针灸:有效还是假象?

作者:十三大爷  于 2010-4-25 10:18 发表于 最热闹的华人社交网络--贝壳村

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现代的科技发展太快了,即使是学过中医的人也不见得了解现今对中医,气功和针灸的基础理论研究。这是我为什么推荐大家常读维基百科的原因。
针灸
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针灸[1]是 在中医学中采用刺或火人体穴位来治疗疾病的 方法。针由远古时代的骨针石砭开始发展到长短、大小、式样、材料、方法各不相同的针具,如电针、磁针、水针 等;灸偏向于传统的艾灸,有艾绒灸艾条灸等,现代医学中采用红外线照射也有类似作用。现代使用的针灸多是钢针,而在古代多使用的是银针, 其功效要比钢针好。

相传伏羲氏九针。为九种针具的总称。出《黄帝内经》。即镵针、员针、鍉针、锋针、铍针、员利针、毫针、长针和大针。《灵枢·官针》:“九针之宜,各有所为; 长短大小,各有所施也,不得其用,病弗能移。”指出九针的形状、用途各异,据情选用,方可去病。

针与灸是治疗方法的两个方面,多用针法来治疗急性病,用灸法来治疗慢性病。中医学中针灸治疗的理论基础在于传统的中医脏腑阴阳经络学说。和中医的方剂治 疗方法相比较,针灸治疗的特点是疗效快、简单、便宜。

目录 [隐藏]
// [编辑] 历史

针灸起源于中国,具有悠久的历史。针刺法萌发于新石器时代,当人们发生某些病痛或不适的时候,不自觉地用手按摩、捶拍,以至 用尖锐的石器按压疼痛不适的部位,而使原有的症状减轻或消失,最早的针具:砭石也之而生,随着古人智慧和社会生产力的不断发展,针具逐渐发展成青铜针、铁 针、金针、银针,直到现在用的不锈钢针。相传,华夏文明的始祖伏羲中医针灸的发明人。伏羲氏不仅画八卦, 结绳为网,教民田猎,而且“尝百药而制九针”(东汉皇甫谧记载于《帝王世纪》)、“尝草制砭”(南宋罗泌记 载于《路 史》)。砭就是砭石,即华夏民 族最早的针灸。灸法的起源与为的发现和使用有着密切的关系,当身体有某种不适时,用以去烘烤得以减轻,继而用各种树枝作为施灸工具,逐渐发展到艾灸。

针灸治疗方法是在漫长的历史过程中形成的,其学术思想也随着临床医学经验的积累渐渐完善。1973年长沙马王堆三号墓出土的医学帛书中有《足臂十一脉灸经》和《阴阳十一脉灸经》,论述了十一条脉的循行分布、病候表现和灸法治疗等, 已形成了完整的经络系统。《黄帝内经》是现存的中医文献中最早而且完整的中医经典著作,已经形成了完整的经络系统,即有十二经脉、十五络脉、十 二经筋、十二经别以及与经脉系统相关的标本、根结、气街、四海等,并对腧穴、针灸方法、针刺适应症和禁忌症等也做了详细的论述,尤其是《灵枢经》所记载的针灸理论更为丰富而系统,所以《灵枢》是针灸学术的第一次总 结,其主要内容至今仍是针灸滨核心内容,故《灵枢》称为《针经》。继《内经》之后,战国时代的神医扁鹊所 著《难经》对针灸学说进行了补充和完善。

晋代医学家皇甫谧潜心钻研《内经》等著作,撰写成《针灸甲乙经》,书中全面论述了脏腑经络学说,发展并确定了349个穴 位,并对其位置、主治、操作进行了论述,同时介绍了针灸方法及常见病的治疗,是针灸学术的第二次总结。

时期,随着经济文化的 繁荣昌盛,针灸学术也有很大的发展,唐代医学家孙思邈在其著作《备急千金要方》中绘制了彩色的"明堂三人图",并提出阿是穴的取法及应用。到了宋代,著名针灸学家王惟一编撰了《铜人腧穴针灸图经》,考证了354个腧穴,并将全书刻于石碑上供学习 者参抄拓印,他还铸造了2具铜人模型,外刻经络腧穴,内置脏腑,作为针灸教学的直观教具和考核针灸医生之用,促进了针灸学术的发展。

元代滑伯仁所者的《十四经发挥》,首次将十二经脉与任、督二脉合称为十四经脉,对后人研究经脉 很有裨益。

明代是针灸学术发展的鼎盛时期,名医辈出,针灸理论研究逐渐深化,也出现了大量的针灸专著,如《针灸大全》、《针灸聚英》、《针灸四书》,特别是杨继洲所著的《针灸大成》,汇集了明以前的针灸著作,总结了临床经验,内容丰富,是后世学习 针灸的重要参考书,是针灸学术的第三次总结。

清初至民国时期,虽然针灸医学由兴盛逐渐走向衰退,但由于针灸深得民心,故仍有《针灸逢源》等著作流传下来。

中华人民共和国成立50年以来,以继承为基础,结合现代医家的临床经验和科研成果,出版了大量的针灸学术专著 和论文,还成立了中国针灸学会,学术交流十分活跃,首创"针刺麻醉"。针灸的研究也从单一的文献整理发展到对其治病的临床疗效进行系统 的观察,结合现代生理学、解剖学、组织学、生化学、免疫学、分子生物学等学科进行针灸治疗的机理探讨,取得了可喜的成就。

针灸学虽源于中国,但早在公元6世纪就传到了朝鲜日本等 国。近年来,随着中外文化交流的不断深入,针灸也随之传到世界各地。为了加速针灸医学的广泛传播,在中国北京上海南京设立了三大国际针灸培训中心,以培养世界各地的针灸人才。1987年成立了世界针灸学会联合会(简称"世界针联"),推动了针灸事业的不断发 展。

针灸灸疗法包括针刺和灸灼两种不同的治疗方法。针刺法也称针治法,是运用一定的操作手法,把金属制成的、形体细长而尖的针刺入人体的某一固定的部位 (穴位),使接受针刺才发生酸、麻、胀、重等感觉,从而产生治疗疾病的作用。灸灼法也称为灸治法,是将艾 绒揉成小团或长条状,点燃后放在(或靠近)人体体表的某些固定的部位,施行热熨或熏,从现时达到治疗疾病的目的。

中国宋代的铜人,上有穴位标注。
[编辑] 原理

中医学认为,人体中的经络系统负责输送全身的“气”、“血”及“津液”,这些输送物质在体内循环,使身体中的各个组织与器官保持平衡与稳定。然而当 经络系统出现阻塞不通的情况时,则影响了这些物质的输送,使“邪气”(各种产生病变的因子)侵入,此时人体就会开始出现异常病变。当针灸的针插进人体之 后,会引起人体自身的反应,加强气血循环,克服经络的阻塞,使经络系统恢复正常,病症因此得以治愈。

[编辑] 对针灸的质疑

对于针灸的质疑,主要是因为针灸的理论基础源于中医学,与现代医学的思维模式相距甚大。中国科学界对于针灸的研究已经有半个世纪,特别是针刺麻醉或者针刺止痛原理的研究,居于世界前列。但是近年来西方对于针灸研究的投入正在不断加大[来源请求]

世界卫生组织(WHO)在1979年所出版的刊物中认可针灸在某些症状中有治疗作用[2]。Cochrane Collaboration的科学家认为针灸对戒烟、气喘、抗类风湿关节炎、头疼等问题没有效用。2007年9月《内医档案》杂志刊登,德国雷根斯堡大学迈克尔·哈克博士主持的实验使用1162名腰痛病患分3组分别进行针灸、假针灸和常规治疗对比试验。发现腰痛情况好转的人,针灸组有47.6%,假针灸 组有44.2%,常规治疗组有27.4%。针灸组和假针灸组没有统计学意义的差别。[3][4]2009 年西雅图的一个研究小组主持的研究表明,对长期腰疼患者,针灸和假针的治疗效果都比传统方法好,但是针灸和假针的疗效没有显著差异。[5]

世界卫生组织在2003年发表了《Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials》,认为有对照试验证实针灸可 有效治疗若干疾病、症状或状态,针灸对于另外一些病症的疗效尚需要更多证据确认,同文又列出了疗效未有足够证据支持,但是可尝试针灸的一些病症。[6]

根据2002年一项全国性调查的结果,全美有八百二十万成年人曾经使用过针灸,有二百一十万人曾在过去一年内进行过针灸。[7]

美国国立卫生研究院(NIH)下属十七个研究所或中心,其中有美国国立替代与补充医学中心(NCCAM),专门从事研究 包括中医、针灸在内的“非西方主流医学”,其中针灸是研究的热门之一,不仅NCCAM对其有很多的立项,其它院所,比如美国 国立癌 症研究所也有很多投入。应用循证医学的方法,多中心、多盲法进行临床研究。[来源请求]1997年NIH的一份报告指出:临床前研究 记录了针灸在某些疾病治疗方面有一些效果,但同时在一些其他研究中没有效果。[8]

[编辑] 美国的针灸界

美国目前有大约3万多名执照针灸师(有的州称为针灸医师或东方医学医师),5千多名应用针灸的西医师。美 国有严格的针灸执照考试制度,要求考试申请人在美国高教部认可的针灸或中医学校学习针灸的相关课程1700到4000学时。[9]

[编辑] 注释
  1. ^ 拼音zhēn jiǔ,注音ㄓㄣ¯ ㄐ一ㄡˇ
  2. ^ Bannerman RH. 1979 “针灸:世界卫生组织的看法”世界卫生组织(英文)
  3. ^ 哪里来的穴位?哪里来的经络?快看德国最新研究报告
  4. ^ 德实验发现:中医针灸治疗腰痛比物理治疗更有效,广州日报
  5. ^ Cherkin DC, Sherman KJ, Avins AL, et al. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Archives of Internal Medicine. 2009;169[9]:858–866.
  6. ^ Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials,第23-26页。(非pdf版见[1]
  7. ^ http://nccam.nih.gov/health/acupuncture/introduction.htm
  8. ^ [2])
  9. ^ 请参看www.nccaom.org.

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发表评论 评论 (27 个评论)

2 回复 ww_719 2010-4-25 10:33
在加州,看针灸是保险是cover的,而且,我去看的一个美国医生群组里,有专门的针灸医生,美国医生在我得到他的治疗后,会建议我去试他们group里的针灸...如果都没效果,那为什么加州保险cover这个,为什么美国医生群里建议去做针灸呢?哈哈哈..
2 回复 十三大爷 2010-4-25 11:09
ww_719: 在加州,看针灸是保险是cover的,而且,我去看的一个美国医生群组里,有专门的针灸医生,美国医生在我得到他的治疗后,会建议我去试他们group里的针灸...如果都没效果
我懒得翻译了-来自维基百科英文板,请自己读完。总而言之:针灸只属于替代医学。国家健康属NIH和美国医生协会AMA都提出了针灸的适应症。最主要的适应症是疼痛。从我贴的那段,你看懂了“假针”在穴位可以提供在近乎针灸同样的镇疼效果吗?有一种学说:皮下近于穴位的针刺会释放nitric oxide有抑制疼痛的作用。Bottom line: 针灸没有说的那么神,仅仅属于替代医学,而且适应症有限。

Evidence-based medicine

There is scientific agreement that an evidence-based medicine (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organizations such as the Cochrane Collaboration and Bandolier publish such reviews. In practice, EBM is "about integrating individual clinical expertise and the best external evidence" and thus does not demand that doctors ignore research outside its "top-tier" criteria.[80]

The development of the evidence base for acupuncture was summarized in a review by researcher Edzard Ernst and colleagues in 2007. They compared systematic reviews conducted (with similar methodology) in 2000 and 2005:

    The effectiveness of acupuncture remains a controversial issue. ... The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.[8]

For acute low back pain there is insufficient evidence to recommend for or against either acupuncture or dry needling, though for chronic low back pain acupuncture is more effective than sham treatment but no more effective than conventional and alternative treatments for short-term pain relief and improving function. However, when combined with other conventional therapies, the combination is slightly better than conventional therapy alone.[15][81] A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain.[82]

There are both positive[83] and negative[84] reviews regarding the effectiveness of acupuncture when combined with in vitro fertilisation.

A Cochrane Review concluded that acupuncture was effective in reducing the risk of post-operative nausea and vomiting with minimal side effects, though it was less than or equal to the effectiveness of preventive antiemetic medications.[16] A 2006 review initially concluded that acupuncture appeared to be more effective than antiemetic drugs, but the authors subsequently retracted this conclusion due to a publication bias in Asian countries that had skewed their results; their ultimate conclusion was in line with the Cochrane Review - acupuncture was approximately equal to, but not better than preventive antiemetic drugs in treating nausea.[85] Another Cochrane Review concluded that electroacupuncture can be helpful in the treatment of vomiting after the start of chemotherapy, but more trials were needed to test their effectiveness versus modern antivomiting medication.[86]

There is moderate evidence that for neck pain, acupuncture is more likely to be effective than sham treatment and offers short-term improvement compared to those on a waiting list.[87]

There is evidence to support the use of acupuncture to treat headaches that are idiopathic, though the evidence is not conclusive and more studies need to be conducted.[88] Several trials have indicated that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment.[89]

There is conflicting evidence that acupuncture may be useful for osteoarthritis of the knee, with both positive,[90][91] and negative[92] results. The Osteoarthritis Research Society International released a set of consensus recommendations in 2008 that concluded acupuncture may be useful for treating the symptoms of osteoarthritis of the knee.[93]

A systematic review of the best five randomized controlled trials available concluded there was insufficient evidence to support the use of acupuncture in the treatment of the symptoms of fibromyalgia.[94]

For the following conditions, the Cochrane Collaboration has concluded there is insufficient evidence to determine whether acupuncture is beneficial, often because of the paucity and poor quality of the research, and that further research is needed:

    * Chronic asthma[95]
    * Bell's palsy[96]
    * Cocaine dependence[97]
    * Depression[98]
    * Primary dysmenorrhoea (incorporating TENS [99]
    * Epilepsy[100]

       

    * Glaucoma[101]
    * Insomnia[102]
    * Irritable bowel syndrome[103]
    * Induction of childbirth[104]
    * Rheumatoid arthritis[105]
    * Shoulder pain[106]

       

    * Schizophrenia[107]
    * Smoking cessation[108]
    * Acute stroke[109]
    * Stroke rehabilitation[110]
    * Tennis elbow[111]
    * Vascular dementia[112]

Positive results from some studies on the efficacy of acupuncture may be as a result of poorly designed studies or publication bias.[113][114] Edzard Ernst and Simon Singh state that as the quality of experimental tests of acupuncture have increased over the course of several decades (through better blinding, the use of sham needling as a form of placebo control, etc.) the results have demonstrated less and less evidence that acupuncture is better than placebo at treating most conditions.[115]
[edit] Neuroimaging studies

A 2005 literature review examining the use of magnetic resonance imaging and positron emission tomography to document the brainwave activity caused by acupuncture[116] concluded that neuroimaging data to date show some promise for being able to distinguish the cortical effects of expectation, placebo, and real acupuncture. The studies reviewed were mostly small and pain-related, and more research is needed to determine the specificity of neural substrate activation in non-painful indications.
[edit] NIH consensus statement

In 1997, the United States National Institutes of Health (NIH) issued a consensus statement on acupuncture that concluded that despite research on acupuncture being difficult to conduct, there is sufficient evidence to expand its use and encourage further studies of the phenomenon. The statement was not a policy statement of the NIH but is the considered assessment of a panel convened by the NIH. The consensus group also noted the relative safety of acupuncture compared to certain other medical interventions. They stated that deciding when to use it in clinical practice depends on multiple factors, including the experience of the clinician, the information available on the treatment, and the individual patient's characteristics.[9]

The consensus statement, and the conference that made it, have been criticized by Wallace Sampson, writing for an affiliated publication of Quackwatch. Sampson stated that the meeting was chaired by a strong proponent of acupuncture, failed to include speakers who had obtained negative results on studies of acupuncture, and that he believed the report showed evidence of pseudoscientific reasoning.[117]

In 2006 the NIH's National Center for Complementary and Alternative Medicine continues to abide by the recommendations of the NIH Consensus Statement the effects of acupuncture have been documented, even if research is still unable to explain its mechanism and relationship to Western medicine.[20]
[edit] World Health Organization statement

In 2003, the World Health Organization's Department of Essential Drugs and Medicine Policy published a report on acupuncture that listed a series of diseases, symptoms or conditions for which acupuncture has been demonstrated as an effective treatment:[17]

    * Acute bacillary dysentery
    * Adverse reactions to radiotherapy and/or chemotherapy
    * Allergic rhinitis
    * Biliary colic
    * Depression
    * Essential hypertension
    * Headache
    * Induction of childbirth and correction of the malposition of fetus
    * Inflammation of the tissues surrounding the shoulder
    * Leukopenia
    * Nausea and vomiting including morning sickness
    * Pain in the epigastrium, face, neck, tennis elbow, lower back, knee, during dentistry and after operations
    * Primary dysmenorrhea
    * Primary hypotension
    * Renal colic
    * Rheumatoid arthritis
    * Sciatica
    * Sprains
    * Strokes

The report also listed other conditions for which acupuncture may be effective.

The WHO explained the report's purpose:

    "In order to promote the appropriate use of acupuncture in those Member States where acupuncture has not been widely used, this document is annexed with a brief abstract of each relevant reference for the assessment of acupuncture practice. The clinical conditions covered in the existing data are also included. It must be emphasized that the list of diseases, symptoms or conditions covered in this publication is based on collected reports of clinical trials and, so, can serve only as a reference. Only national health authorities can determine the diseases, symptoms and conditions for which acupuncture treatment can be recommended."

The report was controversial; critics say it is cited by supporters as an endorsement of the practice by the WHO.[18] Several scientists also expressed concern that the evidence supporting acupuncture was weak, and that the WHO had been biased by the involvement of practitioners of alternative medicine.[18] The report was criticized in the 2008 book Trick or Treatment for containing two major errors - including too many results from low-quality clinical trials, and including a large number of trials originating in China. The latter issue is considered problematic because trials originating in the West include a mixture of positive, negative and neutral results while all trials in China are positive (the book's authors attribute this to publication bias rather than fraud). The authors also stated that the report was drafted by a panel that included no critics of acupuncture at all, resulting in a conflict of interest.[19]
[edit] American Medical Association statement

In 1997, the following statement was adopted as policy of the American Medical Association (AMA), an association of medical doctors and medical students, after a report on a number of alternative therapies including acupuncture:

    "There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."

Specifically regarding acupuncture, the AMA cited reviews conducted in 1992 and 1993 that stated there was not enough evidence to support acupuncture's effectiveness in treating disease, and called for further research.[118]
2 回复 ww_719 2010-4-25 11:11
你十三大爷: 我懒得翻译了-来自维基百科英文板,请自己读完。总而言之:针灸只属于替代医学。国家健康属NIH和美国医生协会AMA都提出了针灸的适应症。最主要的适应症是疼痛。
您这也太长了,看不懂了,哈哈..
2 回复 十三大爷 2010-4-25 11:17
ww_719: 您这也太长了,看不懂了,哈哈..
就看我回你的第一段中文就够了。您也别想看明白,也别多琢磨,就您这单薄身段,看多了一会儿晚上做恶梦。
2 回复 ww_719 2010-4-25 11:23
你十三大爷: 就看我回你的第一段中文就够了。您也别想看明白,也别多琢磨,就您这单薄身段,看多了一会儿晚上做恶梦。
好,听您的,哈哈..
2 回复 Giada 2010-4-25 13:10
越看越不明白。
2 回复 十三大爷 2010-4-25 19:38
Giada: 越看越不明白。
您没救了。。
2 回复 穿鞋的蜻蜓 2010-4-26 00:36
你十三大爷: 您没救了。。
什么居心
2 回复 十三大爷 2010-4-26 01:10
穿鞋的蜻蜓: 什么居心
那位大姐心眼儿小
2 回复 穿鞋的蜻蜓 2010-4-26 01:33
你十三大爷: 那位大姐心眼儿小
她可是个热心人。
2 回复 十三大爷 2010-4-26 03:05
穿鞋的蜻蜓: 她可是个热心人。
你们都有点傻。。。
2 回复 穿鞋的蜻蜓 2010-4-26 03:19
你十三大爷: 你们都有点傻。。。
啥叫傻?与人为善不对吗。
2 回复 十三大爷 2010-4-26 03:34
穿鞋的蜻蜓: 啥叫傻?与人为善不对吗。
这村里的大多数人写博客只为赚眼球。They don't have a fucking clue what they are talking about and its ramnifications.   Sorry, this may not be applicable to you, but applies to many idiots in this village.  It is so pathetic that people behave like that -- I don't understand their motive at all.
2 回复 穿鞋的蜻蜓 2010-4-26 09:49
你十三大爷: 这村里的大多数人写博客只为赚眼球。They don't have a fucking clue what they are talking about and its ramnifications.   Sorry, this may not be applica
Now I am really clueless  about your 大爷脾气There's nothing wrong with 赚眼球 since most people come here for fun,part of which is get some attention.I understand you may mean some folks are not up to your or whatever standard.Well even if that's true,why should they? Relax your honor乱写几句,喝杯啤酒消消火:)
2 回复 十三大爷 2010-4-26 11:23
穿鞋的蜻蜓: Now I am really clueless  about your 大爷脾气There's nothing wrong with 赚眼球 since most people come here for fun,part of which is get some
I am not offended at all.  To have fun on this website is good and I came here for the same reason.  All I have said is that people should attract the attention of others through some meaningful stuff, not some meaningless tasteless blogs that even themselves would found repelled to read (that's what I meant by 赚眼球).  Does writing meaningful stuff require some degree of intelligence?  Probably yes, but more so a sense of honesty, decency and refusal to be a goo.  This should be the universal standard of this village, at least that's my view.
2 回复 goodoctor 2010-4-26 11:38
good one, but kind hard for the people who are not in biology/medicine field
2 回复 十三大爷 2010-4-26 11:46
goodoctor: good one, but kind hard for the people who are not in biology/medicine field
It is from Wikipedia Chinese straight without a change of a word.  Apparently a Chinese group reported last year the reactive oxygen species aligns with the proposed 经络 in rodent。 I guess the whole body (fluorescent or high-resolution PET) imaging in live human will provide more evidence in the near future.  One thing for sure if 经络 and 气功 really works for our physiology, it is science more than anything else
2 回复 Giada 2010-4-26 11:56
你十三大爷: 您没救了。。
2 回复 穿鞋的蜻蜓 2010-4-26 12:01
你十三大爷: I am not offended at all.  To have fun on this website is good and I came here for the same reason.  All I have said is that people should attract th
Good point. I agree. But again, the standard for judging how  "meaningful"or "tasteful" is often rather subjective and personal ,which is natural. Also reading-writing is an interactive process, which involves not only the writers but also the readers'  interest,taste,etc, and the latter's response can repel or propel the former's desire to focus more on a certain theme, style,etc, . I personally think most bloggers  are writing meaningful if not interesting stuff. To me GIADA's  writing is both meaningful and interesting.Many people here are professionals who come here to relax and share whatever pops up and motivates them.Yes,it can be random and sometimes irritating, I guess that's the way it is,which is more fun:)  I like your view about avoiding "meaningless,tasteless 赚眼球" by having "a sense of honesty, decency and refusal to be a goo."
2 回复 十三大爷 2010-4-26 20:29
穿鞋的蜻蜓: Good point. I agree. But again, the standard for judging how  "meaningful"or "tasteful" is often rather subjective and personal ,
yeah don't be a goo.
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