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It is hoped that a good fund of information will Furthermore buy indomethacin 50mg with mastercard rheumatoid arthritis shoes, people with sexually transmitted spur people to ask a doctor’s advice if there is cause diseases are often ostracized because of prejudice or for concern purchase indomethacin without a prescription arthritis in back what to do. In 1999 and 2001 publications purchase indomethacin on line amex rheumatoid arthritis prevention, he reiterated Experts predict that these four will cause the that “we know what works. In fact, this route of transmission is Also, an unclassified version of a national intel- viewed as such a threat that researchers at the U. Also, a large number of tuberculosis- the spread takes drug-resistant and/or more vir- infected illegal immigrants new to the United ulent forms. Introduction xvii Looking at the world picture, it is believed that Finally, the third scenario is the one viewed the most vulnerable region is sub-Saharan Africa, most likely to occur. At highest risk are those soldiers in likely” was one of steady progress—one that the developing countries. In devel- gation,” adding that “immoral persons must not oping countries, these diseases are unreported or under any circumstances be allowed to live in the underreported for several reasons: the stigma, the same house with those who lead moral lives. Doctors can use a prophylactic strategy of nosis and reporting are blurred because morbidity educating the public with regard to “risks of vene- and mortality rates can be multicausal. The figure was 155 per for treating venereal diseases; suppressing all 100,000 men and 184 per 100,000 women. Fur- advertisements of preventives, and so forth, that thermore, London doctors conjecture that these encourage vice by promising impunity; making reported infections are only about 10 percent of all transmission of syphilis an offense that would cases. From 1999 to 2000 in the United Kingdom, merit a jail sentence (adding that this probably the incidence of chlamydia rose by 17 percent, and could not be enforced but that its presence on the the number of cases doubled from 1994 to 2000. With a higher inci- enforcement of existing laws is the best prophylaxis for venereal disease. The To see how matters have changed in regard to sex- buds of an education program were launched; as is ually transmitted diseases, consider the contents of clear from current statistics, it apparently failed the article “Prophylaxis of Venereal Disease,” miserably—or fell on deaf ears. This was suspected but never before con- sexually transmitted diseases, it is not easy to stay firmed. It has tremendous repercussions for those on top of the many new developments that who are sexually active in that persons engaging researchers unveil on a regular basis. None of the participants chose the first information for those in developing countries option. Most of the young women had no symp- where women lack the power to control how toms, whereas results showed that 28. This was the first such case in decades, may have greater potential for disease protec- since the inception of stringent blood screening tion than was previously believed. The saliva, semen, vaginal fluid, and blood of people xx The Encyclopedia of Sexually Transmitted Diseases newly infected by the virus, and these levels a traditional exam. The participants were 228 were higher than or as high as levels in those teenage women. These are findings that suggest many basic misconceptions about the kinds of using combination antiretroviral therapy as an behavior that prevent infection. About 20 per- semen and vaginal fluid with the goal of lower- cent believed use of birth control pills protected ing the number of people contracting the virus. A simple pro- nal samples they obtained during a two-year cedure (much like a Pap smear) can result in study revealed a high percentage of undiagnosed detection of cancerous lesions among high-risk sexually transmitted diseases. Nearly 13 per- head and neck cancers—but it is also associated cent of women who had never previously had a with improved survival rates (more so than such gynecological exam had a positive test finding cancers stemming from other causes). The three-year- (termed intermittent viremia) may not be as omi- old boy had an opportunistic infection seen nous as was once believed. This was announced in February the egg from which the child developed, proba- 2003. Some even experience dramatic Another important figure is the dramatic dips in their counts. The also cause other illnesses such as conjunctivitis most widely known form of needleless acupres- (eye infection). Forty-nine types that cause sure is shiatsu, in which practitioners use finger human illness have been found. Certain types pressure on certain body points to stimulate chi have been shown to cause malignancy in (vital energy). Viewed by ease, adherence has been cited as an important the traditional medical establishment as alternative determinant of degree and duration of virologic medicine, acupuncture has many advocates who suppression. An acupuncturist seeks there is a strong association between poor adher- to correct deficiencies of chi, or life energy, and ence and failed virologic suppression. To this end, nee- predictor of failure to achieve viral suppression dles are used to direct chi to specific areas in the below the level of detection. In essence, what mented that 90 to 95 percent of doses must be this boils down to is that the needling serves to taken for optimal suppression; lesser degrees of activate deep sensory nerves, thus causing the compliance are more often associated with viro- brain to release endorphins, which are generally logic failure. Reasons cited were forgetting, being busy or depressed, disliking adverse side effects, or being acute respiratory distress syndrome The sudden ill. It seems log- 4 advocacy ical that the instability of homelessness would facilitated and promoted by having an assertive automatically lead to a lack of adherence, but that patient advocate. Predictors of poor adherence affirmations Declarations of specific emotional- include lack of rapport between clinician and health platforms, the repetition of which is meant patient, drug/alcohol use, mental illness, lack of to soothe tension and heighten resolve. United States as of December 2001, half were in According to the 2001 Guidelines for the Use of African-American men. In African-American men, the second most calendars); and clinician education aids. In today’s health care system, it is 8 percent of cumulative cases stem from hetero- believed by many that delivery of proper care is sexual exposure. For more on their theo- suffer from the disease—was launched in 1987 in ries, see http://www. The press soon dropped used to treat certain heart conditions, have some- the qualifier probable in their reporting of the times been used as sex stimulants by gays. Furthermore, most of them said that more been exposed to many immunosuppressive risks than half of the partners had been strangers. Physician and drugs with immunosuppressive effects: opiates, alpha-interferon 7 nitrites, cocaine, high-dosage antibiotics (chroni- care facilities; others live with relatives. Some of the services are other viruses, a finding that is inconsistent with support groups, counseling, testing, food banks, established retrovirological principles. States admin- who drink excessive amounts of alcohol problems ister their own programs, and thus eligibility such as cirrhosis of the liver, gastritis, cardiomy- requirements and drugs covered have differed opathy, and peripheral neuritis can develop. In the face of today’s holism is an addiction to alcoholic beverages and is changing health care system and the high costs of considered a disease. Examples with some of her colleagues in demanding are acetaminophen (Tylenol) and aspirin. Without the use of a condom, this Medical Foundation was founded in New York to is considered high-risk sexual activity. A water-based lubricant is rec- in its efforts to respond to emerging needs and ommended, in addition to a condom, to reduce invest in cutting-edge science. Americans with Disabilities Act An important anal-oral sex Sexual contact between one part- equal opportunity law, as well as one designed to ner’s mouth and the other’s anus (also termed prevent discrimination, the Americans with Dis- analingus). Its protection anatomical components include the vulva—the against discrimination is so far-ranging that it even outside parts, including labia, clitoris, and vaginal covers those individuals who could be perceived as opening.

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Long-term therapy includes low dose (antiplatelet) aspirin and in some cases warfarin to prevent clot formation within dilated coronary arteries indomethacin 25mg low cost tylenol arthritis pain para que sirve. The higher rate among people of Japanese ethnicity and within siblings and twins suggests both genetic and environmental factors in the pathophysiology of this disease indomethacin 75mg lowest price arthritis in the fingers remedies. The epidemiologic features of the disease suggest an infectious agent(s) purchase indomethacin on line rheumatoid arthritis young mothers, which is supported by temporal (winter and early spring) and spatial clustering of cases as well as sharing some clinical features with inflamma- tory diseases that have well established underlying infectious causes (e. More recent theories suggested a toxin-mediated syn- drome similar to toxic shock syndrome and the possible role of superantigens induced by certain viral or bacterial agents. Coronary artery involvement is common and leads to much of the morbidity and mortality; however, other arteries like axillary, femoral, iliac, and renal arteries can be involved as well. The acute inflammation of the coronary arteries can lead to thrombus formation and myocardial infarction. Moreover, the inflammatory changes can weaken the structure of the coronary vessels and lead to dilation and ultimately aneurysm formation. The fever is usually high and remittent and does not typically completely respond to antipyretics. It usually lasts 1–2 weeks with a mean duration of 12 days in untreated patients, but it may last up to 30 days. Desquamation around the fingers and toes (periungual desquamation) usually follows at a later stage in the second or third week of illness. Later (1–2 months after onset), deep transverse grooves in the nails (Beau’s lines) may be noted. However, the rash may be scarlatiniform, morbilliform, or urticarial; infants may have an evanescent rash involving the intertriginous areas particu- larly the perineum. Felten • Conjunctivitis: bilateral, nonpurulent conjunctivitis involving the bulbar conjunctivae and sparing the palpebral conjunctiva and the limbus area imme- diately around the cornea. Other ophthalmologic involvement like anterior uveitis, which occurs in up to 83% of cases, is usually asymptomatic. These take the form of red, cracked, and fissured lips, strawberry tongue with promi- nent fusiform papillae and diffuse oral and/or pharyngeal erythema. It typically involves the anterior cervical lymph nodes and is unilateral and with a size of ³1. In addition to the above criteria, other diagnoses with similar presentation should be excluded. This is more common in infants who are at higher risk of coronary artery complications. These are not part of the diagnostic criteria, but are helpful in making the diagnosis. Occasionally, there is transient sensorineural hearing loss and rarely facial nerve palsy. Arthralgia or arthritis involving small and large weight-bearing joints may occur in the first week of illness. Gastrointestinal manifestations including diarrhea, vomiting, and abdominal pain occur in about one-third of the patients. Hepatic involvement is usually asymptomatic, but is detected by elevated transami- nases. Hydrops of the gallbladder is less common, occurring in 15% of patients in the first 2 weeks from onset. Rare manifestations include testicular swelling, pulmonary infiltrates, and pleural effusions. Physical exami- nation of the heart may reveal the presence of flow murmur related to fever and anemia or a murmur of mitral regurgitation. Approximately 50% of patients have mild myocarditis evidenced by sinus tachycardia. Signs of congestive heart failure, such as gallop rhythm, are occasionally seen and indicate more significant myocar- dial involvement. Coronary artery dilatation or ectasia is the most common complication from the acute inflammation. Approximately 8% of untreated patients develop aneurysmal dilatation and only about 1% develop giant aneurysms (>8 mm in diameter). Risk factors for coronary artery involvement include male sex, infants below 1 year of age, and fever of >10 days duration. A complete blood count may show neutrophilic leukocytosis, with white blood cell count >15,000 in more than half of the patients, nonspecific anemia, or thrombocytosis. Other nonspecific laboratory findings include mild to moderate elevation of the liver transaminases (40%), low serum albumin level, sterile pyuria (33%), and aseptic meningitis (up to 50%). Imaging and Studies Chest X-ray may show the nonspecific findings of pulmonary infiltrates or cardio- megaly, but is typically normal. However, coronary artery involvement may develop as late as 6–8 weeks after the onset, so a follow-up echocardiogram is necessary around that time. If the echocardiogram is normal at 6–8 weeks, a follow-up echocardiogram beyond 8 weeks is optional. This dose of aspirin is given until a repeat echocardiogram at 6–8 weeks of illness shows no coronary artery dilatation. Patients with coronary artery abnormalities require long-term treatment with aspirin and possibly other anticoagulants such as warfarin in cases of giant aneurysm of coronary arteries to prevent thromboembolism. A high percentage of patients who develop coronary artery abnormalities show resolution of these abnormalities within 2–5 years, depending on the severity of the initial changes. She was seen by her pediatrician a week ago and sent home on antipyretics with a diagnosis of a viral infection. Scarlet fever could also cause many of these signs and symptoms, but the rash is not classical nor is there any preceding sore throat reported. The manifestations may not be all present at the same time, but appear sequentially. The presence of fever for 9 days, with the other clinical criteria and no obvious infectious cause is supported by the labo- ratory investigations. An echocardiogram will help in looking for coronary artery involvement, but is not essential to make the diagnosis and should not delay starting treatment. Initial echocardiogram is normal so she is discharged home after 3 days on Aspirin at 3 mg/kg/day with no recurrence of fever and with a follow-up echocardiogram in 2 weeks. He had a skin rash earlier on day of presentation which disappeared by the time you saw him. The patient has nonexudative bilateral conjunctivitis and mild pharyngeal and oral erythema with some cracking of the lips. The patient has no skin rash or lymphadenopathy, and the rest of the exam is unremarkable. The echocardiogram in this patient shows a small pericardial effusion, mitral regurgitation, mildly dilated right and left anterior descending coronary arteries, and normal ventricular function.

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There is no evidence that yellow fever has ever been present in Asia; in western Kenya buy indomethacin 25mg with visa arthritis in fingers with nodules, sylvatic yellow fever was reported in 1992–1993 indomethacin 25mg discount arthritis jewelry. Reservoir—In urban areas purchase generic indomethacin pills rheumatoid arthritis jaw, humans and Aedes mosquitoes; in forest areas, vertebrates other than humans, mainly monkeys and possibly marsupials, and forest mosquitoes. Transovarian transmission in mosqui- toes may contribute to maintenance of infection. Humans have no essential role in transmission of jungle yellow fever, but are the primary amplifying host in the urban cycle. Mode of transmission—In urban and certain rural areas, the bite of infective Aedes mosquitoes. In South American forests, the bite of several species of forest mosquitoes of the genus Haemagogus. Period of communicability—Blood of patients is infective for mosquitoes shortly before onset of fever and for the first 3–5 days of illness. The disease is highly communicable where many susceptible people and abundant vector mosquitoes coexist; it is not communicable through contact or common vehicles. Susceptibility—Recovery from yellow fever is followed by lasting immunity; second attacks are unknown. Transient passive immunity in infants born to immune mothers may persist for up to 6 months. Preventive measures: 1) Institute a program for active immunization of all people 9 months or older who are exposed to infection because of residence, occupation or travel. Antibodies appear 7–10 days after immunization and may persist for at least 30–35 years, probably much longer, though immunization or reim- munization within 10 years is required by the International Health Regulations for travel from endemic areas. The vaccine can be given any time after 6 months of age and can be administered with other antigens such as measles vaccine. The vaccine is contraindicated in the first 4 months of life and should be considered for those aged 4–9 months only if the risk of exposure is judged to exceed the risk of vaccine-associated encephalitis, the main complication in this age group. The vaccine is not recommended in the first trimester of pregnancy unless the risk of disease is believed to be higher than the theoretical risk to the pregnancy. There is no evidence of fetal damage from the vaccine, but lower rates of maternal seroconversion have been observed, an indication for reimmunization after delivery or termina- tion. Protective clothing, bednets and repellents are ad- vised for those not immunized. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Case report universally required by International Health Regulations; Class 1 (see Reporting). Prevent access of mosquitoes to patient for at least 5 days after onset by screening the sickroom, by spraying quarters with residual insecticide, and by using insecticide-treated bednets. Search patient’s premises and places of work or visits over the preceding several days for mosquitoes capable of transmitting infec- tion; apply effective insecticide. Investigate mild febrile illnesses and unexplained deaths suggesting yellow fever. Confirmation by the histopathological examination of livers of moribund or recently dead monkeys or by virus isolation is highly desirable. Serological surveys of human populations are not useful where yellow fever vaccine has been widely used. Disaster implications: Mass vaccination may be considered if an epidemic is feared. The International Certificate of Vaccination against Yellow Fever is valid for 10 years from 10 days after date of immunization; if reimmunization occurs within that period, valid 10 years from date of reimmunization. Identification—Infection caused by enteropathogenic Yersinia typically manifested by acute febrile diarrhea with abdominal pain (espe- cially in young children). Other clinical manifestations (extraintestinal or otherwise) include acute mesenteric lymphadenitis mimicking appendici- tis (especially in older children and adults) and systemic infections. The most common post-infectious complications are erythema nodosum (about 10% of adults, particularly women), and reactive arthritis. Bloody diarrhea occurs in up to one-fourth of patients with Yersinia enteritis; diarrhea may be absent in up to a third of Y. The organisms may be recovered on usual enteric media if precautions are taken to prevent overgrowth of fecal flora. Cold enrichment in buffered saline at 4°C (39°F) for 2–3 weeks can be used but this procedure usually enhances the isolation of non-pathogenic species. Strains pathogenic for humans are those of biotypes 1B, 2, 3 and 4; they are pyrazinamidase- negative. Biotype 1A strains are non-pathogenic whereas the very rare strains of biotype 5 have been isolated from hares. Human cases have been reported in association with disease in household pets, particularly puppies and kittens. The highest isolation rates have been reported during the cold season in temperate climates, including northern Europe (especially Scandinavia), North America and temperate regions of South America. Contamination through milk (including pasteurized milk, where postpasteurization contamination is more likely than resistance of the agent to the pasteurization process) is less common. Studies in Europe suggest that many cases are related to ingestion of raw or undercooked pork. Since 20% of infections in older children and adolescents can mimic acute appendicitis, outbreaks can sometimes be recognized by local increases in appendectomies. Asymptomatic pharyngeal carriage is common in swine, especially in winter, and bioserotype 2 (serotype O9) has been isolated from ovine, bovine and caprine origins. Mode of transmission—Fecal-oral transmission through consump- tion of contaminated food or water, or through contact with infected people or animals. There is fecal shedding at least as long as symptoms exist, usually for 2–3 weeks. Susceptibility—Gastroenterocolitis (diarrhea) is more severe in children, postinfectious arthritis more severe in adolescents and older adults. Septicaemia occurs most often among people with iron overload (hemochromatosis) or immunosuppression (through illness or treatment). Preventive measures: 1) Prepare meat and other foods in a sanitary manner, avoid eating raw pork and pasteurize milk; irradiation of meat is effective. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Case reporting obligatory in many countries, Class 2 (see Reporting). Remove persons with diarrhea from food handling, pa- tient care and occupations involving care of young chil- dren. In communities with modern and adequate sewage disposal systems, feces can be discharged directly into sewers without preliminary disin- fection. Epidemic measures: 1) Any group of cases of acute gastroenteritis or cases sugges- tive of appendicitis must be reported at once to the local health authority, even in the absence of specific causal identification. Infections due to Mucorales or to Entomophthorales present distinct epidemiological, clinical and pathological forms. The mainly histopatho- logical differences between them are the eosinophilic perihyphal material or Spendore-Hoeppli reaction seen in entomophthoromycosis. Identification—Infections caused by fungi of the order Mucorales leading to opportunistic disease. These fungi have an affinity for blood vessels, and cause thrombosis, infarction and tissue necrosis.

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Furthermore order indomethacin from india arthritis in the back, the blood carbonylhemoglobin was observed to be higher in smokers; the inner and outer environment of the erythrocytes changed and affected the fluidity of the membrane lipid zone safe 75mg indomethacin arthritis medication taken off the market. This might be the direct action of nicotine or a series of responses to nicotinic derivants purchase indomethacin with mastercard arthritis for dogs home remedies. However, acupuncture is believed to reverse the effect of nicotine on the fluidity of membrane lipid zone, suggesting the role of acupuncture treatment for smoking cessation (Li 1984). According to the theory 433 Acupuncture Therapy of Neurological Diseases: A Neurobiological View of Zang-fu organs, the lung and the large intestine, as well as the spleen and the stomach, are the exterior-interior organs for each other. Hence, the smokers usually exhibit the heat-evil symptoms of the lung and stomach, such as cough with yellow sticky sputum, pain in the chest, xeromycteria, constipation, anorexia, xerostomia, halitosis, etc. Furthermore, smokers generally have a red tongue with yellow coating, and rapid pulse. Therefore, the principle of acupuncture treatment for smoking cessation is to clear away the heat-evil of the lung and stomach (Fig. Smokers usually present the heat evil symptoms of the lung and stomach, such as cough with yellow sticky sputum, pain in the chest, xeromycteria, constipation, anorexia, xerostomia, halitosis, etc. Therefore, the principle of acupuncture treatment for smoking cessation is to clear away the heat evil of lung and stomach. Researchers also found that the psychological factor of acupuncture treatment was principally from the support of therapists, but not the smokers themselves. When combined with the psychological and behavioral therapies, the effect of acupuncture treatment is observed to be better (Cui and Jiang 1992). Sun (2000) randomly divided 60 patients into two groups: auriculo-acupoints group and auriculo-acupoints with psychological treatment group. The patients of the latter group were given a 434 16 Acupuncture for Smoking Cessation professional introduction, transference, teaching, and rising morale. The results showed that there was obvious differences between the two groups, and the withdrawal symptoms of the auriculo-acupoints group, when compared with the auriculo-acupoints with psychological treatment group, were less and statistically insignificant. In summary, as a nature therapy, acupuncture is considered to be effective for smoking cessation, as it is presumed to regulate the whole body. However, there are still many problems that need to be addressed in the future, such as high recurrence rate, unstable immediate effects, etc. When compared with the pharmacologic or psychological methods, acupuncture therapy is observed to be unique and effective. However, owing to limited mechanistic researches, its use and development in the clinic environment is still not widespread. As the study on the effects of acupuncture treatment for smoking cessation has been carried out since the past 30 years, more work on the clinical study or basic research is believed to provide greater insight and offer great help to patients who are attempting to quit smoking. American Journal of Medicine 75: 1033 1036 Cui M (1996) The research development of withdrawal symptoms by acupuncture (continuation one). British Journal of Addition 86: 57 59 Hajek P, West R, Foulds J (1999) Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler. Zhongguo Ming Jian Liao Fa (Chinese Civilian Therapy) 14: 58 60 (in Chinese) Karnath B (2002) Smoking cessation. Zhen Jiu Lin Chuang Za Zhi (Journal of Clinical Acupuncture & Moxibustion) 16: 32 (in Chinese) Zhang Q (1990) 108 cases smokers treated by auriculo acupuncture and body acupuncture. Zhongguo Zhen Jiu (Chinese Acupuncture & Moxibustion) 10: 23 24 (in Chinese with English abstract) 436 17 Beneficial Effect of Acupuncture on Depression Qiong Liu and Jin Yu Department of Integrative Medicine and Neurobiology Shanghai Medical College of Fudan University, Shanghai 200032, P. China Summary This chapter presents the clinical and laboratory evidence regarding the effect of acupuncture on depression and its potential mechanisms. Most of the clinical studies have demonstrated that either acupuncture alone or acupuncture combined with other therapies has a therapeutic effect on subjects with depression. The adverse effects were less and milder in the group under acupuncture treatment than in those under regular medication. Lastly, the hippocampus, an important brain structure that plays a key role in the etiology of depression, has been observed to be involved in the mechanism of acupuncture. Psychologist Martin Seligman addressed depression as the “common cold” of psychological problems, because nearly everyone suffers from it at some time point. Clinical depression is a real medical condition and is different from the term “being depressed” that is used frequently. It is a “whole-body” illness, involving the body, mood, and thoughts, which presents with depressed mood, loss of interest or pleasure, feeling of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These symptoms linger, intensify, and lead to substantial impairments in an individual’s social functioning and/or activities of daily living. In other words, depression can interfere with a person’s normal functioning, and frequently disrupt the work, social, and family adjustment. It makes a person feel sad or hopeless most of the time and lose interest in things that were once enjoyed. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. People who suffer from depression usually struggle to do even the simplest things. The economic cost for this disorder is high, but the cost of human suffering cannot be estimated. It causes pain and suffering not only to those who have the disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the depressed person. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Psychological treatment of depression (psychotherapy) assists the depressed individual in several ways, which include supportive counseling, cognitive therapy, and problem-solving therapy. Some people with milder forms of depression may respond well to psychotherapy alone, while those with moderate to severe depression most often benefit from antidepressants. Most of the patients respond best to combined treatment: Medication—to gain relatively quick symptom relief, and psychotherapy—to learn more effective ways to deal with life’s problems, including depression. However, conventional treatments like psychotherapy and medication can alleviate the symptoms in a whopping 50% 70% of patients who complete the regimen; however, about one-third of the patients who begin therapy never complete it, because they may not observe any improvement or may experience debilitating side effects. Even among people who recover from depression, more than one-third revert back within 18 months. In addition, most empirically supported psychotherapies are also not readily available or affordable. Hence, there is a need for safe, effective, and affordable alternative treatments for depression. Acupuncture originated in China at least 3000 years ago, and moved to the west in the 1970s. It is a type of therapy that involves inserting needles into the acupoints along the body’s meridians.

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