Tra­di­tional Chi­nese Medicine in China

The State Coun­cil In­for­ma­tion Of­fice is­sued its first white pa­per on the de­vel­op­ment of tra­di­tional Chi­nese medicine in China on Tues­day, de­tail­ing poli­cies and mea­sures on TCM de­vel­op­ment and high­light­ing its unique value in the new era. Fol­low­ing is the

China Daily (Hong Kong) - - DOCUMENT - Preface I. II. III. IV. Con­clu­sion 2. Char­ac­ter­is­tics of TCM First, set­ting great store by the holis­tic view. Sec­ond, set­ting great store by the prin­ci­ple of har­mony. Third, em­pha­sis on in­di­vid­u­al­ity. Fourth, em­pha­sis on pre­ven­tive treat­ment. Fifth, simp

Tra­di­tional Chi­nese Medicine in China The State Coun­cil In­for­ma­tion Of­fice of the Peo­ple’s Repub­lic of China, De­cem­ber 2016, First Edi­tion 2016

Contents:

The His­tor­i­cal De­vel­op­ment of TCM Poli­cies and Mea­sures on TCM De­vel­op­ment Car­ry­ing For­ward the Tra­di­tion and En­sur­ing the De­vel­op­ment of TCM In­ter­na­tional Ex­changes and Co­op­er­a­tion in TCM

Preface

Hu­man­ity has cre­ated a col­or­ful global civ­i­liza­tion in the long course of its de­vel­op­ment, and the civ­i­liza­tion of China is an im­por­tant com­po­nent of the world civ­i­liza­tion har­bor­ing great di­ver­sity. As a rep­re­sen­ta­tive fea­ture of Chi­nese civ­i­liza­tion, tra­di­tional Chi­nese medicine is a med­i­cal sci­ence that was formed and de­vel­oped in the daily life of the peo­ple and in the process of their fight against dis­eases over thou­sands of years. It has made a great con­tri­bu­tion to the na­tion’s pro­cre­ation and the coun­try’s pros­per­ity, in ad­di­tion to pro­duc­ing a pos­i­tive im­pact on the progress of hu­man civ­i­liza­tion.

TCM has cre­ated unique views on life, on fit­ness, on dis­eases and on the pre­ven­tion and treat­ment of dis­eases dur­ing its long his­tory of ab­sorp­tion and in­no­va­tion. It rep­re­sents a com­bi­na­tion of nat­u­ral sci­ences and hu­man­i­ties, em­brac­ing pro­found philo­soph­i­cal ideas of the Chi­nese na­tion. As ideas on fit­ness and med­i­cal mod­els change and evolve, tra­di­tional Chi­nese medicine has come to un­der­line a more and more pro­found value.

Since the found­ing of the Peo­ple’s Repub­lic of China in 1949, the Chi­nese gov­ern­ment has set great store by TCM and ren­dered vig­or­ous sup­port to its de­vel­op­ment. TCM and Western medicine have their dif­fer­ent strengths. They work to­gether in China to pro­tect peo­ple from dis­eases and im­prove pub­lic health. This has turned out to be one of the im­por­tant fea­tures and notable strengths of medicine with Chi­nese char­ac­ter­is­tics.

I. The His­tor­i­cal De­vel­op­ment of TCM

In re­mote an­tiq­uity, the an­ces­tors of the Chi­nese na­tion chanced to find that some crea­tures and plants could serve as reme­dies for cer­tain ail­ments and pains, and came to grad­u­ally mas­ter their ap­pli­ca­tion. As time went by, peo­ple be­gan to ac­tively seek out such reme­dies and meth­ods for pre­vent­ing and treat­ing dis­eases. Say­ings like “Shen­nong (Ce­les­tial Farmer) tast­ing a hun­dred herbs” and “food and medicine com­ing from the same source” are char­ac­ter­is­tic of those years.

The dis­cov­ery of al­co­hol in the Xia Dy­nasty (c. 2070-1600 BC) and the in­ven­tion of herbal de­coc­tion in the Shang Dy­nasty (1600-1046 BC) ren­dered medicines more ef­fec­tive.

In the Western Zhou Dy­nasty (1046-771 BC), doc­tors be­gan to be clas­si­fied into four cat­e­gories — di­eti­tian, physi­cian, doctor of de­coc­tions and vet­eri­nar­ian.

Dur­ing the Spring and Au­tumn and War­ring States Pe­riod (770-221 BC), Bian Que drew on the ex­pe­ri­ence of his pre­de­ces­sors and put for­ward the four di­ag­nos­tic meth­ods — in­spec­tion, aus­cul­ta­tion and ol­fac­tion, in­quiry, and pal­pa­tion, lay­ing the foun­da­tion for TCM di­ag­no­sis and treat­ment.

The Huang Di Nei Jing (Yel­low Em­peror’s In­ner Canon) com­piled dur­ing the Qin and Han times (221 BC-AD 220) of­fered sys­tem­atic dis­courses on hu­man phys­i­ol­ogy, on pathol­ogy, on the symp­toms of ill­ness, on pre­ven­tive treat­ment, and on the prin­ci­ples and meth­ods of treat­ment. This book de­fined the frame­work of TCM, thus serv­ing as a land­mark in TCM’s de­vel­op­ment and sym­bol­iz­ing the trans­for­ma­tion from the ac­cu­mu­la­tion of clin­i­cal ex­pe­ri­ence to the sys­tem­atic sum­ma­tion of the­o­ries. A the­o­ret­i­cal frame­work for TCM had been in place.

The Shang Han Za Bing Lun (Trea­tise on Fe­brile Dis­eases and Mis­cel­la­neous Ill­nesses) col­lated by Zhang Zhong jing in the Eastern Han Dy­nasty (25-220) ad­vanced the prin­ci­ples and meth­ods to treat fe­brile dis­eases due to ex­oge­nous fac­tors (in­clud­ing pesti­lences). It ex­pounds on the rules and prin­ci­ples of dif­fer­en­ti­at­ing the pat­terns of mis­cel­la­neous ill­nesses caused by in­ter­nal ail­ments, in­clud­ing their pre­ven­tion, pathol­ogy, symp­toms, ther­a­pies, and treat­ment. It es­tab­lishes the the­ory and method­ol­ogy for syn­drome pat­tern di­ag­no­sis and treat­ment dif­fer­en­ti­a­tion. The Shen Nong Ben Cao Jing (Shen­nong’s Clas­sic of Ma­te­ria Med­ica) — an­other master­piece of med­i­cal lit­er­a­ture ap­peared dur­ing this pe­riod — out­lines the the­ory of the com­pat­i­bil­ity of medic­i­nal in­gre­di­ents. For ex­am­ple, it holds that a pre­scrip­tion should in­clude at the same time the jun (or sov­er­eign), chen (or min­is­ter), zuo (or as­sis­tant) and shi (or mes­sen­ger) in­gre­di­ent drugs, and should give ex­pres­sion to the har­mony of the seven emo­tions as well as the prop­er­ties of drugs known as “four na­tures” and “five fla­vors”. All this pro­vides guid­ance to the pro­duc­tion of TCM pre­scrip­tions, safe ap­pli­ca­tion of TCM drugs and en­hance­ment of the ther­a­peu­tic ef­fects, thus lay­ing the foun­da­tion for the for­ma­tion and de­vel­op­ment of TCM phar­ma­ceu­ti­cal the­ory. In the late years of the Eastern Han Dy­nasty, Hua Tuo (c. 140-208) was recorded to be the first per­son to use anes­thetic (mafeisan) dur­ing surgery.

The Zhen Jiu Jia Yi Jing (AB Canon of Acupunc­ture and Mox­i­bus­tion) by Huangfu Mi dur­ing the Western Jin time (265-316) ex­pounded on the con­cepts of zangfu (in­ter­nal or­gans) and jingluo (merid­i­ans and col­lat­er­als). This was the point when the­ory of jingluo and acupunc­ture and mox­i­bus­tion be­gan to take shape.

Sun Simiao, a great doctor of the Tang Dy­nasty (618-907), pro­posed that mas­ter­ship of medicine lies in pro­fi­cient med­i­cal skills and lofty med­i­cal ethics, which even­tu­ally be­came the em­bod­i­ment of a moral value of the Chi­nese na­tion, a core value that has been con­sci­en­tiously up­held by the TCM cir­cles.

A her­bol­ogy and na­ture master­piece, the Ben Cao Gang Mu (Com­pendium of Ma­te­ria Med­ica) com­piled by Li Shizhen in the Ming Dy­nasty (1368-1644) was the first book in the world that sci­en­tif­i­cally cat­e­go­rized medic­i­nal herbs. It was a pi­o­neer­ing work that ad­vanced TCM phar­ma­ceu­ti­cal the­ory.

The Wen Re Lun (A Trea­tise on Epi­demic Fe­brile Dis­eases) by Ye Tian­shi dur­ing the Qing Dy­nasty (1644-1911) de­vel­oped the prin­ci­ples and meth­ods for pre­ven­tion and treat­ment of pesti­len­tial fe­brile dis­eases. It rep­re­sents the the­ory and re­sults of the prac­tice of TCM in pre­vent­ing and treat­ing such dis­eases.

Fol­low­ing the spread of Western medicine in China from the midQing Dy­nasty, es­pe­cially dur­ing the pe­riod of the Repub­lic of China (1912-49), some TCM ex­perts be­gan to ex­plore ways to ab­sorb the essence of Western medicine for a com­bi­na­tion of TCM with Western medicine.

Dur­ing its course of de­vel­op­ment span­ning a cou­ple of mil­len­nia, TCM has kept draw­ing and as­sim­i­lat­ing ad­vanced el­e­ments of nat­u­ral sci­ence and hu­man­i­ties. Through many in­no­va­tions, its the­o­ret­i­cal base cov­ered more ground and its reme­dies against var­i­ous dis­eases ex­panded, dis­play­ing unique char­ac­ter­is­tics.

TCM deems that the re­la­tion­ship be­tween hu­mans and na­ture is an in­ter­ac­tive and in­sep­a­ra­ble whole, as are the re­la­tion­ships be­tween hu­mans and the so­ci­ety, and be­tween the in­ter­nal or­gans of the hu­man body, so it val­ues the im­pacts of nat­u­ral and so­cial en­vi­ron­ment on health and ill­ness. More­over, it be­lieves that the mind and body are closely con­nected, em­pha­siz­ing the co­or­di­na­tion of phys­i­cal and men­tal fac­tors and their in­ter­ac­tions in the con­di­tions of health and ill­ness.

TCM lays par­tic­u­lar stress on the im­por­tance of har­mony on health, hold­ing that a per­son’s phys­i­cal health de­pends on har­mony in the func­tions of the var­i­ous body or­gans, the mod­er­ate sta­tus of the emo­tional ex­pres­sion, and adap­ta­tion and com­pli­ance to dif­fer­ent en­vi­ron­ments, of which the most vi­tal is the dy­namic bal­ance be­tween yin and yang. The fun­da­men­tal rea­son for ill­ness is that var­i­ous in­ter­nal and ex­ter­nal fac­tors dis­turb the dy­namic bal­ance. There­fore, main­tain­ing health ac­tu­ally means con­serv­ing the dy­namic bal­ance of body func­tions, and cur­ing dis­eases means restor­ing chaotic body func­tions to a state of co­or­di­na­tion and har­mony.

TCM treats a dis­ease based on full con­sid­er­a­tion of the in­di­vid­ual con­sti­tu­tion, cli­matic and sea­sonal con­di­tions, and en­vi­ron­ment. This is em­bod­ied in the term “giv­ing treat­ment on the ba­sis of syn­drome dif­fer­en­ti­a­tion”. Syn­drome dif­fer­en­ti­a­tion means di­ag­nos­ing an ill­ness as a cer­tain syn­drome on the ba­sis of an­a­lyz­ing the spe­cific symp­toms and phys­i­cal signs col­lected by way of in­spec­tion, aus­cul­ta­tion & ol­fac­tion, in­quiry, and pal­pa­tion, while giv­ing treat­ment means defin­ing the treat­ment ap­proach in line with the syn­drome dif­fer­en­ti­ated. TCM ther­a­pies fo­cus on the per­son who is sick rather than the ill­ness that the pa­tient con­tracts, i.e., aim­ing to re­store the har­mo­nious state of body func­tions that is dis­rupted by path­o­genic fac­tors.

Pre­ven­tive treat­ment is a core be­lief of TCM, which lays great em­pha­sis on pre­ven­tion be­fore a dis­ease arises, guard­ing against patho­log­i­cal changes when fall­ing sick, and pro­tect­ing re­cov­er­ing pa­tients from re­lapse. TCM be­lieves that life­style is closely re­lated to health, so it ad­vo­cates health should be pre­served in daily life. TCM thinks that a per­son’s health can be im­proved through emo­tional ad­just­ment, bal­anced la­bor and rest, a sen­si­ble diet, and a reg­u­lar life, or through ap­pro­pri­ate in­ter­ven­tion in the life­style based on peo­ple’s spe­cific phys­i­cal con­di­tions. By these means, peo­ple can cul­ti­vate vi­tal en­ergy to pro­tect them­selves from harm and keep healthy.

TCM doc­tors di­ag­nose pa­tients through in­spec­tion, aus­cul­ta­tion and ol­fac­tion, in­quiry, and pal­pa­tion. In ad­di­tion to med­i­ca­tion, TCM has many non­phar­ma­co­log­i­cal al­ter­na­tive ap­proaches such as acupunc­ture and mox­i­bus­tion, tu­ina (mas­sage), cup­ping and guasha (spoon­ing). There is no need for com­plex equip­ment. TCM tools, for ex­am­ple, the small splints used in Chi­nese os­teopa­thy, the spoons used in guasha, or the cups used in cup­ping ther­apy, can draw from ma­te­ri­als close at hand, so that such treat­ments can spread eas­ily.

TCM is an im­por­tant com­po­nent and a char­ac­ter­is­tic fea­ture of tra­di­tional Chi­nese cul­ture. Ap­ply­ing such prin­ci­ples as “man should ob­serve the law of the na­ture and seek for the unity of the heaven and hu­man­ity”, “yin and yang should be bal­anced to ob­tain the golden mean”, and “prac­tice of medicine should aim to help peo­ple”, TCM em­bod­ies the core value of Chi­nese civ­i­liza­tion. TCM also ad­vo­cates “full con­sid­er­a­tion of the en­vi­ron­ment, in­di­vid­ual con­sti­tu­tion, and cli­matic and sea­sonal con­di­tions when prac­tic­ing syn­drome dif­fer­en­ti­a­tion and de­ter­min­ing ther­a­pies”, “re­in­forc­ing the fun­da­men­tal and cul­ti­vat­ing the vi­tal en­ergy, and strength­en­ing ten­dons and bones”, and “mas­ter­ship of medicine ly­ing in pro­fi­cient med­i­cal skills and lofty med­i­cal ethics”, all con­cepts that en­rich Chi­nese cul­ture and pro­vide an en­light­ened base from which to study and trans­form the world.

TCM orig­i­nated in the Chi­nese cul­ture. It ex­plains health and dis­eases from a macro, sys­temic and holis­tic per­spec­tive. It shows how China per­ceives na­ture. As a unique form of medicine, TCM ex­er­cises a pro­found in­flu­ence on the life of the Chi­nese peo­ple. It is a ma­jor means to help the Chi­nese peo­ple main­tain health, cure dis­eases, and live a long life. The Chi­nese na­tion has sur­vived count­less nat­u­ral dis­as­ters, wars and pesti­lences, and con­tin­ues to pros­per. In this process, TCM has made a great con­tri­bu­tion.

Born in China, TCM has also ab­sorbed the essence of other civ­i­liza­tions, evolved, and grad­u­ally spread through­out the world. As early as the Qin and Han dy­nas­ties (221 BC-AD 220), TCM was pop­u­lar in many neigh­bor­ing coun­tries and ex­erted a ma­jor im­pact on their tra­di­tional medicines. The TCM small­pox vac­ci­na­tion tech­nique had al­ready spread out­side of China dur­ing the Ming and Qing dy­nas­ties (1368-1911). The Ben Cao Gang Mu (Com­pendium of Ma­te­ria Med­ica) was trans­lated into var­i­ous lan­guages and widely read, and Charles Dar­win, the British bi­ol­o­gist, hailed the book as an “an­cient Chi­nese en­cy­clo­pe­dia”. The re­mark­able ef­fects of acupunc­ture and mox­i­bus­tion have won it pop­u­lar­ity through­out the world. The dis­cov­ery of qing­haosu (artemisinin, an anti-malaria drug) has saved mil­lions of lives, es­pe­cially in de­vel­op­ing coun­tries. Mean­while, mas­sive im­ports of medic­i­nal sub­stances such as frank­in­cense and myrrh have en­riched TCM ther­a­pies.

II. Poli­cies and Mea­sures on TCM

China lays great store by the de­vel­op­ment of TCM. When the Peo­ple’s Repub­lic was founded in 1949, the gov­ern­ment placed em­pha­sis on unit­ing Chi­nese and Western medicine as one of its three guide­lines for health work, and en­shrined the im­por­tant role of TCM. In 1978, the Com­mu­nist Party of China Cen­tral Com­mit­tee trans­mit­ted through­out the coun­try the Min­istry of Health’s “Re­port on Im­ple­ment­ing the Party’s Poli­cies Re­gard­ing TCM and Cul­ti­vat­ing TCM Prac­ti­tion­ers”, and lent great sup­port in ar­eas of hu­man re­sources, fi­nance, and sup­plies, vig­or­ously pro­mot­ing the de­vel­op­ment of TCM. It is stip­u­lated in the Con­sti­tu­tion of the PRC that the state pro­motes mod­ern medicine and tra­di­tional Chi­nese medicine to pro­tect the peo­ple’s health. In 1986, the State Coun­cil set up a rel­a­tively in­de­pen­dent ad­min­is­tra­tion of TCM. All prov­inces, au­ton­o­mous re­gions, and mu­nic­i­pal­i­ties di­rectly un­der the cen­tral gov­ern­ment have es­tab­lished their re­spec­tive TCM ad­min­is­tra­tions, which has laid an or­ga­ni­za­tional ba­sis for TCM de­vel­op­ment. At the Fourth Meet­ing of the Sev­enth Na­tional Peo­ple’s Congress, equal em­pha­sis was put on Chi­nese and Western medicine, which was made one of the five guide­lines in China’s health work in the new pe­riod. In 2003 and 2009, the State Coun­cil is­sued the “Reg­u­la­tions of the Peo­ple’s Repub­lic of China on Tra­di­tional Chi­nese Medicine” and the “Opin­ions on Sup­port­ing and Pro­mot­ing the De­vel­op­ment of Tra­di­tional Chi­nese Medicine”, grad­u­ally form­ing a rel­a­tively com­plete pol­icy sys­tem on TCM.

Since the CPC’s 18th Na­tional Congress in 2012, the Party and the gov­ern­ment have granted greater im­por­tance to the de­vel­op­ment of TCM, and made a se­ries of ma­jor pol­icy de­ci­sions and adopted a num­ber of plans in this re­gard. At the Na­tional Con­fer­ence on Hy­giene and Health held in Au­gust 2016, Pres­i­dent Xi Jin­ping em­pha­sized the im­por­tance of re­vi­tal­iz­ing and de­vel­op­ing tra­di­tional Chi­nese medicine. The CPC’s 18th Na­tional Congress and the Fifth Ple­nary Ses­sion of the 18th CPC Cen­tral Com­mit­tee both re­it­er­ated the ne­ces­sity to pay equal at­ten­tion to the de­vel­op­ment of tra­di­tional Chi­nese medicine and Western medicine and lend sup­port to the de­vel­op­ment of TCM and eth­nic mi­nor­ity medicine. In 2015, the ex­ec­u­tive meet­ing of the State Coun­cil ap­proved the Law on Tra­di­tional Chi­nese Medicine (draft) and sub­mit­ted it to the Stand­ing Com­mit­tee of the Na­tional Peo­ple’s Congress for de­lib­er­a­tion and ap­proval, in­tend­ing to pro­vide a sounder pol­icy en­vi­ron­ment and le­gal ba­sis for TCM de­vel- op­ment. In 2016 the CPC Cen­tral Com­mit­tee and the State Coun­cil is­sued the Out­line of the Healthy China 2030 Plan, a guide to im­prov­ing the health of the Chi­nese peo­ple in the com­ing 15 years. It sets out a se­ries of tasks and mea­sures to im­ple­ment the pro­gram and de­velop TCM. The State Coun­cil is­sued the Out­line of the Strate­gic Plan on the De­vel­op­ment of Tra­di­tional Chi­nese Medicine (2016-30), which made TCM de­vel­op­ment a na­tional strat­egy, with sys­temic plans for TCM de­vel­op­ment in the new era. These de­ci­sions and plans have mapped out a grand blue­print that fo­cuses on the full re­vi­tal­iza­tion of TCM, ac­cel­er­ated re­form of the med­i­cal and health­care sys­tem, the build­ing of a med­i­cal and health­care sys­tem with Chi­nese char­ac­ter­is­tics, and the ad­vance­ment of the healthy China plan, thus ush­er­ing in a new era of de­vel­op­ment for TCM.

The ba­sic prin­ci­ples and main mea­sures en­vi­sioned to de­velop TCM are: TCM roots deep among the pub­lic, and the philoso­phies it con­tains are easy to un­der­stand. To meet the peo­ple’s de­mand for health­care, China en­deav­ors to ex­pand the sup­ply of TCM ser­vices, im­prove com­mu­nitylevel TCM health man­age­ment, ad­vance the in­te­gral de­vel­op­ment of TCM with com­mu­nity ser­vice, care of the el­derly and tourism, spread knowl­edge of TCM and ad­vo­cate healthy ways of life and work, en­hance wel­fare for the pub­lic, and en­sure that the peo­ple can en­joy safe, ef­fi­cient, and con­ve­nient TCM ser­vices.

Equal sta­tus shall be ac­corded to TCM and Western medicine in terms of ide­o­log­i­cal un­der­stand­ing, le­gal sta­tus, aca­demic de­vel­op­ment, and prac­ti­cal ap­pli­ca­tion. Ef­forts shall be made to im­prove sys­tem of ad­min­is­tra­tion re­lated to TCM, in­crease fi­nan­cial in­put, for­mu­late poli­cies, laws and reg­u­la­tions suited to the unique fea­tures of TCM, pro­mote co­or­di­nated de­vel­op­ment of TCM and Western medicine, and make sure that they both serve the main­te­nance and im­prove­ment of the peo­ple’s health.

The state en­cour­ages ex­changes be­tween TCM and Western medicine, and cre­ates op­por­tu­ni­ties for Western med­i­cal prac­ti­tion­ers to learn from their TCM coun­ter­parts. Mod­ern medicine cour­ses are of­fered at TCM col­leges and uni­ver­si­ties to strengthen the cul­ti­va­tion of doc­tors who have a good knowl­edge of both TCM and Western medicine. In ad­di­tion to the gen­eral de­part­ments, TCM hos­pi­tals have been en­cour­aged to open spe­cial­ized de­part­ments for spe­cific dis­eases. Gen­eral hos­pi­tals and com­mu­nity-level med­i­cal care or­ga­ni­za­tions have been en­cour­aged to set up TCM de­part­ments, and TCM has been made avail­able to pa­tients in the ba­sic med­i­cal care sys­tem and ef­forts have been made to make it play a more im­por­tant role in ba­sic med­i­cal care. A mech­a­nism has been es­tab­lished for TCM to par­tic­i­pate in med­i­cal re­lief of pub­lic emer­gen­cies and the pre­ven­tion and con­trol of se­ri­ous in­fec­tious dis­eases.

A sys­tem has been es­tab­lished to carry for­ward the the­o­ries and clin­i­cal ex­pe­ri­ence of well-known vet­eran TCM ex­perts, and ef­forts have been made to re­dis­cover and cat­e­go­rize an­cient TCM clas­sics and folk med­i­cal ex­pe­ri­ence and prac­tices. A sys­tem of tech­no­log­i­cal in­no­va­tion has been es­tab­lished to ad­vance TCM progress, and ef­forts have been made to carry out sys­temic re­search on the fun­da­men­tal the­o­ries, clin­i­cal di­ag­no­sis and treat­ment, and ther­a­peu­tic eval­u­a­tion of TCM. In­ter­dis­ci­plinary ef­forts have been or­ga­nized in joint re­search on the treat­ment and con­trol of ma­jor dif­fi­cult and com­pli­cated dis­eases and ma­jor in­fec­tious dis­eases, as well as re­search on the pre­ven­tion and treat­ment of com­mon dis­eases, fre-

JONAS EKSTROMER / REUTERS

Tu Youyou, win­ner of the 2015 No­bel Prize in Phys­i­ol­ogy or Medicine, re­ceives her award from King Carl Gustaf of Swe­den in Stockholm. Tu dis­cov­ered (artemisinin) which is now widely used to treat the trop­i­cal dis­ease of malaria.

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