Roma Vivarnata BT AT56

Effect on Kandu
Mean Kandu BT (SE) 0.300 (0.179) AT (SE) 0.150 (0.109) 0.150 50% 0.489 0.109 =1.371 P=0.186 Difference in Means S.D. S.E.M t P % Paired t Test

0.35 0.3 0.25 0.2 BT 0.15 0.1 0.05 0 Kandu AT56

Effect on percentage of body involvement


Mean % of body involvement BT (SE) 2.250 (0.228) AT (SE) 1.250 (0.280)
2.5 2 1.5 BT 1 0.5 0 % of body area involved AT56

Difference in Means

Paired t Test

S.D. 1.000 44.44% 0.725

S.E.M

0.162

=6.164

P=<0.001

Effect on Number of shwitra patches


Mean Number of patches BT (SE) 2.450 (0.256) AT (SE) 1.400 (0.343) 1.050 42.85% 0.759 0.170 =6.185 P=<0.001 Difference in Means S.D. S.E.M t P % Paired t Test

3.5 3 2.5 2 1.5 1 0.5 0 Number of patches BT AT56

Effect on colour of patches


Mean colour of patches BT (SE) 3.200 (0.186) AT (SE) 0.850 (0.221) 2.350 73.43% 0.933 0.209 =11.261 P=<0.001 Difference in Means S.D. S.E.M t P % Paired t Test

4 3.5 3 2.5

2
1.5 1 0.5 0 Colour of patches

BT AT56

Effect on size of patches


Mean size of patches BT (SE) 3.300 (0.164) AT (SE) 1.600 (0.373)
4.5 4 3.5 3 2.5 2 1.5 1 BT AT56

Difference in Means

Paired t Test t

S.D. 1.700 73.43% 1.261

S.E.M

0.282

=6.030

P=<0.001

0.5
0 Size of the patches

Effect on Black spots over shwitra patches


Mean Black spots over patches BT (SE) 1.950 (0.0500) AT (SE) 0.300 (0.105) 1.650 84.61% 0.489 0.109 =6.030 P=<0.001 Differenc e in Means S.D. S.E.M t P % Paired t Test

3 2.5 2 1.5 1 0.5 0 Black spots over shwitra patches -0.5

BT
AT56

DISCUSSION
During pigmentation process, two types of improvement was seen. In 1st type repigmentation started at the margins of the patches which showed delayed reduction of size. After 56 days

2nd type repigmentation started in the middle of the patches in form of black spots and those repigmented patches joined together resulting in configured the normal skin colour by aggregation. The pigmentation process was faster in case of small patches. After 28 days

Shashilekha vati is a Herbomineral preparation; contains Shuddha Parada,Shuddha Gandhak, Tamra Bhashma and Bakuchi ;elitly indicated in Shwitra as well as Kushtha.

Gomutra is claimed to be an omniscient effective medication in the cure of the shwitra particularly Gomutrasava ; contains Chitrak, Shunthi, Marich, Pippali, Gomutra.Palatability was the main drawback against acceptance of Gomutrasava so in the present study with the Ghanakriya it was converted into Gomutra Ghana vati to rescue the issues related to adaptation of Gomutrasava.

During the course of the study, Redness of the patches without any sphota was observed that after giving treatment for 28days (1st visit), In few patients blister developed due to Pitta Prakopa particularly who had underwent shodhana in past. After rupturing, there was improvement. Some patients developed local or generalized itching and it was observed that these patients had a faster rate of improvement

1st visit

Aruna and Shyava coloration of the lesion accounts for the vitiation of Vata Dosha in the skin. It is decreased by 75 % in subject; This change is considered due to more pigmentation after healing of ruptured blister.

Before treatment

After treatment

Shweta coloration or Depigmentation of the lesion is due to the morbid kapha Dosha .it is rectified by 71.74 %.Bakuchi and Tamra are known for its effect in rectifying the Swetata of the skin. Reddish coloration is due to the morbidity of Pitta Dosha. This was rectified by 70.58 % in the subject. By its Prabhava Bakuchi is Shwitragna, kushtaghna and Krimighna and pitta vardhaka and corrects the Bhrajaka pitta to perform its function for relieving the Tamra varnata of the skin.

Before treatment

After treatment

Tamra, the fourth layer of the Twak, wherein a copper containing enzyme known as Tyrocinase which is solely responsible for the synthesis of melanin pigments by the melanocytes in the presence of sun light. Copper and furocoumarins such as Psoralens which are essential ingredient present in Bakuchi seed, acts on photo active stimulation of melanocytes, and induce their proliferation. Hitherto , Shwitra is a chronic lingering disease, the Shashilekha vati and Gomutra Ghana vati is tried only for 56 days showed marked response. From this discussion it can be confidently said that, Shashilekha Vati and Gomutra Ghana vati is very effective in the treatment of Shwitra Roga, and for better results the pre-treatment with Shodhana and longer duration of Shamana with combination of Shashilekha vati and Gomutra Ghana vati secures best results.

CONCLUSION
Shwitra identical to Kushta in general, is caused due to the morbidity of the three dosha involving Tvak, Rakta, Mamsa and Meda. Shashilekha vati and Gomutra Ghana vati is effective in reducing the severity of symptoms of Shwitra. Marked reduction in the mean score of outcome measures was identified such as Twaka Shwetata, Aruna Varnata, Tamra Varnata, Rukshta, Kandu, Daha, Roma Vivarnata, extent of body region affected, number, size, colour, and appearance of black spot on shwitra patches; all are recorded and are mostly statistically highly significant. Shashi lekha vati and Gomutra Ghana vati effectively said to be reduces the activity of Shwitra. Activity of Shwitra is assessed by VIDA score and is more reliable if done after a period of one year With few incidences of blister formation on application of Bakuchi Taila, the medication is safe with no any untoward symptoms

PARTANTRA AVALOKAN

Go-Hatya

(Root cause)
H.ni.3 (10-12 AD)

Nidana Parivarjana

? 21st century ? India is Ranked 1st in Beef exporting

Akhand Bharat

Towards the end of civilization ?


India Vs Pak bitter enemy Modern India 1 $ = 65 INR Riots everywhere

Ancient India Gold as currency ( Golden Sparow) Hindu and Muslim communities which had coexisted peacefully for the last 700 years River inform of milk Great civilization - Hadappa

Fighting for water Worlds largest slum in mumbai

handlooms and textiles Exporting cotton


Largest Spices and herbal spices due to 16 biodiversity zone

Ranked 1st Beef export (3,600 slaughterhouses legally) over 30,000 illegal
40000 suicides by farmers every year, failing agriculture and highest number of malnourished children in the world

SWARNIM BHARAT (2 CENTURY AGO)


Cow was the foundation of this great nation

Master plan to destabilize India

First ever slaughter house in Indian in 1760 was initiated

1740, in the Arcot District of Tamil Nadu, 54 Quintals of rice was harvested from one acre of land using manure and pesticides made from cow urine and cow dung

Governor of British India, Robert Clive madean

February 2nd , 1755.I have traveled across the length and breath of India and I have not seen one person who is a beggar, who is a thief, such wealth I have seen in this country, such high moral values, people of such caliber (of noble character), that I do not think we would ever conquer this country..unless we break the very backbone of this nation which is her spiritual and cultural heritage.

Global

Western economic models roots colonization with exploitation of colonies resources globalization of everything and anything debt-based credit rating IMF Fragile The Run away global Military Budgets- $1.62 trillion in 2010

China - 47 million barrels of oil per day global oil demand 82 million Indias oil import bill$101.7 billion 2010 Indias oil bill priority

China -98 million barrels of oil per day global oil demand 120 million (DoE) India - ? 2030

over health care,education and agriculture. over 100 farmers committing suicide /day With instable global prices India today stands at the cross roads, without a clue !!

Cow based ( Pancha gavya ) Economy as per veda which we Left Behind
Milk,Curd,Ghee : India ranks as the world's largest milk producer during 2010-11 with an annual output of 116.2 million tonnes. It accounts for 16% approx. of the world total output. White revolution by Dr vergesew Kurien Cowdung : Liaoning Huishan Cow Farm in China - worlds largest waste-to-energy biogas project 250,000 cows 38000 MWh annually through four GE Jenbacher gas engines India Livestock population of 250 million - 125 million tonnes of cowdung one cows cowdung/year to produce methane gas = 225 litres of petrol in energy terms (gobar gas research station in Uttar Pradesh)

LPG and kerosen for 100 crore population = methane gascylinders, from the cowdung of 75 million cows. Petrol need =40 million cows. 85 million cows to meet the electrical energy

Gomutra : appreciable growth in revenue approx 5,000 cr as organic fertiliser as well as Medicine ( Domestic Market ). Requires Revolution ????????? ; by AYURVEDA Since inception

BIBLIOGRAPHIC REFERENCES

Agnivesha, Charaka Samhita revised by Charaka &Dridabala,with Ayurveda Dipika comentary by Chakrapanidatta, foreword by Acharya Yadav ji Trikam ji. 5th edition.Varanasi: Choukhamba Sanskrit Sansthan;2007. Sushruta, Sushruta Samhita, with Nibhandha Sangraha comentary by Dalhana, foreword by Acharya Yadav ji Trikam ji. 8th edition.Varanasi: Choukhamba Sanskrit Sansthan;2005. Vagbhata, Ashtangahrdayam Sarvanga sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri, Edited by Bhishagacharya Harishastri Paradakara Vaidya, 9th Edition.Varanasi: Choukhambha Orientalia;2005 Sharangadhara, Sharangadhara Samhita, with Adhamllas deepika and Kashiramas Gudartha Deepika Commentary, edited by Pandith Parashuram Shastry, Bombay, Nirnaya Sagara Press, 1931,2nd ed Valia R.G. ; IADVL Text Book and Atlas of Dermatology (Vol I) ; Ameet R Walia ; Mumbai ; Bhalani publication house ; II Edition Davidson, Goldburg; Principles and Practice of Madicine Medicine, edited by Nicki R Colledge,,Brain R.Walker,Stuart H.Ralston, New York,Churchill Livingstone Publication, 21th edition ,2010 Harita, Harita Samhita,Nirmala Hindi commentary Edited and Translated byVaidya Jaymini Pandey, Chowkambha Visvabharati Varanasi;1st edition 2010 Rigveda,Tamil Nadu Nityagnihotri somyaji 1979 Atharva veda Samhita, Delhi NAG Publisher 1994 Yajurveda Samhita, Delhi Chaukhamba sanskrit pratishthan Dr sahadeva dasa, To Kill Cow Means To End Human Civilization. Dr sahadeva dasa, Capitalism Communism & Cowism - A New Economics For The 21st Century.

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