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专家解析阴性艾滋病疑云:心理状态影响免疫系统
2011年04月11日 14:03 来源：扬子晚报
阴性艾滋病为何疑云不散——
心理状态影响人的免疫系统
为什么有那么一批人，被定性为“恐艾症”后、在获知美国并没有查出“新病毒”后，仍坚持认为自己患上了比艾滋病更为可怕的“阴性艾滋病”？
他们坚持有病的原因，是躯体确实有疾病症状，他们不知，其实，他们患的是 “国际疾病和相关健康问题分类”第十版疾病分类中的“躯体化障碍”、“疑病症”。
采访专家：南京中医药大学心理学院 杜文东教授
1 血样送到美国没有查出新病毒
现在全国至少有六省市共数千人(江苏7位)，坚信自己患上了“阴性艾滋病”。
“阴性艾滋病”，是指自称染上了艾滋病病毒，有与艾滋病感染极为类似的症状，但经过多次HIV(艾滋病)检查，均显示阴性，因此认为自己感染的是变异的艾滋病或可怕的未知病毒——一种无法检测的、可以唾液传播的、攻击人类免疫系统的类艾滋病病毒。
个案——
(1)港人汪先生(个案均为化名)，30多岁，2009年，与妻子吵架，愤而离家，与香港女网友发生了一次无保护措施的性行为，担心自己感染性病，到医院进行多项检查，均证明没有感染艾滋病或性病。
但是，去年十一月，他开始出现全身乏力、淋巴肿大、舌苔长出绒毛、肌肉跳动及关节离奇作响等症状，抵抗力不断变差，体重急跌七八磅，多次求医，找不出病因。
最近他怀疑将病毒传染给妻子，因为其妻长期出现咽喉炎、腹泻及肠胃胀气等症状。
(2)广西姜先生，26岁，去年七月一次召妓时安全套穿洞，翌日病发，出现腹肠作响、恶心，其后皮肤出现红疹、四肢乏力、胸口闷、心悸及关节响等。他花上一万元作身体检查亦找不出问题。疑因同桌吃饭将惊世病毒传染给三名同事。
(3)安徽黄先生，2008年在巴士上疑被“针”扎了一下，一星期后出现盗汗、恶心、反胃、淋巴肿痛的情况，体重急跌十五公斤。虽然艾滋病测试呈阴性，但病情始终没有好转。怀疑已将不明病毒传给妻子、哥哥、嫂嫂。
(4)黑龙江人章先生，2007年，光顾色情场所，被一名突然闯进的妓女用舌头舔了左胸一下，他立即清洗了口水，但翌日却感冒发烧，并陆续出现低烧、腹泻、牙龈疼痛等病征。一个月后身体出现莫名红点。三个月后患上脑膜炎。他曾在三个月内接受七次艾滋病测试，并进行多项身体检查，均未知病因，担心会传染家人而离家独居。
(5)上海林先生，其母2008年在医院输血后，相继出现盗汗、手脚麻木及出皮疹等症状。后来他在一次母亲受伤的意外中沾到母亲的血，两周后，林忽然全身淋巴肿大、皮肤出现大块血斑、肌肉有不寻常的虫爬感。2009年初，晕倒在上班的路上。经八次艾滋病的检测均为阴性，其他检查亦未能查明病因。
6日，卫生部新闻发言人邓海华表示：根据调查，目前可排除自述疑似艾滋病感染人群感染艾滋病毒；中疾控将血液标本送美国相关实验室检测，其结果是：已经检测的样本艾滋病抗体均为阴性，尚未检测到相关致病病原体。
因此说，“阴性艾滋病”只是恐艾症状。
但是，检测结果和初步结论没有得到该人群认可。他们异口同声地说：“我们经过多次艾滋病测试，已完全脱恐。但如果说没有病，为什么症状还是不退呢？”
2 心因性“躯体障碍”很常见
让他们坚持有病的原因，是实实在在的“躯体症状”，其实这种心因性的“躯体障碍”很常见。
个案：警察让一位母亲去辨认一具女尸，看是否是她前几天离家出走的女儿。她就在发现那女尸穿的衣服就是自己女儿临走前穿的衣服时，立刻晕倒了，醒过来后，她发现自己的双腿不听使唤了——瘫痪了！
个案：女，13岁，因哮喘发作住院。她已哮喘发作好几天，门诊用数种药物解痉平喘治疗无效。入院时神志清晰，呼吸深慢、胸廓起伏明显，随着呼吸弯腰伸颈。体格检查无紫绀及鼻扇，肺部听诊无哮鸣音。详细追问病史，父亲刚去世不久，原与父亲比较亲近，生活上依赖性较强。
个案1的瘫痪和个案2的哮喘，均是心因性的“躯体形式障碍”。
躯体形式障碍，是“国际疾病和相关健康问题分类”第十版(ICD-10)及“美国精神病诊断与统计手册”第四版(DSM-IV)中一个疾病分类。
其临床特征是：病人主诉一种或多种躯体症状，但规范的治疗常常不能解决患者的病痛。
世卫组织统计，全球约有10%的人存在心理问题，其中躯体化障碍的终身患病率为0.2%～2%。
其病因为何呢？心理学家解释——
是个体在心理应激反应下，当情绪不能正常地从言语和／或行为方面发泄时便被潜抑下来，而以“器官语言”的形式表现出来，这就形成躯体化症状。这种躯体不适和症状不能用病理来解释。
患者用躯体化症状置换内心不愉快的心情，如，表达了某种想法和情绪，或者减轻了由某种原因造成的自罪感，等。在潜意识中，他们感受到了患病的好处，躯体化的疾患行为维持下来成为慢性躯体化障碍(并非有意伪装，一切都是潜意识中的行为)。
换言之，“躯体化”在潜意识中，成为病人对付心理、社会各方面困境的一种方式，是退行到儿童早年的方式。
个案1的双腿瘫痪，客观上冲淡了让她难以承受的丧女之痛；个案2的哮喘，冲淡的是她的亡父之痛。
“恐艾症”呢？很多患者起因于不良性行为，在一时冲动之下有了越轨行为，冷静下来后，必然会面临道德层面的自责，而“患病”，在一定程度上会减轻罪恶感。
“躯体病”更多的是“恐艾心理”的转化。但是，“躯体病”的本意是想减缓患者对可能感染上艾滋病的恐惧，没想到却因“躯体病”，让其产生了更大的“恐艾心理”，这却是人在进化过程产生的这种“自救方式”所始料未及的。
而更大的“恐艾心理”，又转化形成了新的“慢性躯体化障碍”。
3 心理和生理是个统一体
“情绪”为何能够用“器官语言”的形式表现出来？
原因是，人是由躯体和心理组成的统一体。在这个统一体里，神经、 免疫和内分泌系统各自内部均存在正负反馈性调节机制，由此各系统的功能活动方能协调、准确而精细。但是，在病理条件下，某些反馈机制可引起机体较严重的损伤。
个案1：有一位母亲，其儿子弱智。儿子60多岁时，她已90多岁了，她知道自己一死儿子就没人照料了，潜意识中，她认为自己不能死，所以精神头挺好，每天忙碌着，为儿子洗衣做饭。有一天儿子不小心掉河里溺死了，第二天老母亲也在睡梦中平静地离开了人世。
儿子溺水身亡后，老母亲的潜意识中已失去了活的意义，她的死，是心因性的。
个案2：有一位小战士患癌症住院，一开始不知道自己患的是癌症，每天乐呵呵地扫地，学雷锋，医生对他的康复怀有很大信心；但当他无意间知道自己的病情后，立刻躺倒了，一个星期后病逝了。
癌症是消耗性疾病，不可能在如此短的时间内夺命，小战士的死，是被癌症吓死的。有资料说明，“80%的癌症患者被吓死”的。“恐艾症”的“躯体形式”，就是对艾滋病巨大的恐惧，引起的某些反馈机制的结果。
“恐艾症”患者一般都有“高危行为”，或疑似“高危因素”。
港人汪先生和广西姜先生是不良性行为；安徽黄先生疑被“针”扎了一下；黑龙江章先生被妓女用舌头舔了一下；上海林先生是意外中沾到了病人的血等。
由于对感染艾滋病途径的一知半解，他们均以为自己被感染上了艾滋病，由此心理上产生了巨大的恐惧！
4 恐惧调动了“器官语言”
情绪是如何调动“器官语言”的呢？
很多患者是在“高危行为”和“高危因素”的第二天就出现了躯体障碍，这是为什么呢？
因为心因性的躯体障碍，又叫应激性躯体障碍，即应激事件一发生，就激活了“丘脑—垂体—肾上腺皮质轴”，随之影响到内分泌和免疫系统，躯体症状就出现了。
(1)心律失常
主述症状：心律失常、盗汗、心悸、出汗、颤抖、脸红等。
出现这些症状的原因是什么？
这是“躯体形式的植物功能紊乱”现象。因为在应激状态下，中枢神经系统引起的反应(如巨大恐惧引起的反应)，最终能激活“下丘脑—垂体—肾上腺皮质轴”，进而激活“交感—肾上腺轴”，交感神经功能紊乱，持续兴奋，就会产生“心律失常”等症状。
(2)肌肉疼痛
主述症状：肌肉跳动、肌肉有不寻常的虫爬感及疼痛、全身乏力、手脚麻痹等。这又是为什么呢？
原因是，丘脑—垂体—肾上腺皮质轴被激活后，肾上腺素、儿茶苯胺等激素分泌增多，这些激素有增强肌力的作用，这些激素最终要通过肝脏来代谢掉，但是因为分泌得过多了，肝脏无法将其完全代谢掉，代谢的中间产物滞留在肌肉中，就造成了疼痛、蚁爬等种种症状。
(3)各类炎症
主述症状：关节离奇作响及疼痛、全身多处淋巴肿胀疼痛、咽喉炎 、牙龈发炎、口腔溃烂、白色念珠菌感染等。
关节离奇作响及疼痛等，属无菌性炎症。它的发生和免疫功能紊乱有关。
牙龈发炎等，属有菌炎症。我们都有劳累了，着急上火了，造成免疫力低下，而牙龈发炎的感受、恐艾症引起的有菌炎症，同样是精神因素引起的免疫力低下的结果。
(4)腹泻厌食
主述症状：腹泻、肠胃胀气、厌食、口干、迅速消瘦等。
怀疑自己感染上艾滋病的人群，往往整天处于恐惧和焦虑之中。长期的神经紧张(如恐惧、着急)，极易引起内分泌和植物神经系统的紊乱，进而导致上述的种种症状。
5 患者可能有疑病性人格
“恐艾症”者，也可能是疑病症患者或具有疑病性人格的人。
疑病症，又称“疑病性神经症”，是对自身感觉或征象作出不切实际的病态解释，致使整个心身被由此产生的疑虑、烦恼和恐惧所占据的一种神经症。
它和“躯体形式障碍”一样，也是“国际疾病和相关健康问题分类”第十版(ICD-10)及“美国精神病诊断与统计手册”第四版(DSM-IV)中的一个疾病分类。
据国外报道，“疑病症”约占各种疾病的1%。
个案：南京一位女警察在办案过程中沾上了疑似艾滋病病人的血，当时她很紧张，但做过有关检查后，证明她没有感上艾滋病病毒，她的心情随之释然，又热情地投入到警务工作中。
其实我们每一个正常人在某一时期也会过分重视自己的健康，对不严重的普通疾病或不适感产生疑惧，出现疑病观念，如哪里出现了肿块就会怀疑是不是癌症等，但经检查证实无病，给予适当解释后就会放弃疑病观念。
为什么疑病症患者，如“恐艾症”患者却会反复就医，医生的解释和客观检查均不足以消除其看法，仍坚持自己有病呢？
这可能和患者有着疑病性人格有关。很多患者病前的个性，是敏感、谨慎、多疑、主观、固执、自我中心、自怜和孤僻，或是要求十全十美的等。
疑病症患者肯定有躯体症状，如舌苔发白、局部红疹等，这些症状往往也都是由心理焦虑或抑郁所继发的，是情绪调动的。
“恐艾症”如何治疗呢？心病当然要心药治。其治病原则：心理治疗为主，药物治疗为辅！
李兰陵
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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HIV-negative suspicions expert analysis: state of mind affects the immune system
At 14:03 on April 11, 2011 Source: Yangtze Evening News
Why is HIV-negative suspicions that lingers -
Psychological state of the human immune system
Why are there so a group of people, be characterized as "fear of AIDS disease" after the United States did not identify informed the "new virus", still insisted that he was suffering more terrible than AIDS, "HIV negative"?
Sick because they insist, is the body that are symptoms of the disease, they do not know, in fact, they are suffering from the "International Classification of Diseases and Related Health Problems" ICD Tenth Edition of "somatization disorder", "hypochondria."
Expert Interview: Nanjing University of Chinese Medicine Psychology Professor Du Wendong
A blood sample sent to the United States has not identified a new virus
Now there are at least six provinces and cities nationwide total of thousands of people (Jiangsu 7), convinced that he was suffering from a "negative AIDS."
"Negative AIDS", refers to himself infected with the AIDS virus, and HIV infection have very similar symptoms, but after several HIV (AIDS) examination were negative, so that is a variation of their HIV infection or terrible unknown virus - a can not be detected, can be transmitted in saliva, attacks the human immune system, HIV class.
Case -
(1) Mr. Wang Hong Kong (both cases a pseudonym), 30 years old, in 2009, and his wife quarrel, anger away from home, there was a Hong Kong Nvwang unprotected sex, worry about sexually transmitted diseases, to hospital for a number of checks, have proved not infected with AIDS or sexually transmitted diseases.
However, last November, he began to malaise, lymph nodes, tongue grow hair, muscle and joint bizarre Zuoxiang beat and other symptoms, resistance to continued deterioration, weight plummeted seventy-eight pounds, several times for treatment, can not find the cause.
He suspected the virus has recently spread to his wife because his wife Persistent sore throat, diarrhea and flatulence and other symptoms.
(2) Guangxi Mr Jiang, 26, last July, when a prostitute condom holes the next day the disease appeared abdominal bowel sounds, nausea, followed by skin rash, limb weakness, chest, nausea, heart palpitations and joint ring and so on. He spend one million for the physical examination also can not find the problem. Stunning due to the same table to eat the suspect virus to three colleagues.
(3) Huang of Anhui, in 2008 allegedly on the bus, "needle" bar a bit, a week after sweating, nausea, nausea, lymph swelling and pain of the situation, weight plummeted kilograms. Although HIV testing was negative, but her condition has not improved. Suspect has an unknown virus to his wife, brother, sister.
(4) people in Heilongjiang, Mr. Zhang, in 2007, visited porn sites, suddenly broke into a prostitute by a tongue lick the left chest, and he immediately wash the saliva, but has a fever the next day and start to appear low-grade fever, diarrhea, gum pain symptoms. A month later his body inexplicable red dot. Three months after suffering from meningitis. He has received seven HIV testing within three months, and the number of physical examination, are unknown etiology, worried about his family and left home alone is contagious.
(5) Shanghai Lin, his mother in 2008 after blood transfusion in the hospital, one after another, night sweats, numbness in hands and feet and a skin rash and other symptoms. His mother was injured in an accident in the mother's blood stained, two weeks later, Lin suddenly the whole body lymph nodes, large blood spots skin, muscle unusual sense of insects crawling. In early 2009, collapsed the way to work. The eight HIV were negative, other tests also failed to identify the cause.
6, Ministry of Health spokesman Deng Haihua, said: According to the survey, can be excluded from the readme suspected of HIV infection among HIV-infected; in the blood samples were sent to the U.S. disease control will be related to laboratory testing, the result is: You have a sample of HIV antibodies were detected negative, disease-related pathogens have been detected.
So, to say, "negative AIDS" is just fear of AIDS symptoms.
However, the test results and preliminary findings have not been recognized in this population. They said in unison: "We repeated HIV testing, has been completely off the fear. But if not ill, why the symptoms are not to reclaim it?"
2 psychogenic "physical barriers" are common
Because they adhere to the sick, is real "somatic symptoms", in fact this psychogenic "Body obstacles" are common.
Case: Police make a mother to identify the body of a woman to see if her daughter left home a few days ago. In the body of a woman she found that her daughter is wearing the clothes to wear clothes before leaving, immediately fainted, woke up, she found his legs to lose control - and paralyzed!
Case: Female, 13 years old, hospitalized because of asthma attacks. She had an asthma attack for several days, the number of outpatient drugs with antispasmodic asthma treatment ineffective. Clear consciousness on admission, slow deep breathing, chest rise and fall significantly, with the bending Shenjing breathing. No physical examination and nasal cyanosis fan, lung auscultation without wheezing. Asked detailed medical history, his father had just passed away shortly after the original and his father are closer, strong dependence of life.
Case 1 Case 2, paralysis and asthma, are psychogenic "somatoform disorder."
Somatoform disorders, is the "International Classification of Diseases and Related Health Problems," Tenth Edition (ICD-10) and "American Psychiatric Diagnostic and Statistical Manual," Fourth Edition (DSM-IV) in a disease category.
The clinical features are: The patient complained of one or more physical symptoms, but the standard treatment of patients with pain often can not solve.
WHO statistics, about 10% of people with mental problems, including somatization disorder lifetime prevalence rate of 0.2% to 2%.
The etiology Why? Psychologists explain -
Psychological stress is an individual, when the mood does not work from verbal and / or behavioral inhibition vent down when it was submerged, and the "organ language" forms, which form a somatization symptoms. The physical discomfort and symptoms can not be explained by pathology.
Somatization symptoms in patients with replacement heart unpleasant mood, such as expression of certain thoughts and emotions, or reduce the causes by a self-guilt, and so on. Subconsciously, they feel the benefits of illness, physical behavior of the disease down to maintain a chronic somatization disorder (not interested in camouflage, all unconscious of the act).
In other words, "body" of the subconscious, as patients deal with psychological and social plight of all aspects of an approach, a regression approach to children's early years.
Case 1 of the legs paralyzed, objectively diluted woman mourning her unbearable pain; Case 2 of the asthma, dilute the pain of her late father.
"Fear of AIDS disease" mean? Many patients the cause of the sexual misconduct, in the spur of the moment with deviant behavior, calm down, will face moral dimensions of the self-blame, and "sick", to a certain extent, will reduce the guilt.
"Physical disease" more of a "psychological fear of AIDS," the transformation. However, the "body" disease in patients with intention is to reduce the fear may be infected with HIV, did not expect because of "physical disease", on making it a more "psychological fear of AIDS", which is generated in the evolutionary process This "self-help approach" by the unexpected.
An even greater "fear of AIDS psychology", but also into the formation of a new "chronic somatization disorder."
3 is a unity of psychological and physiological
"Emotional" why can use "organ language" manifest themselves?
The reason is that people are formed by the physical and psychological unity. In this continuum, the nervous, immune and endocrine systems exist in their respective positive and negative feedback of the internal regulatory mechanism, which the system can only coordination of functional activities, accurate and precise. However, in pathological conditions, some of the feedback mechanism the body can cause more serious damage.
Case 1: A mother, her son mentally handicapped. Son, more than 60 years old, she has more than 90 years old, she knew no one care of a dead son, and the subconscious, she felt she could not die, so the spirit of the first good, busy day, cooking and cleaning for her son. One day his son fell into the river accidentally drowned, the next day the old mother also passed away peacefully in her sleep.
After the drowning death of his son, the subconscious old mother has lost the meaning of life, her death was cardiac in nature.
Case 2: There is a small hospital cancer fighters, at first did not know is suffering from cancer, cheerfully sweep the floor every day, learn from Lei Feng, a doctor of great confidence in his recovery harbor; but when he inadvertently aware of their condition immediately after lying down, and passed away after a week.
Cancer is a wasting disease, it is impossible in such a short time, life-threatening, a small soldier's death was cancer, scared to death. Data shows that "80% of cancer patients were scared to death," the. "Fear of AIDS disease" and "somatoform" is a huge fear of AIDS, causing some of the feedback mechanisms of the result.
"Fear of AIDS disease" patients generally have a "high-risk behavior," or suspected "high-risk factors."
Mr. Wang and Mr. Jiang is the people of Guangxi sexual misconduct; Anhui Huang allegedly "needle" prick; Heilongjiang, Mr. Zhang was a prostitute with a tongue licking; Shanghai Lin was an accident in a patient's blood and other stains.
Because of the scanty means of HIV infection, they all think they are infected with HIV, which has a huge psychological fear!
4 fear of mobilizing the "organ language"
Emotion is how to mobilize the "organ language" it?
Many patients in the "high-risk behavior" and "risk factors" in the body appeared the next day obstacles, this is why?
Because the body of psychogenic disorder, also known as somatic stress disorder, which stress the incident, to activate the "hypothalamus - pituitary - adrenal axis", with the attendant impact on endocrine and immune systems, somatic symptoms appeared .
(1) arrhythmia
Thematic symptoms: arrhythmia, sweating, palpitations, sweating, trembling, flushing and so on.
These symptoms occur because of what?
This is the "plant functional somatoform disorder" phenomenon. Because the stress state, the central nervous system caused by the reaction (eg, caused great fear reaction), eventually be able to activate the "hypothalamus - pituitary - adrenal axis", and then activate the "sympathetic - adrenal axis", sympathetic dysfunction, continued excitement, it will have a "cardiac arrhythmia" and other symptoms.
(2) muscle pain
Thematic symptoms: muscle twitching, muscle unusual sense of insects crawling and pain, malaise, numbness hands and feet. Why is this it?
The reason is that the hypothalamus - pituitary - adrenal axis is activated, adrenaline, protocatechuic aniline increased hormone secretion, these hormones can enhance the strength of the role of these hormones to eventually metabolized by the liver, but because of too much secretion , the liver can not be completely metabolized, metabolic intermediates remain in the muscles and causing pain, ants crawling and various symptoms.
(3) various types of inflammation
Thematic symptoms: strange sounds and joint pain, swollen lymph many body pain, sore throat, gum inflammation, oral ulcers, Candida albicans infections.
Zuoxiang and joint pain mysterious, is aseptic inflammation. Its occurrence and immune function disorders.
Gingival inflammation, is a bacterial inflammation. We are tired, anxious lit, resulting in low immunity, and the feeling of gingival inflammation, fear of AIDS caused by a fungus disease inflammation caused by psychological factors are also the result of low immunity.
(4) diarrhea, anorexia
Thematic symptoms: diarrhea, flatulence, anorexia, dry mouth, rapid weight loss and so on.
Suspect that people infected with HIV, often all day in fear and anxiety. Long-term neurological stress (such as fear, worry) can easily cause endocrine and autonomic nervous system disorders, which led to all these symptoms.
5 patients may have personality hypochondria
"Fear of AIDS patients" who may be suspected in patients with symptoms or with suspected disease of the personality of the person.
Hypochondria, also known as "hypochondriacal neurosis" is a sign of their own making unrealistic feeling sick or explanations which are the resulting physical and mental concerns, worries and fears are occupied by a nerve disease.
It and "somatoform disorders" as is "International Classification of Diseases and Related Health Problems," Tenth Edition (ICD-10) and "American Psychiatric Diagnostic and Statistical Manual," Fourth Edition (DSM-IV) in a disease category.
According to foreign reports, "hypochondria" about 1% of various diseases.
Case: Nanjing, a policewoman in the process of handling cases stained with the blood of patients with suspected AIDS, when she was very nervous, but after the inspection done to prove that she did not have a sense of the AIDS virus, along with her heart at ease, and enthusiasm into police work.
In fact, every one of us normal people will be too much at one time or attention to their health, is not a serious illness or discomfort produced general apprehension, there the concept of hypochondriasis, such as where there will be suspicious lump is not cancer, but after examination confirmed disease-free, given proper explanation will give up the concept of hypochondria.
Why do patients with suspected disease, such as the "fear of AIDS disease" but will be repeated in patients with medical treatment, the doctor's explanation and objective tests were not sufficient to eliminate its view, still stick to their sick?
This may be suspected in patients with personality related disease. Many patients with premorbid personality, is a sensitive, cautious, suspicious, subjective, stubborn, self-centered, self-pity and lonely, or require perfect and so on.
Hypochondriac patient must have physical symptoms, such as the tongue pale, local rash, these symptoms often are made by secondary mental anxiety or depression, is the emotional mobilization.
"Fear of AIDS disease" how to treat it? Of course, heart medicine for heart disease. The treatment principles: based psychotherapy, drug therapy, supplemented by!
Li Lanling
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