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Charak Samhita

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एकोवायदिवाऽनेकोयस्यवैकारिकःस्वरः। सहसोत्पद्यते जन्तोर्हीयमानस्नास्ति सः ॥२४॥

In chronic immune deficient person, there is all possibilities of dhatusaraheenatha (Severe wasting of tissues) can lead to abnormal voice.

english translation