LIMBS

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Chapter 64

LIMBS

Chapter contents

MUSCLE ACHE IN THE LIMBS

Interrogation, Chapter 39

PAIN IN THE LIMBS

Interrogation, Chapter 39

Wind

Wandering pain in the joints that may come and go, especially in the upper part of the body.

This pattern is Wind Painful Obstruction Syndrome and, in acute cases, the pulse is Floating.

Cold

Pain in the joints that is aggravated by exposure to cold and alleviated by application of heat, usually in one joint only, cold limbs.

This is Cold Painful Obstruction Syndrome and, in acute cases, the pulse is Tight.

Dampness

Pain in the joints with swelling, a feeling of heaviness, numbness of the limbs.

This is Damp Painful Obstruction Syndrome and, in acute cases, the pulse is Slippery.

Damp-Heat

Pain in the joints with swelling and redness, hot to touch, a feeling of heaviness and numbness of the limbs, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Qi and Blood deficiency

Chronic, dull ache in the joints that is aggravated when tired and alleviated by rest, poor appetite, loose stools, weak voice, tiredness, blurred vision, dizziness, numbness/tingling of limbs, palpitations, dull-pale complexion, Pale tongue, Weak or Choppy pulse.

Liver and Kidney deficiency

Dull ache in the joints especially in the lower part of the body, weak knees, dizziness, lower backache, tinnitus.

Other clinical manifestations, including tongue and pulse, depend on whether there is Yin or Yang deficiency.

HANDS AND FEET

Cold hands and feet

Interrogation, Chapter 39

Yang deficiency

Coldness of hands and feet, the cold feeling extending to arms and legs, feeling of cold in general, bright-pale complexion, Pale tongue, Deep-Weak pulse.

These are the symptoms of a general Yang deficiency and other manifestations depend on the organ involved, which may be the Heart, Lungs, Spleen or Kidneys.

Blood deficiency

Coldness of hands and feet, numbness/tingling of the limbs, blurred vision, dizziness, insomnia, Pale tongue, Choppy or Fine pulse.

This pattern is much more common in women and it may be due to either Liver-Blood or Heart-Blood deficiency.

Qi stagnation

Coldness of hands and feet, especially of the fingers and toes, hypochondrial or epigastric distension, irritability, moodiness, a feeling of a lump in the throat, premenstrual tension, Wiry pulse.

Phlegm

Coldness of hands and feet, a feeling of heaviness of the limbs, numbness/tingling of the limbs, a feeling of oppression of the chest, Swollen tongue, Slippery pulse.

Heat stagnating in the Interior (True Heat-False Cold)

Coldness of hands and feet, dark face, bright eyes with lustre, dry red lips, irritability, strong body, breathing noisy, loud voice, thirst with a desire to drink cold fluids, scanty dark urine, constipation, a burning sensation in the anus, coldness of the limbs, hot chest, a feeling of heat of the face, red face, mental restlessness, thirst, Red tongue, Rapid pulse.

This pattern is quite rare and the cold hands and feet are due to Heat stagnating in the Interior and preventing Qi from reaching the extremities.

Clinical note

• Cold hands and feet are a reliable indication of Yang deficiency or Cold. In women, do not be surprised if this symptom is accompanied by a feeling of heat of the face.

Hot hands and feet

Interrogation, Chapter 39

Damp-Heat

Heat in hands and feet, sweating of hands and feet, swollen, red and hot joints of the hands and feet, a feeling of heaviness and numbness of the limbs, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Heart and Kidney-Yin deficiency with Empty-Heat

Heat in hands and feet, or in palms and soles, palpitations, mental restlessness, insomnia, dream-disturbed sleep, anxiety, poor memory, dizziness, tinnitus, hardness of hearing, lower backache, a feeling of heat in the evening, night sweating, five-palm heat, scanty dark urine, dry stools, Red tongue with redder tip and a Heart crack, Floating-Empty and Rapid pulse.

Stomach-Heat

Heat in hands and feet, burning epigastric pain, thirst, sour regurgitation, nausea, excessive hunger, foul breath, a feeling of heat, Red tongue with a yellow coating, Overflowing-Rapid pulse.

Stomach-Yin deficiency with Empty-Heat

Heat in hands and feet worse in the afternoon, dull or burning epigastric pain, a feeling of heat in the afternoon, dry stools, dry mouth and throat especially in the afternoon, thirst with a desire to drink in small sips, a feeling of hunger but no desire to eat, night sweating, five-palm heat, bleeding gums, Red tongue without coating in the centre, Floating-Empty and Rapid pulse.

ABNORMAL FEELINGS IN THE LIMBS

Numbness/tingling of the limbs

Interrogation, Chapter 39

Liver-Blood deficiency

Tingling and weakness of the limbs, dizziness, blurred vision, floaters, numbness/tingling of limbs, scanty menstruation, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Phlegm in the limbs

Numbness of the limbs, a feeling of heaviness of the limbs, tendency to obesity, Swollen tongue, Slippery pulse.

Wind-Phlegm

Numbness of the limbs, especially the upper limbs and often unilateral, a feeling of heaviness of the limbs, tremor, dizziness, headache, Swollen and Stiff tongue, Wiry-Slippery pulse.

Liver-Wind

Numbness of the limbs, especially the upper limbs and often unilateral, tremors, severe dizziness, tinnitus, headache, numbness of the limbs, tics, Stiff, Deviated or Moving tongue, Wiry pulse.

Dampness

Numbness of the limbs, especially the legs, pain in the joints with swelling, muscle ache, a feeling of heaviness, sticky tongue coating, Slippery pulse.

Damp-Heat

Numbness of the limbs, especially the lower limbs, ache, redness, heat and swelling of the joints, muscle ache, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Qi stagnation and Blood stasis

Numbness/tingling of the limbs, stiffness and pain of the limbs, dark complexion, Purple tongue.

Invasion of Wind-Cold

Numbness/tingling of the limbs, aversion to cold, fever, occipital headache, stiff neck, sneezing, body aches, tongue with thin white coating, Floating-Tight pulse.

Clinical note

• Numbness is more indicative of Phlegm or Wind, whereas tingling is more indicative of a deficiency of Blood.

Feeling of heaviness of the limbs

Interrogation, Chapter 39

Dampness

A feeling of heaviness of the limbs, especially the legs, numbness, swelling of the legs, a feeling of heaviness in general, epigastric fullness, sticky tongue coating, Slippery pulse.

Damp-Heat

A feeling of heaviness of the limbs, especially the legs, swelling of the legs, hot feet, muscle ache, numbness, epigastric fullness, sticky yellow coating, Slippery-Rapid pulse.

Spleen-Qi deficiency with Dampness

A slight feeling of heaviness of the limbs, especially of the legs, weakness of the limbs, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, loose stools, abdominal fullness, a sticky taste, poor digestion, undigested food in the stools, nausea, dull frontal headache, Pale tongue with sticky coating, Soggy pulse.

Kidney-Yang deficiency with Dampness

A slight feeling of heaviness of the limbs, especially the legs, weak and cold knees, lower backache, a feeling of cold, bright-white complexion, tiredness, lassitude, abundant clear urination, urination at night, impotence, decreased libido, excessive vaginal discharge, Pale and wet tongue with a sticky coating, Deep-Weak and slightly Slippery pulse.

Stomach and Spleen-Qi deficiency with Dampness

A slight feeling of heaviness of the limbs, weakness of the limbs, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, loose stools, abdominal fullness, sticky taste, uncomfortable sensation in the epigastrium, Pale tongue with sticky coating, Soggy pulse.

Phlegm in the limbs

A feeling of heaviness of the limbs, numbness of the limbs, sputum in the throat, a feeling of oppression of the chest, Swollen tongue with sticky coating, Slippery pulse.

Clinical note

• A feeling of heaviness of the limbs is a very reliable symptom of Dampness in the lower part of the body.

Feeling of distension of the limbs

Interrogation, Chapter 39

Qi stagnation with Dampness

A feeling of distension or heaviness of the limbs, swelling of the skin, sticky tongue coating, Wiry-Slippery pulse.

Blood stasis from Qi deficiency

A feeling of distension of the limbs, aggravated by overexertion, pain in the limbs, purple colour of the lower legs, tiredness, poor appetite, loose stools, weak voice, shortness of breath, Wiry or Choppy pulse.

Wind-Phlegm

A feeling of distension or heaviness of the limbs, numbness/tingling of the limbs, severe dizziness, blurred vision, tremors, tinnitus, nausea, sputum in the throat, a feeling of oppression of the chest, Stiff or Deviated and Swollen tongue, Wiry-Slippery pulse.

WEAKNESS AND ATROPHY

Weakness of the limbs

Interrogation, Chapter 39

Stomach-Qi deficiency

Weakness of the four limbs, especially of the legs, an uncomfortable feeling in the epigastrium, no appetite, lack of sense of taste, loose stools, tiredness especially in the morning, Pale tongue, Empty pulse.

Deficiency of Qi and Blood

Weakness of all limbs, poor appetite, loose stools, weak voice, tiredness, blurred vision, dizziness, numbness/tingling of limbs, palpitations, dull-pale complexion, Pale tongue, Weak or Choppy pulse.

Kidney-Yang deficiency

Weakness of the limbs, especially the legs, weak knees, lower backache, cold knees, a feeling of cold, bright-white complexion, tiredness, lassitude, abundant clear urination, urination at night, impotence, decreased libido, Pale and wet tongue, Deep-Weak pulse.

Atrophy of the limbs

Observation, Chapter 18

Stomach and Spleen-Qi deficiency

Atrophy or thinning of the muscles of the four limbs, weakness of the limbs, muscular weakness, gait like a duck, feet turning in or out, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, loose stools, an uncomfortable feeling in the epigastrium, lack of sense of taste, Pale tongue, Empty pulse.

In children this corresponds to the sequelae stage of poliomyelitis.

Liver and Kidney-Yin deficiency

Atrophy or thinning of the muscles, especially of the legs, weak knees, staggering gait, dizziness, tinnitus, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, numbness/tingling of limbs, dry eyes, blurred vision, dry throat, dry hair and skin, brittle nails, night sweating, dry stools, scanty menstruation or amenorrhoea, normal-coloured tongue without coating, Floating-Empty pulse.

This pattern is more common in the elderly.

Spleen and Kidney-Yang deficiency

Atrophy or thinning of the muscles, muscular weakness, cold limbs, cold knees, weak legs, feeling of cold generally or in the back, oedema of the lower legs, lower backache, bright-white complexion, weak knees, decreased libido, tiredness, lassitude, abundant clear or scanty clear urination, urination at night, loose stools, poor appetite, slight abdominal distension, early-morning diarrhoea, chronic diarrhoea, Pale and wet tongue, Deep-Weak pulse.

Deficiency of Qi and Blood

Atrophy or thinning of the muscles, poor appetite, loose stools, weak voice, tiredness, blurred vision, dizziness, numbness/tingling of limbs, palpitations, dull-pale complexion, Pale tongue, Weak or Choppy pulse.

Kidney-Essence deficiency

Atrophy or thinning of the muscles, late development in children, hands unable to grasp, inability to put feet down, slow mental development.

This pattern occurs only in children or babies and is often associated with the Five Retardations (slow development in children involving standing, walking, teeth development, hair development and speech) and the Five Flaccidities (late closure of the fontanelles, flaccidity of mouth, hands, feet and muscles).

Flaccidity of the limbs

Observation, Chapter 18

Stomach and Spleen-Qi deficiency

Flaccidity of the four limbs, cold and weak limbs, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, uncomfortable feeling in the epigastrium, lack of sense of taste, Pale tongue, Empty pulse.

Damp-Heat in the Stomach and Spleen

Flaccidity of the four limbs, a feeling of fullness and pain of the epigastrium and lower abdomen, poor appetite, a feeling of heaviness, thirst without a desire to drink, nausea, loose stools with offensive odour, a feeling of heat, dull-yellow complexion, sticky taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Kidney-Yin deficiency

Flaccidity of the four limbs, dizziness, tinnitus, hardness of hearing, poor memory, night sweating, dry mouth and throat at night, lower backache, constipation, scanty dark urine, tiredness, normal-coloured tongue without coating, Floating-Empty pulse.

Qi deficiency with Blood stasis

Flaccidity of the four limbs in children, pain in the limbs especially at night, listlessness, poor appetite, tendency to catch colds, weak voice, shortness of breath, loose stools, Bluish-Purple tongue, Weak or Choppy pulse.

Heat at the Nutritive-Qi level

Flaccidity of the four limbs with acute onset, fever at night, mental confusion, delirium, Red tongue without coating, Fine-Rapid pulse.

LIMB SWELLING

Oedema of the limbs

Observation, Chapters 18 and 19; Interrogation, Chapter 39; Symptoms and Signs, Chapters 65, 66, 68

Spleen-Yang deficiency

Pitting oedema of the limbs and abdomen, feeling of cold generally or in limbs, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, slight depression, tendency to obesity, Pale and wet tongue, Deep-Weak pulse.

Kidney-Yang deficiency

Pitting oedema of the ankles and legs, weak knees, lower backache, a feeling of cold generally or in the knees, bright-white complexion, weak knees, tiredness, lassitude, abundant clear urination, urination at night, impotence, decreased libido, Pale and wet tongue, Deep-Weak pulse.

Lung-Qi deficiency

Pitting oedema of the hands and face, slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, dislike of speaking, bright-white complexion, tendency to catch colds, tiredness, dislike of cold, Pale tongue, Empty pulse.

Damp-Heat

Swelling of the legs and ankles, aching, swelling, redness and heat of the joints, hot limbs, sticky yellow tongue coating, Slippery-Rapid pulse.

Other symptoms and signs depend on the organ involved.

Qi stagnation

Non-pitting oedema of the limbs, with the skin springings back on pressing the swollen area, a feeling of distension of the limbs.

Cold-Dampness

Swelling of the legs and ankles, a feeling of heaviness of the limbs, cold limbs, ache in the joints, a feeling of cold, sticky white tongue coating, Slippery-Slow pulse.

Qi deficiency and Blood stasis

Oedema of the limbs, cold hands and feet, numbness of the limbs, muscular weakness, purple colour of hands or feet or both, tiredness, poor appetite, loose stools, weak voice, Bluish-Purple tongue, Choppy pulse.

Wind-Water invading the Lungs

Sudden swelling of the eyes, face and hands gradually spreading to the whole body, bright-shiny complexion, scanty and pale urination, aversion to wind, fever, cough, slight breathlessness, sticky white tongue coating, Floating-Slippery pulse.

This is an acute type of oedema and this pattern is a type of external Wind-Cold.

Swelling of the joints of the limbs

Observation, Chapter 18

Damp Painful Obstruction (Bi) Syndrome

Swelling and pain of the joints, a feeling of heaviness of the limbs and the body.

In the case of Damp-Heat, in addition to the above symptoms, the joints would be also red and hot to the touch.

Phlegm in the joints

Long-term, chronic swelling and deformities of joints, osteophytes, a feeling of heaviness of the limbs and body, sputum in the throat, a feeling of oppression of the chest, Swollen tongue with sticky coating, Slippery pulse.

LIMB MOVEMENT

Rigidity of the limbs

Observation, Chapter 18

Wind in the joints

Stiffness of the limbs, difficulty in extending the limbs, pain in the joints.

This pattern corresponds to Wandering Painful Obstruction Syndrome.

Qi stagnation and Blood stasis

Rigidity of the limbs, pain in the muscles and joints, inability to bend arms, abdominal distension, irritability, Purple tongue, Wiry pulse.

Liver-Yang rising

Rigidity of the upper limbs, tense upper back muscles, headache, dizziness, tinnitus, irritability, propensity to outbursts of anger, Wiry pulse.

Liver and Kidney-Yin deficiency

Rigidity of the lower limbs, thin limbs, weak knees, numbness/tingling of the limbs, dizziness, tinnitus, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, dry eyes, blurred vision, dry throat in the evening, dry hair and skin, brittle nails, night sweating, dry stools, scanty menstruation or amenorrhoea, normal-coloured tongue without coating, Floating-Empty pulse.

Liver-Wind

Rigidity of the upper limbs, tremors, severe dizziness, tinnitus, headache, numbness of limbs, tics, Stiff, Deviated or Moving tongue, Wiry pulse.

Wind-Phlegm

Rigidity of the limbs, numbness or tingling of limbs, severe dizziness, blurred vision, tremors, tinnitus, nausea, sputum in the throat, a feeling of oppression of the chest, Stiff or Deviated and Swollen tongue, Wiry-Slippery pulse.

Paralysis of the limbs

Observation, Chapter 18

Stomach and Spleen-Qi deficiency

Paralysis of the four limbs, weak and cold limbs, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, loose stools, an uncomfortable feeling in the epigastrium, lack of sense of taste, Pale tongue, Empty pulse.

Deficiency of Qi and Blood

Paralysis of the four limbs, weak limbs, poor appetite, loose stools, weak voice, tiredness, blurred vision, dizziness, numbness/tingling of limbs, palpitations, dull-pale complexion, Pale tongue, Weak or Choppy pulse.

Liver and Kidney-Yin deficiency

Paralysis of the four limbs, dizziness, tinnitus, weak knees, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, numbness/tingling of the limbs, dry eyes, blurred vision, dry throat in the evening, dry hair and skin, brittle nails, night sweating, dry stools, scanty menstruation or amenorrhoea, normal-coloured tongue without coating, Floating-Empty pulse.

Liver and Kidney-Yin deficiency with internal Wind

Tremor or spasms of limbs, weak limbs, weak knees, numbness/tingling of the limbs, lower backache, dizziness, tinnitus, hardness of hearing, dull occipital or vertical headache, insomnia, dry eyes, blurred vision, dry throat in the evening, dry hair and skin, brittle nails, night sweating, dry stools, scanty menstruation or amenorrhoea, normal-coloured Deviated or Moving tongue without coating, Floating-Empty and slightly Wiry pulse.

Retention of Dampness in the muscles

Paralysis of the four limbs, a feeling of heaviness of the body on limbs, swelling of the limbs and joints, epigastric fullness, sticky taste, sticky tongue coating, Slippery pulse.

Liver-Blood stasis

Paralysis of the four limbs, pain in the limbs which may be worse at night, hypochondrial/abdominal pain, painful periods, dark and clotted menstrual blood, masses in the abdomen, purple nails and lips, purple or dark complexion, Purple tongue, Wiry or Firm pulse.

Wind and Phlegm in the channels

Hemiplegia, numbness/tingling of the limbs (usually unilateral), sputum in the throat, feeling of oppression of the chest, Swollen and Deviated tongue, Slippery and Wiry pulse.

This corresponds to the sequelae stage of Wind-stroke.

Contraction of the limbs

Observation, Chapter 18

Liver-Blood deficiency

Contraction and numbness of the limbs, weak muscles, tingling of the limbs, dizziness, blurred vision, floaters, scanty menstruation, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Liver and Kidney-Yin deficiency

Contraction of the lower limbs, thin limbs, weak knees, dizziness, tinnitus, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, numbness/tingling of the limbs, dry eyes, blurred vision, dry throat in the evening, dry hair and skin, brittle nails, night sweating, dry stools, scanty menstruation or amenorrhoea, normal-coloured tongue without coating, Floating-Empty pulse.

Cold-Dampness

Contraction and swelling of the limbs, a feeling of cold generally or in the limbs, ache in the joints, a feeling of heaviness of the limbs, sticky white tongue coating, Slippery-Slow pulse.

Internal Wind

Contraction of the upper limbs, tremors, severe dizziness, tinnitus, headache, numbness of the limbs, tics, Stiff, Deviated or Moving tongue, Wiry pulse.

Invasion of Wind-Cold

Contraction of the upper limbs, aversion to cold, fever, cough, itchy throat, slight breathlessness, stuffed or runny nose with clear watery discharge, sneezing, occipital headache, body aches, thin white tongue coating, Floating-Tight pulse.

Phlegm

Contraction of the limbs, a feeling of heaviness of the limbs, numbness/tingling of the limbs, a feeling of oppression of the chest, sputum in the throat, Swollen tongue, Slippery pulse.

Blood stasis

Contraction of the limbs, pain of the limbs, hypochondrial pain, abdominal pain, painful periods, dark complexion, Purple tongue, Wiry pulse.

Tremor or spasticity of the limbs

Observation, Chapters 4 and 18; Interrogation, Chapter 39; Symptoms and Signs, Chapter 66

Liver-Wind

Pronounced tremor of the limbs, severe dizziness, tinnitus, headache, numbness of the limbs, tics, Stiff, Deviated or Moving tongue, Wiry pulse.

Wind-Phlegm

Tremor of the limbs, severe dizziness, blurred vision, numbness/tingling of the limbs, tinnitus, nausea, sputum in the throat, a feeling of oppression of the chest, Stiff or Deviated and Swollen tongue, Wiry-Slippery pulse.

Liver-Blood or -Yin deficiency leading to Empty-Wind

Mild tremor of the limbs, slight tremor of the head or hand or both, facial tic, dizziness, blurred vision, numbness/tingling of a limb, dry eyes.

The tongue and pulse presentation depends on whether there is Liver-Blood or Liver-Yin deficiency.

Heat generating Wind

Tremor of the limbs, convulsions, twitching of limbs, high fever, fainting, rigidity of neck, opisthotonos, macular rash, eyeballs turning up, clenching of teeth, Dark-Red tongue without coating, Wiry-Rapid pulse.

This is an acute pattern occurring during a febrile disease and it corresponds to the Blood level within the identification of patterns according to the Four Levels.

Convulsions of the limbs

Observation, Chapter 18

Liver-Yang rising generating Liver-Wind

Convulsions of the four limbs, tremors, severe dizziness, tinnitus, headache, numbness of the limbs, tics, irritability, propensity to outbursts of anger, Stiff, Deviated or Moving tongue, Wiry pulse.

Liver-Blood deficiency generating Liver-Wind

Slight convulsions or twitching of the four limbs, numbness/tingling of the limbs, dizziness, blurred vision, floaters, facial tics, dull-pale complexion, Pale and Stiff tongue, Choppy or Fine and slightly Wiry pulse.

Liver-Wind and Phlegm

Convulsions of the four limbs, facial tic, tremors, numbness/tingling of the limbs, severe dizziness, blurred vision, tinnitus, nausea, sputum in the throat, a feeling of oppression of the chest, Stiff or Deviated and Swollen tongue, Wiry-Slippery pulse.

Liver and Kidney-Yin deficiency and Liver-Blood deficiency giving rise to Liver-Wind

Slight convulsions of the four limbs, dizziness, tinnitus, weak knees, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, numbness/tingling of the limbs, dry eyes, blurred vision, floaters, dry throat in the evening, dry hair and skin, brittle nails, night sweating, dry stools, scanty menstruation or amenorrhoea, dull-pale complexion with red cheekbones, normal-coloured or Pale tongue without coating, Choppy, Fine or Floating-Empty pulse.

This pattern usually occurs during pregnancy or after childbirth.

Heat victorious stirring Wind (Blood level)

Convulsions of the four limbs with acute onset, tremor or twitching of the limbs, high fever, fainting, neck rigidity, opisthotonos, macular rash, turning up of the eyeballs, clenching of the teeth, Dark-Red tongue without coating, Wiry-Rapid pulse.

Yin deficiency generating Empty-Wind (Blood level)

Slight convulsions or twitching of the four limbs with acute onset, low-grade fever, tremor of the limbs, loss of weight, malar flush, listlessness, Dark-Red tongue without coating and Dry, Fine-Rapid pulse.

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