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PERSPECTIVE
Year : 2020  |  Volume : 9  |  Issue : 5  |  Page : 91-96

COVID 19 in ayurvedic perspective


1 Department of Community Medicine, JSSMC, Hyderabad, Telangana, India
2 Dr. BRKR Government Ayurveda College, Hyderabad, Telangana, India

Date of Submission12-May-2020
Date of Decision24-May-2020
Date of Acceptance13-May-2020
Date of Web Publication04-Jun-2020

Correspondence Address:
Dr. V Kirthana
J P Nagar, Mysore - 570 031, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_110_20

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  Abstract 


The age-old science of Ayurveda has many secrets hidden within. The coronavirus disease is a novel disease, as indicated by its nomenclature also. The plural medical system approach is being implemented to combat the disease. There are many references in the ayurvedic textbooks/classics/Samhitas about janapadodwamsa or epidemics in the age of gods and the management of such epidemics or janapadodwamsa can also be evidenced in the classics of Ayurveda. The principles of Ayurveda can be applied for both preventive and curative aspects of disease. The practical knowledge and the knowledge about the stage of the disease are essential to bridge the ayurvedic principles with the preventive and curative aspects of the disease. The efficiency of ayurvedic drugs is known by practice. However, new drugs can be formulated with a combination of drugs. The search for new drugs and new preventive practices in an integrated approach is what the approach is to be to tackle the novel virus. In this regard, the current paper aims to bridge the preventive aspects of COVID 19 with respect to various stages of disease in ayurvedic aspect.

Keywords: Ayurveda, COVID 19, health, prevention, public


How to cite this article:
Kirthana V, Venkataiah B, Murthy M R. COVID 19 in ayurvedic perspective. Int J Health Allied Sci 2020;9, Suppl S1:91-6

How to cite this URL:
Kirthana V, Venkataiah B, Murthy M R. COVID 19 in ayurvedic perspective. Int J Health Allied Sci [serial online] 2020 [cited 2020 Jul 15];9, Suppl S1:91-6. Available from: http://www.ijhas.in/text.asp?2020/9/5/91/285955




  Introduction Top


(Acharya Charaka in his treatise Charaka samhita, Vimana sthana 3:6 quotes about JANAPADODWAMSA or EPIDEMICS.)

The conversation between Atreya and Agnivesha, which is documented as Charaka samhita, a standard treatise in the Ayurveda science quotes that all though there are dissimilarities between every individual, there are certain factors which are similar among all. They are AIR, WATER, DESHA (Place of living), KALA (time/season). Vitiation among any of these factors manifests diseases having similar symptoms, which ultimately may lead to the destruction of country. Such manifested disease leading to destruction in mass is termed as “JANAPADODWAMSA or EPIDEMIC .”

The history of such an epidemic outbreak dates back to 3000 BC, where an epidemic wiped out a whole village in China. The archaeological site is now called “Hamin Mangha.” The latest being CORONA VIRUS PANDEMIC, named later as COVID-19 or NOVEL CORONA VIRUS DISEASE or nCoV, which began in December 2019 in a Hubei province of China called as Wuhan city.

The virus has affected 206 countries causing 40,777 confirmed deaths and 827,419 confirmed cases globally (as on April 1, 2020).[1] The situation is no less bad in India with 1764 active Cases, 150 Cured/Discharged, 50 deaths and 1 migrated case as on April 2, 2020.[2]

The World Health Organization (WHO) declared it as a pandemic on March 11, 2020.[1]

This pandemic has the following symptoms:[3]

  1. Fever– Usually high grade
  2. Cough– Nonproducive/dry
  3. Shortness of breath
  4. Running nose
  5. Gastrointestinal disturbance– Diarrhea/nausea
  6. Headache.


The symptoms get exhibited within 2–14 days of exposure to virus.[3]

Acharya Charaka, in his treatise has widely explained the etiology, signs/symptoms, and treatment protocol for aagantuja jwara.

(Charaka samhita. Chikitsa sthana. 3:4)

Acharaya Charaka has mentioned that Jwara is that which causes distress to Deha (Body), Indriya (Sense organs), manas (Mental faculty), that which disease which produces greater discomfort among all diseases and that which takes a lot of Bali is termed as Jwara and that is explained by Acharyas initially owing to its importance in its destructive capacity.

Mentioning various types of Jwara's, he also mentioned about Aagantuja jwara, that which is caused by external/foreign bodies or Germs.


  The Current Pandemic Can Be Grouped under Aagantuja Jwara Top


Ayurveda categorizes diseases and treatment in terms of Doshas vitiated (Dushyas), Prakriti of the individual (Body constitution), Adhishthana of disease (Target organ of disease).

However, the treatment of a disease includes much more aspects like Roga marga (Pathway of disease), Kala (Time/Season of disease manifested).

Trying to understand COVID 19 in Ayurveda perspective:


  Doshas Involved– Vata, Pitta Top


Since the disease produces dryness (Dry Cough) and shortness of breath, it can be considered that vitiation of Vata dosha is present.

The presence of high-grade fever annotes vitiation of pitta dosha.


  Roga Marga– Abhyantara Top


Since the disease involves phupusa (lungs), the pathway of the disease can be considered as internal.


  Adhishtana– Phupusa Top


The target organ for the disease manifestation is phupusa or lungs.


  Type of Vyadhi– Agantuja Jwara Top


That which is caused by Virus (Foreign body).


  Kala– Time of Vyadhi– in Indian Context– Summer Top


Most of the cases started by the end of February and the beginning of March, i.e., end of Shishira ritu and beginning of Vasantha ritu.

The period was Ritusandhi, i.e., junction period of two ritus, where it is said that the time is apt for the occurrence of any disease as the immunity of individuals would have reduced.


  Transmission– Droplet Top


Ayurveda way of treatment

The treatment aspect of Ayurveda can be understood in three categories–

  1. Ahara
  2. Vihara
  3. Aushada.


    1. Abhyantara
    2. Bahya.


Aushada– Abhyantara aushadi

Acharya Charaka in his treatise, has explained that Tikta rasa aushadi should be given during Jwara kala.

(Bitter taste dominant medications)

Accordingly, considering the prakriti of the individual, roga and rogi bala, kala and adhisthana of roga the treatment of different type of jwara is to be decided.

Since the COVID is vatapittaja vyadhi,

  1. Kirata– Swertia chirata– Gentianaceae:


  2. The anti-pyretic activity of kirata is documented by RL Singh, Pankaj singh, Anju agarwal that both the crude and purified extracts significantly inhibited cell proliferation and induced apoptosis. It may cure infectious diseases, tonsilitis, bronchitis, pneumonia, whooping cough, acute enteritis, gastritis, urethritis, nephritis, tuberculosis, gall bladder infection, influenza and high blood pressure. Besides, the anti-helmintic, hypoglycemic and antipyretic antifungal and antibacterial properties there are amarogentin (most bitter compound), swerchirin, swertiamarin and other active principles of the herb.[4] The plant also has hypoglycaemic property and hence should be administered carefully

    A study by Bhargava et al. reported the anti-pyretic activity of kirata by studying Antipyretic Potential of Swertia chirata Buch Ham. Root Extract. They reported that the antipyretic effect of the extract was comparable to that of paracetamol (150 mg kg − 1 body weight, p. o.), a standard antipyretic agent.[5]

  3. Amrita– Tinospora cordifolia– Menispermaceae


  4. The antipyretic activity of amrita is very well known and documented. However, its anti-pyretic activity is studied by Upadhyaya et al. reported that traditionally T. cordifolia is known for its jwarahara activity (antipyretic activity). The water-soluble fraction of 95% ethanolic extract of T. cordifolia plant has shown significant antipyretic activity. In another experimental study, antipyretic effects have been reported in the hexane-and chloroform-soluble portions of T. cordifolia stems. Various studies show remarkable anti-infective and antipyretic properties of T. cordifolia. Pre-treatment with T. cordifolia was shown to impart protection against mortality induced by intra-abdominal sepsis following coecal ligation in rats and significantly reduced mortality from induced by Escherichia coli –induced peritonitis in mice[6]

    A study by Neha rawat and Rakesh Roushan reported that Guduchi is highly rich in anti-oxidants. It also has anti-pyretic, anti-viral, and wound healing properties.[7]

  5. Katu rohini– Picrorhiza kurroa-Plantaginaceae


  6. A study by Masood et al. documented that the plant is considered as an important medicinal plant which is mostly used in the traditional medicinal system for asthma, jaundice, fever, malaria, snake bite, and liver disorders. Different pharmacological activities of P. kurroa include anti-microbial, anti-oxidant, anti-bacterial, anti-mutagenic, cardio-protective, hepato-protective, anti-malarial, anti-diabetic, anti-inflammatory, anti-cancer, anti-ulcer, and nephro-protective activities were recorded from this plant[8]

    A study by Krupashree et al. reported that the study demonstrates antioxidant and protective effects of Picrorhiza kurroa against oxidative damage of macromolecules such as DNA, protein, and lipids.[9]

  7. Musta– Cyperus rotundus– Cyperaceae


  8. A review by Nagarajan et al. suggested that both Aconitum heterophyllum and Cyperus rotundus are reported to possess anti-inflammatory, antipyretic, antibacterial and antidiarrheal properties, while anti-inflammatory and antibacterial activities are attributed to C. scariosus.[10]

  9. Vasa– Adathoda vasica– Acanthacea


  10. A potential drug with highly used in Kasa (Cough), Swasa (Respiratory distress/Asthma/Bronchitis) is reviewed by Ankit Gupta and P. K. Prajapati and reported that Highly significant (P < 0.001) results on Shwasakashtata (Difficulty in respiration) were found in all the test drug groups except in Vasa Ghrita, which was only significant (P < 0.05). The effect on Kasa (Cough) was also highly significant (P < 0.001) in all groups, whereas it was insignificant (>0.10) in the Vasa Ghrita (Medicated ghee prepared with Vasa) group.[11]

  11. Usage of Ginger, Turmeric, Long pepper, Clove, Garlic, Cumin, Coriander, Cinnamon, Basil leaves (Tulsi) in excess either along with food or alone


  12. Ushna jalapana (Frequent intake of hotwater)– Can be added with Mint leaves and Coriander leaves, Fennel, Ajwain.


Aushada– Bahya– Urdhwagata shodana

  1. Nasya– Medicated Nasal drops can be instilled into both the nostrils every day and night. Since the pathway of disease is upper respiratory track, Nasya can be beneficial to combat the disease and to keep the channel clear for breathing


  2. Kavala graha– Keeping the medicated oil or kashaya (decoction) in the mouth for some time until the eyes starts watering


  3. This keeps the oral cavity clean, strengthens the gums, and, most importantly, clears the mucus plugs if adhered in the channel.

  4. Gandusha– Gargling


  5. The procedure helps to clear the sinuses and keeps the channel patent

  6. Swedana– Sudation


  7. Frequent inhalation of steam with addition of bronchodilating drugs like Vasa (Adathoda vasica), Bharangi (Clerodendrum Serratum) depending on roga and rogi bala.

    The procedure helps to clear the airways and aids smooth respiration.

  8. Dhupana– Fumigation


Fumigating the house and surroundings periodically with drugs like guggulu (Commiphora mukul), Nimba (Azadirachta indica), Vacha (Acorus calamus)

The efficiency and mode of action of dhoopana drugs are documented by Shrestha et al. in their work Dhoopana Karma: A review through Brihatrayi[12]

A study by Tillu et al. further noted the medical benefits of both bahya and abhyantara chikitsa. He further states that immunomodulators such as Ashwagandha, Guduchi, Yashtimadhu, Shatavari, and Amalaki can be provided to diseased persons to enhance their immunity. They further recommend clinical research of the same.[13]

Vihara

  1. Avoid unnecessary gathering
  2. Maintain distance from each other
  3. Maintain isolation
  4. Avoid sleeping during the daytime
  5. Avoid excessive physical activity including excessive walking or jogging Among individuals under observation, to combat mental stress and anxiety.


  • Application of lukewarm oil on anterior fontanelle is known to reduce anxiety
  • Shirodhara– A panchakarma procedure is known to reduce mental stress and anxiety can be performed
  • A good sleep.


Yogasana can be practiced for positive health:

  1. Pranayama– Particularly bastrika and kapalabhaati can be performed for 10 min each
  2. Asanas like– Bhujangasana, Vajrasana, and Padaangushtasana, can be performed for respiratory wellness.



  Ritusandhi Top


Ritusandhi refers to the junction of two ritus. It is said that the disease during this period occurs because of change in kala i.e., shifting one one ritu to another (the last 15 days of previous ritus and initial 15 days of successive ritu) and that the human body fails to adjust for such changes. Hence to combat the disease during this period, the achara (regime) and ahara (diet) during this period should gradually change from the previous ritu to successive ritu.

In the current scenario, since the COVID outbreak in India started in ritusandhi kala, the diet and regime should be followed carefully.

The diet and regime of both Shishira and Vasantha ritu should be followed.


  Shishira Ritu Top


Mid-January to mid-March (approximately) is considered as Shishira Ritu (winter). During this season, the environment remains cold. The strength of the person becomes less, deposition of the Kapha Dosha and digestive capacity remains in a higher state. Foods having Amla (sour) as the predominant taste are preferred. Cereals and pulses, wheat/gram flour products, new rice, corn, are advised. Ginger, Garlic, Pippali (fruits of Piper longum), Sugarcane products, Turmeric, Clove, Cinnamon, Cumin are to be taken in more quantity.


  Vasantha Ritu Top


The approximate time is from mid-March to mid-May. Strength of the person remains in a medium degree, vitiation of Kapha Dosha occurs and Agni remains in Manda state.

One should take easily digestible foods. Among cereals, old barley, wheat, rice are preferred. Among pulses, lentil, Mugda, and others, can be taken. Food items tasting Tikta (bitter), Katu (pungent), and Kashaya (astringent) are to be taken.

A study by Ravi Philip Rajkumar has identified a potential psychoneuroimmuno modulator mechanism for the interventions suggested by the government. He has stated that “A potential psychoneuroimmune mechanism was identified for five of the proposed methods, via neurobiological mechanisms such as modulation of monoamine function, stress axis response and autonomic activity, as well as reduction of anxiety, depression and perceived stress in human subjects.”[14]


  Ayurveda and Public Health Top


Acharya Sushruta has depicted different modes of communicable disease transmission while explaining the treatment model for Kushta roga (type of skin disease) in his classical treatise Sushruta Samhita.

He says through excess of all forms of contact (Prasanga), physical contact (Gatrasamsparsat), expelled air (Nihsvasat), eating with others in the same plate (Saha bhojanata), sharing a bed (Sahashayyasanat), using clothes, garlands or ornaments of infected individuals (Vastra malaanuepanat) infectious diseases spread from person to person.

Owing to the reference and evidencing the current scenario, it can be said that role of Ayurveda in maintaining Public Health is highly influential.

The very aim of Ayurveda is treating the diseased and Pretecting the health of the healthy

(Charaka samhita. Sutra sthana. 30:26) i.e., Protecting the health of healthy and reducing the ailment of diseased.

The aim of Ayurveda and Public health seems to be in line with each other.

Integrating the age-old practice of Ayurveda with modern problems provides a better alternative for the problems.

The Ayurvedic practice is not just for those who are diseased but also for those who are healthy to protect their health status. The iceberg phenomenon can be understood with Shatkriya Kalas of the Ayurvedic concept.

Ayurveda explains the stages of disease in 6 stages, i.e.,

  1. Sanchaya– Stage of accumulation– This is the first stage of any disease where the doshas (Responsible for disease formation) are increased in their own site. This can be analyzed with the aversion toward food or activities or a feeling of uneasiness before the onset of Vyadhi (Disease-CoVID 19)
  2. Prakopa– Stage of provocation– With the advancement in disease, the increased doshas tends to leave its site of origin and tries to move to other site. The stage of vyadhi (Disease– CoVID 19) when doshas start producing respiratory symptoms
  3. Prasara– Stage of propogation– The doshas having a tendency to leave their site of origin to site of disease expression (Target organ) will start moving from their site of origin. This is the stage of when all the symptoms of vyadhi (CoVID 19) starts exhibiting (cough, gastro-intestinal disturbances, Fever, Running nose, Myalgia)
  4. Sthanasamshraya– Stage of localization– The vitiated doshas starts localizing in such areas which are prone to respective disease. The virus producing CoVID 19 is prone to producing respiratory symptoms and the target organ is lungs. This stage can be considered as the premonitory stage of the disease. Once the infection has occurred the above stages may occur simultaneously depending on the severity of infection and susceptibility of the individual
  5. Vyakta– Stage of manifestation– The doshas localized in the target organs starts exhibiting the symptoms. This is the visible stage of the disease. The vyadhi (CoVID 19) is exhibited with all the signs and symptoms in its full form
  6. Bheda– Stage of complication– The dosha vitiation will be completed by fifth stage. If the treatment is not available at disease manifested stage, then the disease may further aggravate to produce complications. The vyadhi (CoVID 19) may produce renal complications and pneumonia leading to death of the individual.


It is up to the stage of sthanasamsraya (Stage of localization) the disease is not clear in its manifestation and can be compared to the iceberg hidden in the water. The stages after sthanasamsraya are perceivable to eyes and are being treated.

The concept of prevention can be applied at each level of kriyakala.

The primordial prevention can be applied at stage 1 and stage 2:

The act of social distancing and preventing unnecessary movement within or outside the unaffected countries.

The primary prevention can be applied at stage 3 and stage 4:

Prophylacyic medications can be started in such countries where the disease has started a slow raise. Health education to all classes of people is the need of the hour. Bursting the myths and wrong messages being spread in the community should be stopped and should be replaced with correct information. Providing adequate specific protection measures like supply of masks, hand sanitizers to those who are in need.

The secondary prevention can be applied at stage 4 and stage 5:

The countries which have already developed clusters of diseases with community transmission should accelerate the process of disease detection and adequate treatment for the same. The disease should be identified at stage 4 in order to prevent the community spread. The people should be educated to the extent such that the chain of infection is broken by their non-participation in the epidemiological triad.

The tertiary prevention can be applied at stage 6:

The people who are at the verge of losing life due to CoVID 19 are to be given supportive care to prevent to aid the process of respiration.

A study by Sanjeev Rastogi, Deep Narayan Pandey, Ram Harsh Singh suggested disease stage-wise categorization of patients into unexposed asymptomatic, exposed symptomatic, with mild symptoms and with moderate-to-severe symptoms and treatment protocol to be assigned depending on the disease stage.[15]


  Conclusion Top


COVID 19, a new strain of virus causing mortality all over the world, can be prevented with appropriate food intake, hygiene, and social distancing.

The stage of the disease in the community needs to be decided, and the administration of medicine can be done by ascertaining the roga bala and rogi bala.

Prophylactic measures can be applied by administering anti-pyretic drugs like Amrita, Kirata inappropriate and required form and dosage. Intake of Ginger, Garlic, Cumin, Coriander, Cinnamon, Clove, and Turmeric in excess quantity for its prevention.

Distancing one from the affected individuals is the key. Respiratory and personal hygiene is to be followed in order to protect oneself from the disease.

Following the recovery, the individuals should not resort to daily routine activities until the individual regains strength and his agni bala (digestive capacity) is normal.

Ayurveda not only aims to heal the diseased but also to protect the health of the healthy individuals; hence, the measures applied for the treatment of disease should also be followed by healthy individuals to prevent the disease occurrence.

”PREVENTION IS BETTER THAN CURE”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Coronavirus Disease; 2019. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Last accessed on 2020 Apr 03].  Back to cited text no. 1
    
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Covid – 19 India. Available from: https://www.mohfw.gov.in/. [Last accessed on 2020 Apr 03].  Back to cited text no. 2
    
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CDC. Coronavirus Disease 2019 (COVID-19) – Symptoms. Centers for Disease Control and Prevention; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/sym ptoms.html. [Last accessed on 2020 Apr 03].  Back to cited text no. 3
    
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Singh RL, Singh P, Agarwal A. Chemical constituents and bio-pharmacological activities of Swertia chirata: A review. An Indian J N 2012;8:238-47.  Back to cited text no. 4
    
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Bhargava S, Rao PS, Bhargava P, Shukla S. Antipyretic potential of Swertia Chirata buch ham. Root extract. Scientia Pharmaceutica 2008;77:617-23.  Back to cited text no. 5
    
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Upadhyay AK, Kumar K, Kumar A, Mishra HS. Tinospora cordifolia (Willd.) Hook. f. and Thoms. (Guduchi) – Validation of the Ayurvedic pharmacology through experimental and clinical studies. Int J Ayurveda Res 2010;1:112-21.  Back to cited text no. 6
    
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Rawat N, Roushan R. Guduchi-A potential drug in Ayurveda. World J Pharm Res 2018;7:355-61.  Back to cited text no. 7
    
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Masood M, Arshad M, Qureshi R, Sabir S, Amjad MS, Qureshi H, et al. Picrorhiza kurroa: An ethnopharmacologically important plant species of Himalayan region. Pure Appl Biol 2015;4:407-417.  Back to cited text no. 8
    
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Krupashree K, Hemanth Kumar K, Rachitha P, Jayashree GV, Khanum F. Chemical composition, antioxidant and macromolecule damage protective effects of Picrorhiza kurroa Royle ex Benth. South Afr J Bot 2014;94:249-54.  Back to cited text no. 9
    
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Nagarajan M, Kuruvilla GR, Kumar KS, Venkatasubramanian P. Pharmacology of Ativisha, Musta and their substitutes. J Ayurveda Integr Med 2015;6:121-33.  Back to cited text no. 10
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Gupta A, Prajapati PK. A clinical reviewof different formulations of Vasa (Adhatoda vasica) on Tamaka Shwasa (asthma). Ayu 2010;31:520-4.  Back to cited text no. 11
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Tillu G, Chaturvedi S, Chopra A, Patwardhan B. Public health approach of ayurveda and yoga for COVID-19 prophylaxis. J Altern Complement Med 2020;26:360-4.  Back to cited text no. 13
    
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Rajkumar RP. Ayurveda and COVID 19: Where psychoneuroimmunology and the meaning response meet. Brain Behav Immun.2020;S0889-1591(20)30637-1.  Back to cited text no. 14
    
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Sanjeev Rastogi. Deep Narayan Pandey, ram Harsh Singh. COVID 19 Pandemic: A pragmatic plan for ayurveda intervention. Journal of Ayurveda and Integrative medicine. 2020;10.1016/j.jaim.2020.04.002.  Back to cited text no. 15
    




 

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  In this article
Abstract
Introduction
The Current Pand...
Doshas Involved&...
Roga Marga–...
Adhishtana–...
Type of Vyadhi&#...
Kala– Time...
TransmissionR...
Ritusandhi
Shishira Ritu
Vasantha Ritu
Ayurveda and Pub...
Conclusion
References

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