Difference between revisions of "Varna"
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== Prakriti vis-a-vis varna == | == Prakriti vis-a-vis varna == | ||
<p style="text-align:justify;">Though the complexion of a person is an outcome of many factors such as humidity, temperature, race, occupation, etc.but prakriti (constitution) of individuals pre-dominantly affects his complexion.Since vata dosha is dry, rough and cold in nature due to predominance of vayumahabhuta,vata prakriti individuals are more prone to have lustreless,dry dusky complexion.[Cha. Sa. VimanaSthana 8/98] [Ast. Hri. SharirSthana 3/85]Since pitta dosha is unctuous, hot, and fluid in nature due to predominance of agnimahabhuta,pitta prakriti individuals are prone to have fair complexion, with freckles and blackmoles.[Cha. Sa. VimanaSthana 8/97] [Ast. Hri. ShariraSthana 3/90]Since kapha dosha is unctuous, smooth, soft, cold and clear due to predominance of jalamahabhuta, kapha prakriti individuals are prone to have a pleasing smooth fair complexion with lustre, comparable to gorochan (an auspicious yellow pigment collected from ox), lotus or gold. [Cha. Sa. VimanaSthana 8/96] [Ast. Hri. SharirSthana 3/97] Thus the specific complexion in specific prakriti may be attributed to the composition of their respective predominant dosha. The prakriti depends on genetic constitution of a person. Fewresearches have identified the genome responsible for imparting skin colour.Several genome-wide association studies for pigmentation have now been conducted and identified single nucleotide polymorphism (SNP) markers in known, TYR, TYRP1, OCA2, SLC45A2, SLC24A5, MC1R, ASIP, KITLG and previously unknown SLC24A4, IRF4, TPCN2, candidate genes.<ref name="ref4">Pavan WJ, Sturm RA. The Genetics of Human Skin and Hair Pigmentation. Annu Rev Genomics Hum Genet. 2019 Aug 31;20:41-72. doi: 10.1146/annurev-genom-083118-015230. Epub 2019 May 17. PMID: 31100995.</ref><ref name="ref5">Sturm RA. Molecular genetics of human pigmentation diversity. Hum Mol Genet. 2009 Apr 15;18(R1):R9-17. doi: 10.1093/hmg/ddp003. PMID: 19297406.</ref></p> | <p style="text-align:justify;">Though the complexion of a person is an outcome of many factors such as humidity, temperature, race, occupation, etc.but prakriti (constitution) of individuals pre-dominantly affects his complexion.Since vata dosha is dry, rough and cold in nature due to predominance of vayumahabhuta,vata prakriti individuals are more prone to have lustreless,dry dusky complexion.[Cha. Sa. VimanaSthana 8/98] [Ast. Hri. SharirSthana 3/85]Since pitta dosha is unctuous, hot, and fluid in nature due to predominance of agnimahabhuta,pitta prakriti individuals are prone to have fair complexion, with freckles and blackmoles.[Cha. Sa. VimanaSthana 8/97] [Ast. Hri. ShariraSthana 3/90]Since kapha dosha is unctuous, smooth, soft, cold and clear due to predominance of jalamahabhuta, kapha prakriti individuals are prone to have a pleasing smooth fair complexion with lustre, comparable to gorochan (an auspicious yellow pigment collected from ox), lotus or gold. [Cha. Sa. VimanaSthana 8/96] [Ast. Hri. SharirSthana 3/97] Thus the specific complexion in specific prakriti may be attributed to the composition of their respective predominant dosha. The prakriti depends on genetic constitution of a person. Fewresearches have identified the genome responsible for imparting skin colour.Several genome-wide association studies for pigmentation have now been conducted and identified single nucleotide polymorphism (SNP) markers in known, TYR, TYRP1, OCA2, SLC45A2, SLC24A5, MC1R, ASIP, KITLG and previously unknown SLC24A4, IRF4, TPCN2, candidate genes.<ref name="ref4">Pavan WJ, Sturm RA. The Genetics of Human Skin and Hair Pigmentation. Annu Rev Genomics Hum Genet. 2019 Aug 31;20:41-72. doi: 10.1146/annurev-genom-083118-015230. Epub 2019 May 17. PMID: 31100995.</ref><ref name="ref5">Sturm RA. Molecular genetics of human pigmentation diversity. Hum Mol Genet. 2009 Apr 15;18(R1):R9-17. doi: 10.1093/hmg/ddp003. PMID: 19297406.</ref></p> | ||
| + | |||
| + | == Excellence of body tissues (sara) vis-a-vis varna == | ||
| + | <p style="text-align:justify;">The excellence of dhatus (body tissues) is studied with reference to sara. Sara is classified into eight categories. Among these eight categories, twak sara (excellence in rasa dhatu) individuals have unctuous, smooth, soft, clear, fine, less numerous, deep rooted and tender hair with lustrous skin.[Cha. Sa. VimanaSthana 8/103] Rasa dhatu is rich in jalamahabhuta imparting smoothness, softness and unctuousness to the skin. <br/>Rakta sara (excellence in rakta dhatu) individuals have unctuousness, red colour, beautiful dazzling appearance of the ears, eyes, face, tongue, nose, lips, sole of the hand and feet, nails, forehead and genital organs.[Cha. Sa. VimanaSthana 8/104]These individuals are believed to have well developed intra-dermal blood capillaries and circulation along with overall excellence in blood vascular system. <br/>Meda sara (excellence in meda dhatu) individuals have unctuousness in complexion, eyes, scalp hair and other parts of the body, nails, teeth, lips, urine and faeces.[Cha. Sa. VimanaSthana 8/106]These individuals have excellence in adipose tissue which is unctuous in nature. <br/>Majja sara (excellence in majja dhatu) individuals too have unctuous complexion.[Cha. Sa. VimanaSthana 8/108]Majja dhatu is predominantly formed of jalamahabhuta. <br/>Shukra sara (excellence in shukra dhatu) individuals have a gentle look, having eyes as if filled with milk, cheerfulness, having teeth which are unctuous, round, strong, even, beautiful, clean and have unctuous complexion with dazzling appearance.[Cha. Sa. VimanaSthana 8/109]Shukra dhatu or reproductive tissues are believed to be formed at the end from essence of all other dhatus. Thusit indicate the excellence of all dhatus.</p> | ||
| + | |||
| + | == Effect of dinacharya(daily regimen) on varna == | ||
| + | <p style="text-align:justify;">A healthy daily regimen helps in maintaining a healthy varna. These regimens include following: <br/>Consumption of food in proper quantity[Cha. Sa. Sutra Sthana 5/8] <br/>Applying udvartana (massaging the body with soft, fragrant powder) [Ast. Hri. Sutra Sthana 2/15] <br/>Maintaining the three supports of life viz. food, sleep and brahmacharya (avoidance of sexual act physically, mentally and verbally in all ways under any circumstances) in life[Cha. Sa. Sutra Sthana 11/35] <br/>Use of rasayana[Cha. Sa. ChikitsaSthana 1/1/7] (the drug, food or therapy which has capacity to prevent ageing, improve longevity, provide immunity against the diseases, promote mental competence, increase vitality and lustre of the body) <br/>Jatharagni (digestive capacity) is also responsible for complexion [Cha. Sa. ChikitsaSthana 15/3], hence such diet should be consumed which establishes a healthy jatharagni. Importance of diet in imparting good complexion is mentioned.[Cha. Sa. Sutra Sthana 27/349] [Cha. Sa. Sutra Sthana 27/3]. The food that is consumed is digested by jatharagni. This digestion produces nourishment to the dhatus (tissues) of the body. Healthy tissues are responsible for maintenance of healthy skin, thus indicating role of jatharagni in varna.</p> | ||
| + | |||
| + | == Ojas & varna == | ||
| + | <p style="text-align:justify;">Ojas is the essence of the body tissues (dhatus) [Su. Sa. Sutra Sthana 15/24]. As healthy state of all dhatu keeps the skin healthy.Thusone of the functions of ojas is to maintain varna.[Su. Sa. Sutra Sthana 15/25] The qualitative deterioration (ojavyapat) causes impairment of complexion.[Su. Sa. Sutra Sthana 15/29]</p> | ||
| + | |||
| + | == Varna as an atmaja bhava == | ||
| + | <p style="text-align:justify;">Ayurveda believes that six procreative factors affect the formation of foetus. One among these factors is atmaja (atma=soul, ja=emerging from) factor. Atmaja factor is belived to affect varna.[Cha. Sa. SharirSthana 3/10]</p> | ||
| + | |||
| + | == Importance of concept == | ||
| + | === Importance in diagnosis & prognosis of disease === | ||
| + | <p style="text-align:justify;">The natural complexion indicates a state of health or natural physiological processes inside the body. Sudden spontaneous change in natural complexion may be due to some pathology. Sudden drastic change in natural complexion may also indicate death in near future. Apart from discussing the natural complexion, some of the abnormal complexions like blue, grey, coppery, green and albino (extremely white) are described. [Cha. Sa. IndriyaSthana 1/9] Example, cyanotic complexion is observed in severe right ventricular hypertrophic cardiomyopathy.<ref name="ref6">Li M, Zhang L, Zhang Z, Wang S, Dong N, Wang G, Xie M. Isolated Severe Right Ventricular Hypertrophic Cardiomyopathy. Ann Thorac Surg. 2019 Jan;107(1):e23-e25. doi: 10.1016/j.athoracsur.2018.05.061. Epub 2018 Jun 23. PMID: 29944878.</ref> The abnormalities include if half of the body has natural complexion and the other have abnormal complexion, and both of them are evenly demarcated by a line. These normal and abnormal complexions may simultaneously appear in left and right sides, front and back sides, upper and lower parts or internal and external parts of the body. Natural and abnormal complexions simultaneously appearing in face or other parts of the body, are the morbid signs indicating imminent death.[Cha. Sa. IndriyaSthana 1/10]For example, amelanotic melanomas presenting as red skin lesions are often lethal.<ref name="ref7">McClain SE, Mayo KB, Shada AL, Smolkin ME, Patterson JW, Slingluff CL Jr. Amelanotic melanomas presenting as red skin lesions: a diagnostic challenge with potentially lethal consequences. Int J Dermatol. 2012 Apr;51(4):420-6. doi: 10.1111/j.1365-4632.2011.05066.x. PMID: 22435430; PMCID: PMC4465919.</ref> </p> | ||
| + | |||
| + | === Clinical diagnosis based on varna === | ||
| + | <p style="text-align:justify;">Some diseases often have an impact on varna. Thus varna can be used as one of the diagnostic criterias for identification of diseases. Examples are as follows: | ||
| + | * Pandu (anaemia); Pale colour. [Cha. Sa. ChikitsaSthana 16/11] | ||
| + | * Kamla (jaundice): Yellowish [Cha. Sa. ChikitsaSthana 16/35] | ||
| + | * Vitiligo: Depigmented patches over skin. | ||
| + | * Albinism: Depigmentation of skin. | ||
| + | * Cyanosis: Bluish colour (may be due to heart defect). </p> | ||
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Revision as of 06:43, 23 May 2023
Varna means colour or complexion and is referred to assess skin colour. It is important biologically, cosmetically, and socially. Modern literature considers that differences in skin colour among individuals is caused only by variation in pigmentation. This is a result of genetics (inherited from one's biological parents and or individual gene alleles), exposure to the sun, natural and sexual selection, or all of these. Apart from these factors, Ayurveda considers other factors too like daily regimen, excxellence of body tissues, constitution (prakriti) of the person, etc as the factors affecting varna.Equilibrium of dosha is essential for healthy varna.Derangement in the homeostasis of dosha often causes discoloration of varna. Bhrajak pitta[Su. Sa. Sutra Sthana 21/10] [Ast. Hri. Sutra Sthana 12/14] and udanavayu[A. Hri. Sutra Sthana 12/5] carry the physiological functions for maintaining varna. Several medicinal formulations for the enhancement of varna are mentioned in ayurveda texts. E.g. group of ten herbs for improving colour of skin (varnyadashemani) includes Chandana (Santalum album), Tunga (Calophylluminophyllum), Padmaka (Prunus cerasoides), Ushira (Vetiveriazizanioides), Madhuka (Glycyrrhiza glabra), Manjishtha (Rubia cordifolia), Sariva (Hemidesmus indicus), Payasya (Pueraria tuberosa), Sita (Cynodondactylon) and Lata (Cynodon linearis). [Cha. Sa. Sutra Sthana 4/8] This article describes the physiological and pathological aspects of varna and its importance in healthcare.
| Section/Chapter/topic | Concepts / Varna |
|---|---|
| Authors |
Bhojani M.K.1, Yadav Vandana 1 |
| Reviewer | Basisht G.2 |
| Editor | Deole Y.S.3 |
| Affiliations |
1 Department of Kriya Sharira, All India Institute of Ayurveda, New Delhi, India 2 Rheumatologist, Orlando, Florida, U.S.A. 3Department of Kayachikitsa, G.J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Anand, Gujarat, India |
| Correspondence email |
meera.samhita@aiia.gov.in, carakasamhita@gmail.com |
| Publisher | Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India |
| Date of first publication: | May20, 2023 |
| DOI | 10.47468/CSNE.2023.e01.s09.139 |
Classification
Human skin colour ranges from the darkest brown to the lightest hues. Ayurveda scholars have classified varna based on proportions of mahabhutacomposing them as follows:
| S. No | Type of Varna | CharakSamhita ShariraSthana |
CharakSamhita IndriyaSthana |
SushrutaSamhita ShariraSthana |
Colour |
|---|---|---|---|---|---|
| 1 | Gaura | ✓ | ✓ | White/fair complexion | |
| 2 | Krishna | ✓ | ✓ | ✓ | Black/dark complexion |
| 3 | Shyam | ✓ | ✓ | Dark blue/brown | |
| 4 | Shyamavdata | ✓ | Bluish white | ||
| 5 | Avadata | ✓ | White/fair | ||
| 6 | Krishna Shyam | ✓ | Bluish black complexion | ||
| 7 | Gaur Shyam | ✓ | Bluish white cmplexion |
| Varna | Mahabhuta Acc. To Charak | Mahabhuta Acc. To Susruta |
|---|---|---|
| Gaura | Agni+Jala+Akash | Jala+Agni |
| Krishna | Agni+Prithvi+Vayu | Prithvi+Agni |
| Shyam | Akash+Vayu+Agni+Jala+Prithvi | |
| Gaura Shyam | Jala+Akash+Agni | |
| Krishna Shyam | Prithvi+Akash+Agni |
[Cha. Sa. ShariraSthana 8/15],[Cha. Sa. IndriyaSthana 1/8],[Su. Sa. ShariraSthana 2/37]
Inheritance of varna
The disorders of various body systems affect varna. E.g. disorders in rakta dhatu (blood and its components) results in skin discolouration and diseases.[Cha. Sa. Sutra Sthana 28/11-13] [Su. Sa. Sutra Sthana 24/11]Skin diseases have detrimental effect on varna. Rakta dhatu in its optimum quantity and quality leads to superior complexion. Similarly,presence of optimum body and scalp hair, cutaneous blood vessels, too affect the varna. The health of liver, spleen and other digestive organs is important to maintain a normal varna. These organs like heart, liver, spleen areoriginated from maternal factors, while some like hair, blood vessels, etc are contributed by paternal factors.[Ast. Hri. ShariraSthana 3/4-5]Thus varna of child is believed to be inherited from parents. Contemporary science believes that three classes of genes contribute to normal human color variation through the production of hypopigmented phenotypes or by genetic association with skin type and hair color. The MSH cell surface receptor and the melanosomal P-protein are the two most obvious candidate genes influencing variation in pigmentation phenotype, and may do so by regulating the levels and activities of the melanogenic enzymes tyrosinase, TRP-1 and TRP-2. Varna being regulated by genes may indicate its inheritance from parents.[1]
Effect of gestational diet pattern on varna of baby
The gestational diet and behaviour of mother influence varna of the new born child. Foetus gets nutrition from the mother; hence the diet and regimen of pregnant woman has a strong importance on the varna of offspring. During the gestational period, if the mother indulges in sweet foods such as milk, the colour of the child will be whitish-yellow; indulgence in foods which cause heart burn, such as sesame will lead to black colour of the child; and the use of mixed types of food will result in blue-black colour of the child.[A. Sam. ShariraSthana 1/61][2] A 2003 study found that diet of female mouse can change her offspring's coat colour by permanently modifying DNA methylation.[3] Ayurveda considers that the varna of foetus gets enhanced in sixth month of gestational period and the varna of the mother simultaneously gets decreased during sixth month.[Cha. Sa. ShariraSthana 4/22] The varna of child also depends on the colour of the apparel usedby mother during pregnancy. [Cha. Sa. ShariraSthana 8/12] However, more understanding and researches are needed on this concept. Satmya is the suitability towards the diet and regimens consumed by mother during the period of pregnancy. Satmyaja factors have a great impact in the formation of varna.[Cha. Sa. ShariraSthana 3/11]
Prakriti vis-a-vis varna
Though the complexion of a person is an outcome of many factors such as humidity, temperature, race, occupation, etc.but prakriti (constitution) of individuals pre-dominantly affects his complexion.Since vata dosha is dry, rough and cold in nature due to predominance of vayumahabhuta,vata prakriti individuals are more prone to have lustreless,dry dusky complexion.[Cha. Sa. VimanaSthana 8/98] [Ast. Hri. SharirSthana 3/85]Since pitta dosha is unctuous, hot, and fluid in nature due to predominance of agnimahabhuta,pitta prakriti individuals are prone to have fair complexion, with freckles and blackmoles.[Cha. Sa. VimanaSthana 8/97] [Ast. Hri. ShariraSthana 3/90]Since kapha dosha is unctuous, smooth, soft, cold and clear due to predominance of jalamahabhuta, kapha prakriti individuals are prone to have a pleasing smooth fair complexion with lustre, comparable to gorochan (an auspicious yellow pigment collected from ox), lotus or gold. [Cha. Sa. VimanaSthana 8/96] [Ast. Hri. SharirSthana 3/97] Thus the specific complexion in specific prakriti may be attributed to the composition of their respective predominant dosha. The prakriti depends on genetic constitution of a person. Fewresearches have identified the genome responsible for imparting skin colour.Several genome-wide association studies for pigmentation have now been conducted and identified single nucleotide polymorphism (SNP) markers in known, TYR, TYRP1, OCA2, SLC45A2, SLC24A5, MC1R, ASIP, KITLG and previously unknown SLC24A4, IRF4, TPCN2, candidate genes.[4][5]
Excellence of body tissues (sara) vis-a-vis varna
The excellence of dhatus (body tissues) is studied with reference to sara. Sara is classified into eight categories. Among these eight categories, twak sara (excellence in rasa dhatu) individuals have unctuous, smooth, soft, clear, fine, less numerous, deep rooted and tender hair with lustrous skin.[Cha. Sa. VimanaSthana 8/103] Rasa dhatu is rich in jalamahabhuta imparting smoothness, softness and unctuousness to the skin.
Rakta sara (excellence in rakta dhatu) individuals have unctuousness, red colour, beautiful dazzling appearance of the ears, eyes, face, tongue, nose, lips, sole of the hand and feet, nails, forehead and genital organs.[Cha. Sa. VimanaSthana 8/104]These individuals are believed to have well developed intra-dermal blood capillaries and circulation along with overall excellence in blood vascular system.
Meda sara (excellence in meda dhatu) individuals have unctuousness in complexion, eyes, scalp hair and other parts of the body, nails, teeth, lips, urine and faeces.[Cha. Sa. VimanaSthana 8/106]These individuals have excellence in adipose tissue which is unctuous in nature.
Majja sara (excellence in majja dhatu) individuals too have unctuous complexion.[Cha. Sa. VimanaSthana 8/108]Majja dhatu is predominantly formed of jalamahabhuta.
Shukra sara (excellence in shukra dhatu) individuals have a gentle look, having eyes as if filled with milk, cheerfulness, having teeth which are unctuous, round, strong, even, beautiful, clean and have unctuous complexion with dazzling appearance.[Cha. Sa. VimanaSthana 8/109]Shukra dhatu or reproductive tissues are believed to be formed at the end from essence of all other dhatus. Thusit indicate the excellence of all dhatus.
Effect of dinacharya(daily regimen) on varna
A healthy daily regimen helps in maintaining a healthy varna. These regimens include following:
Consumption of food in proper quantity[Cha. Sa. Sutra Sthana 5/8]
Applying udvartana (massaging the body with soft, fragrant powder) [Ast. Hri. Sutra Sthana 2/15]
Maintaining the three supports of life viz. food, sleep and brahmacharya (avoidance of sexual act physically, mentally and verbally in all ways under any circumstances) in life[Cha. Sa. Sutra Sthana 11/35]
Use of rasayana[Cha. Sa. ChikitsaSthana 1/1/7] (the drug, food or therapy which has capacity to prevent ageing, improve longevity, provide immunity against the diseases, promote mental competence, increase vitality and lustre of the body)
Jatharagni (digestive capacity) is also responsible for complexion [Cha. Sa. ChikitsaSthana 15/3], hence such diet should be consumed which establishes a healthy jatharagni. Importance of diet in imparting good complexion is mentioned.[Cha. Sa. Sutra Sthana 27/349] [Cha. Sa. Sutra Sthana 27/3]. The food that is consumed is digested by jatharagni. This digestion produces nourishment to the dhatus (tissues) of the body. Healthy tissues are responsible for maintenance of healthy skin, thus indicating role of jatharagni in varna.
Ojas & varna
Ojas is the essence of the body tissues (dhatus) [Su. Sa. Sutra Sthana 15/24]. As healthy state of all dhatu keeps the skin healthy.Thusone of the functions of ojas is to maintain varna.[Su. Sa. Sutra Sthana 15/25] The qualitative deterioration (ojavyapat) causes impairment of complexion.[Su. Sa. Sutra Sthana 15/29]
Varna as an atmaja bhava
Ayurveda believes that six procreative factors affect the formation of foetus. One among these factors is atmaja (atma=soul, ja=emerging from) factor. Atmaja factor is belived to affect varna.[Cha. Sa. SharirSthana 3/10]
Importance of concept
Importance in diagnosis & prognosis of disease
The natural complexion indicates a state of health or natural physiological processes inside the body. Sudden spontaneous change in natural complexion may be due to some pathology. Sudden drastic change in natural complexion may also indicate death in near future. Apart from discussing the natural complexion, some of the abnormal complexions like blue, grey, coppery, green and albino (extremely white) are described. [Cha. Sa. IndriyaSthana 1/9] Example, cyanotic complexion is observed in severe right ventricular hypertrophic cardiomyopathy.[6] The abnormalities include if half of the body has natural complexion and the other have abnormal complexion, and both of them are evenly demarcated by a line. These normal and abnormal complexions may simultaneously appear in left and right sides, front and back sides, upper and lower parts or internal and external parts of the body. Natural and abnormal complexions simultaneously appearing in face or other parts of the body, are the morbid signs indicating imminent death.[Cha. Sa. IndriyaSthana 1/10]For example, amelanotic melanomas presenting as red skin lesions are often lethal.[7]
Clinical diagnosis based on varna
Some diseases often have an impact on varna. Thus varna can be used as one of the diagnostic criterias for identification of diseases. Examples are as follows:
- Pandu (anaemia); Pale colour. [Cha. Sa. ChikitsaSthana 16/11]
- Kamla (jaundice): Yellowish [Cha. Sa. ChikitsaSthana 16/35]
- Vitiligo: Depigmented patches over skin.
- Albinism: Depigmentation of skin.
- Cyanosis: Bluish colour (may be due to heart defect).
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References
- ↑ Sturm R, Box N, Ramsay M. Human pigmentation genetics: the difference is only skin deep. doi:10.1002/(SICI)1521-1878(199809)20.
- ↑ Mitra J, editor, (1st ed.). Sasilekha Sanskrit Commentary by Indu on Astanga Samgrah of Vriddha Vagbhata, Sharir Sthana; Putrakamiyo Adhyaya: Chapter 1, Verse 61. Varanasi: Chowkhamba Sanskrit Series Office, 2016; 273.
- ↑ Dominguez-Salas P, Moore SE, Baker MS, Bergen AW, Cox SE, Dyer RA, Fulford AJ, Guan Y, Laritsky E, Silver MJ, Swan GE, Zeisel SH, Innis SM, Waterland RA, Prentice AM, Hennig BJ. Maternal nutrition at conception modulates DNA methylation of human metastable epialleles. Nat Commun. 2014 Apr 29;5:3746. doi: 10.1038/ncomms4746. PMID: 24781383; PMCID: PMC4015319.
- ↑ Pavan WJ, Sturm RA. The Genetics of Human Skin and Hair Pigmentation. Annu Rev Genomics Hum Genet. 2019 Aug 31;20:41-72. doi: 10.1146/annurev-genom-083118-015230. Epub 2019 May 17. PMID: 31100995.
- ↑ Sturm RA. Molecular genetics of human pigmentation diversity. Hum Mol Genet. 2009 Apr 15;18(R1):R9-17. doi: 10.1093/hmg/ddp003. PMID: 19297406.
- ↑ Li M, Zhang L, Zhang Z, Wang S, Dong N, Wang G, Xie M. Isolated Severe Right Ventricular Hypertrophic Cardiomyopathy. Ann Thorac Surg. 2019 Jan;107(1):e23-e25. doi: 10.1016/j.athoracsur.2018.05.061. Epub 2018 Jun 23. PMID: 29944878.
- ↑ McClain SE, Mayo KB, Shada AL, Smolkin ME, Patterson JW, Slingluff CL Jr. Amelanotic melanomas presenting as red skin lesions: a diagnostic challenge with potentially lethal consequences. Int J Dermatol. 2012 Apr;51(4):420-6. doi: 10.1111/j.1365-4632.2011.05066.x. PMID: 22435430; PMCID: PMC4465919.