Acupuncture
uses tiny, sterile, disposable needles which are gently inserted into various points on the body (acupoints) to balance the body's Qi (energy) in order to promote healing.
Acupuncture therapy is a therapeutic method which prevents or treats diseases by applying needles to stimulate certain superficial parts of the body.
Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine (TCM), acupuncture aims to restore and maintain health through the stimulation of specific points on the body. In the United States, where practitioners incorporate healing traditions from China, Japan, Korea, and other countries, acupuncture is considered part of complementary and alternative medicine (CAM). Acupuncture practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. In traditional Chinese medicine theory, this regulates the flow of qi (vital energy) along pathways known as meridians. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, 1.4 percent of respondents (an estimated 3.1 million Americans) said they had used acupuncture in the past year. A special analysis of acupuncture data from an earlier NHIS found that pain or musculoskeletal complaints accounted for 7 of the top 10 conditions for which people use acupuncture. Back pain was the most common, followed by joint pain, neck pain, severe headache/migraine, and recurring pain.
What are the most common symptoms and conditions that you treat in your acupuncture clinic? We treat over 80 symptoms and conditions in our clinic. From most to least common, the top 12 are
What the Science Says About Acupuncture for Pain Acupuncture has been studied for a wide range of pain conditions, such as postoperative dental pain, carpal tunnel syndrome, fibromyalgia, headache, low-back pain, menstrual cramps, myofascial pain, osteoarthritis, and tennis elbow.
Overall, it can be very difficult to compare acupuncture research results from study to study and to draw conclusions from the cumulative body of evidence. This is because studies may use different acupuncture techniques (e.g., electrical vs. manual), controls (comparison groups), and outcome measures. One particularly complex factor in acupuncture research is choosing the controls for a clinical trial. The choice depends in part on whether the researchers want to study a particular aspect of acupuncture (e.g., effects on the brain) or to determine whether acupuncture is useful compared with other forms of care. Examples of control groups include study participants who receive no acupuncture, simulated acupuncture (procedures that mimic acupuncture, sometimes also referred to as "placebo" or "sham"), or other treatments (in addition to or in place of acupuncture or simulated acupuncture). An emerging theme in acupuncture research is the role of the placebo. For example, a 2009 systematic review of research on the pain-relieving effects of acupuncture compared with placebo (simulated) or no acupuncture was inconclusive. The reviewers found a small difference between acupuncture and placebo and a moderate difference between placebo and no acupuncture; the effect of placebo acupuncture varied considerably, and the effect of acupuncture appeared unrelated to the specific kind of placebo procedure used. All of the study participants received standard care, typically consisting of analgesic drugs and physical therapy.
Acupuncture Side Effects That Are Normal By Sara Calabro
The most common side effects of acupuncture are things everyone wants: better sleep, more energy, mental clarity, better digestion and less stress. One or several of these side effects occur routinely for many, many acupuncture goers.
Following the publication of an article on the most common side effects of acupuncture, AcuTake received multiple inquires from readers about certain unpleasant side effects of acupuncture and whether they too were common.
And indeed, there are other, less pleasant side effects of acupuncture. These additional side effects are much rarer than the most common side effects of acupuncture, but they can and do occasionally happen.
None are life-threatening and all typically are fleeting. Still, they are good to be aware of so that if you do experience them, you know they’re normal and nothing to be too concerned about.
Infrequent But Possible Side Effects of AcupunctureIn my experience, the following seven side effects can occur after acupuncture. Acupuncturist readers are encouraged to chime in, in the comment section below, about other possible side effects of acupuncture.
Worse symptoms
While most people notice a marked improvement in their symptoms following acupuncture, some feel worse before they start feeling better. In natural medicine circles this is sometimes referred to as a healing crisis. The idea is that as your body starts undergoing the changes involved in moving toward health, things get stirred up. This can cause not only an exacerbation of current symptoms but also the recurrence of previous ailments that had been dormant.
Acupuncture awakens your self-healing capabilities. With that can come an onslaught of bodily awareness. This usually is a positive experience but it also can mean heightened sensitivity or intolerance for things that previously felt normal. An example of this is someone who unconsciously adapts to stress by tightening and hunching up his shoulders. After an acupuncture treatment, once this person’s bodily felt sense has been woken up, his mild upper back and neck tension might start screaming.
The good news about this side effect is that it’s a sign that things are moving. In the case of acupuncture, this means that the primary objective is being met. That is, you are starting to transition on multiple levels from stuck to unstuck.
Fatigue
People can feel wiped out after acupuncture. A more common result is increased energy but sometimes the “acu land” effect hangs on a little longer. This is your body telling you that it’s depleted. Feeling fatigued after acupuncture is not cause for concern but it is a warning sign that you need to rest.
If you have this experience, take it easy for the remainder of the day. Take a bath that night. Go to bed early. Come morning, the combination of acupuncture and rest will leave you feeling born again.
Soreness
Body parts where acupuncture needles get inserted can feel sore after needles are removed. I’ve found that this most commonly occurs with points in the hands and feet, especially Large Intestine 4, an acupuncture point located between the thumb and index finger. You also may experience muscle soreness away from the needling site if a trigger or ashi point was released during your treatment.
Soreness from acupuncture typically dissipates within 24 hours. However, big trigger point releases can cause residual soreness that lasts a few days. Most acupuncturists will warn you about this before you leave your appointment.
Bruising
Although less common than soreness, bruising can occur at the needling site. Sometimes bruising is the result of a hematoma, a localized collection of blood that gets initiated when the needle punctures the skin. Bruises, unfortunately, usually last longer than soreness from an acupuncture needle. Still, they generally are not anything to worry about beyond the aesthetic inconvenience.
It is unknown why some people bruise from acupuncture. I have a few patients who, no matter what I try in terms of needle brand, size or technique, they bruise every time. (Again, I often see it happen at Large Intestine 4.) Others—the majority—never experience bruising anywhere.
Muscle twitchingEvery time I get acupuncture, no matter where the needles are placed, my right quadricep muscle twitches like crazy. Don’t ask me why. People may experience involuntary muscle twitching during or after acupuncture. I’ve seen this occur in muscles that receive acupuncture needles and, as in my case, on seemingly random parts of the body that are far away from any needles.
Muscle twitching is different from full-on muscle spasm. If during or after an acupuncture treatment you feel that one of your muscles is acutely spasming, especially if it’s a muscle that was just needled, tell your acupuncturist. He or she might be able to release it before you go on your merry way.
Light headedness
This is pretty rare but is can happen—and on very rare occasions, post-acupuncture lightheadedness can result in fainting. Getting up quickly from the acupuncture table can cause lightheadedness, as can coming for acupuncture on an empty stomach. Remember that eating is one of the key things to remember before an acupuncture appointment.
When your acupuncture session is over, take your time getting up and move gently as you gather your things to leave. If you find yourself feeling lightheaded after the treatment, sit in your acupuncturist’s waiting room for a few minutes and take some deep breaths. Acupuncture can be a physically and emotionally intense experience, and sometimes our bodies are not fully recovered at exactly the moment our hour is up. It is okay if you need a little extra time.
Emotional release
Sometimes people cry in acupuncture. Not because they’re in pain but because their emotions, which often get stifled while powering through life, become free flowing. The emotional release that can happen in acupuncture usually is a positive experience, but it can be surprising, especially for people who tend to be more emotionally stoical.
Feeling extra sensitive or tear prone in an acupuncture session, or in the days that follow, is completely normal. It’s also a sign that the acupuncture is working. Even if you’re seeking acupuncture for a physical ailment, increased emotional expression is an indication that healing is happening. From an acupuncture perspective, physical and emotional health are interconnected, so emotional shifts suggest forthcoming physical changes as well.
While these side effects are rarely cause for concern, you know your body best. If any of the above side effects feel like they’re too severe or lasting too long—or if you notice any additional negative reactions to an acupuncture treatment—you should contact your acupuncturist.
Acupuncture therapy is a therapeutic method which prevents or treats diseases by applying needles to stimulate certain superficial parts of the body.
Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine (TCM), acupuncture aims to restore and maintain health through the stimulation of specific points on the body. In the United States, where practitioners incorporate healing traditions from China, Japan, Korea, and other countries, acupuncture is considered part of complementary and alternative medicine (CAM). Acupuncture practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. In traditional Chinese medicine theory, this regulates the flow of qi (vital energy) along pathways known as meridians. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, 1.4 percent of respondents (an estimated 3.1 million Americans) said they had used acupuncture in the past year. A special analysis of acupuncture data from an earlier NHIS found that pain or musculoskeletal complaints accounted for 7 of the top 10 conditions for which people use acupuncture. Back pain was the most common, followed by joint pain, neck pain, severe headache/migraine, and recurring pain.
What are the most common symptoms and conditions that you treat in your acupuncture clinic? We treat over 80 symptoms and conditions in our clinic. From most to least common, the top 12 are
- Chronic and acute pain
- Osteoarthritis
- Fibromyalgia
- Sports injuries
- Sciatica and neuralgia
- Automobile-accident injuries
- Autoimmune diseases
- Allergies and asthma
- Depression, anxiety, and stress
- Bell's palsy and paralysis
- Skin rashes and eczema
- Side effects of chemotherapy and radiation therapy for cancer.
What the Science Says About Acupuncture for Pain Acupuncture has been studied for a wide range of pain conditions, such as postoperative dental pain, carpal tunnel syndrome, fibromyalgia, headache, low-back pain, menstrual cramps, myofascial pain, osteoarthritis, and tennis elbow.
Overall, it can be very difficult to compare acupuncture research results from study to study and to draw conclusions from the cumulative body of evidence. This is because studies may use different acupuncture techniques (e.g., electrical vs. manual), controls (comparison groups), and outcome measures. One particularly complex factor in acupuncture research is choosing the controls for a clinical trial. The choice depends in part on whether the researchers want to study a particular aspect of acupuncture (e.g., effects on the brain) or to determine whether acupuncture is useful compared with other forms of care. Examples of control groups include study participants who receive no acupuncture, simulated acupuncture (procedures that mimic acupuncture, sometimes also referred to as "placebo" or "sham"), or other treatments (in addition to or in place of acupuncture or simulated acupuncture). An emerging theme in acupuncture research is the role of the placebo. For example, a 2009 systematic review of research on the pain-relieving effects of acupuncture compared with placebo (simulated) or no acupuncture was inconclusive. The reviewers found a small difference between acupuncture and placebo and a moderate difference between placebo and no acupuncture; the effect of placebo acupuncture varied considerably, and the effect of acupuncture appeared unrelated to the specific kind of placebo procedure used. All of the study participants received standard care, typically consisting of analgesic drugs and physical therapy.
Acupuncture Side Effects That Are Normal By Sara Calabro
The most common side effects of acupuncture are things everyone wants: better sleep, more energy, mental clarity, better digestion and less stress. One or several of these side effects occur routinely for many, many acupuncture goers.
Following the publication of an article on the most common side effects of acupuncture, AcuTake received multiple inquires from readers about certain unpleasant side effects of acupuncture and whether they too were common.
And indeed, there are other, less pleasant side effects of acupuncture. These additional side effects are much rarer than the most common side effects of acupuncture, but they can and do occasionally happen.
None are life-threatening and all typically are fleeting. Still, they are good to be aware of so that if you do experience them, you know they’re normal and nothing to be too concerned about.
Infrequent But Possible Side Effects of AcupunctureIn my experience, the following seven side effects can occur after acupuncture. Acupuncturist readers are encouraged to chime in, in the comment section below, about other possible side effects of acupuncture.
Worse symptoms
While most people notice a marked improvement in their symptoms following acupuncture, some feel worse before they start feeling better. In natural medicine circles this is sometimes referred to as a healing crisis. The idea is that as your body starts undergoing the changes involved in moving toward health, things get stirred up. This can cause not only an exacerbation of current symptoms but also the recurrence of previous ailments that had been dormant.
Acupuncture awakens your self-healing capabilities. With that can come an onslaught of bodily awareness. This usually is a positive experience but it also can mean heightened sensitivity or intolerance for things that previously felt normal. An example of this is someone who unconsciously adapts to stress by tightening and hunching up his shoulders. After an acupuncture treatment, once this person’s bodily felt sense has been woken up, his mild upper back and neck tension might start screaming.
The good news about this side effect is that it’s a sign that things are moving. In the case of acupuncture, this means that the primary objective is being met. That is, you are starting to transition on multiple levels from stuck to unstuck.
Fatigue
People can feel wiped out after acupuncture. A more common result is increased energy but sometimes the “acu land” effect hangs on a little longer. This is your body telling you that it’s depleted. Feeling fatigued after acupuncture is not cause for concern but it is a warning sign that you need to rest.
If you have this experience, take it easy for the remainder of the day. Take a bath that night. Go to bed early. Come morning, the combination of acupuncture and rest will leave you feeling born again.
Soreness
Body parts where acupuncture needles get inserted can feel sore after needles are removed. I’ve found that this most commonly occurs with points in the hands and feet, especially Large Intestine 4, an acupuncture point located between the thumb and index finger. You also may experience muscle soreness away from the needling site if a trigger or ashi point was released during your treatment.
Soreness from acupuncture typically dissipates within 24 hours. However, big trigger point releases can cause residual soreness that lasts a few days. Most acupuncturists will warn you about this before you leave your appointment.
Bruising
Although less common than soreness, bruising can occur at the needling site. Sometimes bruising is the result of a hematoma, a localized collection of blood that gets initiated when the needle punctures the skin. Bruises, unfortunately, usually last longer than soreness from an acupuncture needle. Still, they generally are not anything to worry about beyond the aesthetic inconvenience.
It is unknown why some people bruise from acupuncture. I have a few patients who, no matter what I try in terms of needle brand, size or technique, they bruise every time. (Again, I often see it happen at Large Intestine 4.) Others—the majority—never experience bruising anywhere.
Muscle twitchingEvery time I get acupuncture, no matter where the needles are placed, my right quadricep muscle twitches like crazy. Don’t ask me why. People may experience involuntary muscle twitching during or after acupuncture. I’ve seen this occur in muscles that receive acupuncture needles and, as in my case, on seemingly random parts of the body that are far away from any needles.
Muscle twitching is different from full-on muscle spasm. If during or after an acupuncture treatment you feel that one of your muscles is acutely spasming, especially if it’s a muscle that was just needled, tell your acupuncturist. He or she might be able to release it before you go on your merry way.
Light headedness
This is pretty rare but is can happen—and on very rare occasions, post-acupuncture lightheadedness can result in fainting. Getting up quickly from the acupuncture table can cause lightheadedness, as can coming for acupuncture on an empty stomach. Remember that eating is one of the key things to remember before an acupuncture appointment.
When your acupuncture session is over, take your time getting up and move gently as you gather your things to leave. If you find yourself feeling lightheaded after the treatment, sit in your acupuncturist’s waiting room for a few minutes and take some deep breaths. Acupuncture can be a physically and emotionally intense experience, and sometimes our bodies are not fully recovered at exactly the moment our hour is up. It is okay if you need a little extra time.
Emotional release
Sometimes people cry in acupuncture. Not because they’re in pain but because their emotions, which often get stifled while powering through life, become free flowing. The emotional release that can happen in acupuncture usually is a positive experience, but it can be surprising, especially for people who tend to be more emotionally stoical.
Feeling extra sensitive or tear prone in an acupuncture session, or in the days that follow, is completely normal. It’s also a sign that the acupuncture is working. Even if you’re seeking acupuncture for a physical ailment, increased emotional expression is an indication that healing is happening. From an acupuncture perspective, physical and emotional health are interconnected, so emotional shifts suggest forthcoming physical changes as well.
While these side effects are rarely cause for concern, you know your body best. If any of the above side effects feel like they’re too severe or lasting too long—or if you notice any additional negative reactions to an acupuncture treatment—you should contact your acupuncturist.
Moxibustion
Moxibustion means the use of a moxa as a cautery by igniting it on the skin. Moxa:
1. a soft woolly mass prepared from the young leaves of various wormwoods of eastern Asia and applied esp. in Chinese popular medicine as a cautery by being ignited on the skin.
2. Any of various substances applied and ignited like moxa as a counterirritant.
灸法，是指应用高温（主要是艾药或其他物质燃烧后产生的温热）或低温，或者以某些材料（对皮肤有剌激作用的药物或其他物质）直接接触皮肤表面后产生的刺激，作用于人体的穴位或特定部位，从而达到预防或治疗疾病的一种疗法。是针灸医学的主要组成部分，也是我国重要的传统非药物疗法之一。
灸法属于温热疗法，与火的关系密切，火的历史在我国可以追溯到50万年前的“北京人”或80万年前的“蓝田人”时代，乃至更远。据考古学的研究，在北京周口店发掘的含骨化石地层中，就发现有遗留的灰烬和烧过的动物骨骼或土石。早在大约5万年前的原始氏族公社时期，我们的祖先就懂得了用火来取暖、熟食，尤其是1.8万年前的“山顶洞人”已掌握了人工取火的方法。灸法是随着火的应用而萌芽，并在其应用实践中不断发展的。
古人在煨火取暖时，由于偶然被火灼伤而解除了某种病痛，从而得到了烧灼可以治病的启示，这就是灸法的起源.“灸”字在《说文解字》中解释为“灼”，是灼体疗病之意.最早可能采用树枝、柴草取火熏、熨、灼、烫以消除病痛，以后才逐渐选用艾（moxa）为主要灸料。艾，自古以来就在我国广大的土地上到处生长，因其气味芳香，性温易燃，且火力缓和，于是便取代一般的树枝燃料，而成为灸法的最好材料。据《左传》记载，鲁成公10年（公元前581年），晋景公病，秦国太医令医缓来诊，医缓说：“疾不可为也，在肓之上，膏之下，攻之不可，达之不及，药不治焉。”晋朝杜预注解：“攻”指艾灸，“达”指针刺。汉代张仲景的《伤寒杂病论》中有“可火”与“不可火”的记载，其所言之火，亦指艾灸。
“灸”字在现存文献记载中，以《庄子•盗跖》最早提及，如孔子劝说柳下跖：“丘所谓无病自灸也.”《孟子•离娄》也曾记载：“今人欲王者，犹七年之病，求三年之艾也”，显然也是指的艾灸。从中可以推断在春秋战国时代，灸法是颇为盛行的。1973年在我国湖南长沙马王堆发掘了三号汉墓。在出土的帛书中，记载了经脉灸法的就有3篇，是目前发现的《内经》以前最早的珍贵文献。在医学专著中，灸法最早见于《内经》.《素问•异法方宜论》说：“北方者，天地所闭藏之域也，其地高陵居，风寒冰冽，其民乐野处而乳食，脏寒生满病，其治宜灸炳，故灸炳者，亦从北方来。”说明灸法的产生与我国北方人民的生活习惯、条件和发病特点有着密切的关系。
以后历代出现许多针灸方面的著作，如晋代皇甫谧的《针灸甲乙经》、唐代孙思邈的《备急千金要方》都大力提倡针灸并用。唐代王焘的《外台秘要》则弃针而言灸，可见当时对灸的重视。以后从宋代王执中的《针灸资生经》，明代高武的针灸聚英》、杨继洲的《针灸大成》，到清代廖润鸿的《针灸集成》无不注重灸法。历代灸法的专著还有很多，如公元3世纪就有《曹氏灸方》，唐代有《骨蒸病灸方》，宋代有《黄帝明堂灸经》《灸膏肓俞穴法》《备急灸法》，元代有《痈疽神秘灸经》，清代有《太乙神针》《神灸经纶》等。
灸法治病，最初古人多采用直接灸，且艾炷较大，壮数（艾炷的计数单位）较多，如《太平圣惠方》指出：“灸炷虽然数足，得疮发脓坏，所患即差；如不得疮发脓坏，其疾不愈。”《医宗金鉴•刺灸心法要诀》也说：“凡灸诸病，火必足气到，始能求愈。”同时古人非常推崇应用化脓灸进行身体保健和预防疾病。现代灸法则有了长足发展，为了减轻患者接受灸疗的痛苦，多采用小艾炷少壮灸，并衍化出多种灸法，如艾条灸、药条灸（包括太乙神针灸、雷火神针灸等）、温灸器灸、温针灸、天灸、灯火灸等。根据病情不同，
1. a soft woolly mass prepared from the young leaves of various wormwoods of eastern Asia and applied esp. in Chinese popular medicine as a cautery by being ignited on the skin.
2. Any of various substances applied and ignited like moxa as a counterirritant.
灸法，是指应用高温（主要是艾药或其他物质燃烧后产生的温热）或低温，或者以某些材料（对皮肤有剌激作用的药物或其他物质）直接接触皮肤表面后产生的刺激，作用于人体的穴位或特定部位，从而达到预防或治疗疾病的一种疗法。是针灸医学的主要组成部分，也是我国重要的传统非药物疗法之一。
灸法属于温热疗法，与火的关系密切，火的历史在我国可以追溯到50万年前的“北京人”或80万年前的“蓝田人”时代，乃至更远。据考古学的研究，在北京周口店发掘的含骨化石地层中，就发现有遗留的灰烬和烧过的动物骨骼或土石。早在大约5万年前的原始氏族公社时期，我们的祖先就懂得了用火来取暖、熟食，尤其是1.8万年前的“山顶洞人”已掌握了人工取火的方法。灸法是随着火的应用而萌芽，并在其应用实践中不断发展的。
古人在煨火取暖时，由于偶然被火灼伤而解除了某种病痛，从而得到了烧灼可以治病的启示，这就是灸法的起源.“灸”字在《说文解字》中解释为“灼”，是灼体疗病之意.最早可能采用树枝、柴草取火熏、熨、灼、烫以消除病痛，以后才逐渐选用艾（moxa）为主要灸料。艾，自古以来就在我国广大的土地上到处生长，因其气味芳香，性温易燃，且火力缓和，于是便取代一般的树枝燃料，而成为灸法的最好材料。据《左传》记载，鲁成公10年（公元前581年），晋景公病，秦国太医令医缓来诊，医缓说：“疾不可为也，在肓之上，膏之下，攻之不可，达之不及，药不治焉。”晋朝杜预注解：“攻”指艾灸，“达”指针刺。汉代张仲景的《伤寒杂病论》中有“可火”与“不可火”的记载，其所言之火，亦指艾灸。
“灸”字在现存文献记载中，以《庄子•盗跖》最早提及，如孔子劝说柳下跖：“丘所谓无病自灸也.”《孟子•离娄》也曾记载：“今人欲王者，犹七年之病，求三年之艾也”，显然也是指的艾灸。从中可以推断在春秋战国时代，灸法是颇为盛行的。1973年在我国湖南长沙马王堆发掘了三号汉墓。在出土的帛书中，记载了经脉灸法的就有3篇，是目前发现的《内经》以前最早的珍贵文献。在医学专著中，灸法最早见于《内经》.《素问•异法方宜论》说：“北方者，天地所闭藏之域也，其地高陵居，风寒冰冽，其民乐野处而乳食，脏寒生满病，其治宜灸炳，故灸炳者，亦从北方来。”说明灸法的产生与我国北方人民的生活习惯、条件和发病特点有着密切的关系。
以后历代出现许多针灸方面的著作，如晋代皇甫谧的《针灸甲乙经》、唐代孙思邈的《备急千金要方》都大力提倡针灸并用。唐代王焘的《外台秘要》则弃针而言灸，可见当时对灸的重视。以后从宋代王执中的《针灸资生经》，明代高武的针灸聚英》、杨继洲的《针灸大成》，到清代廖润鸿的《针灸集成》无不注重灸法。历代灸法的专著还有很多，如公元3世纪就有《曹氏灸方》，唐代有《骨蒸病灸方》，宋代有《黄帝明堂灸经》《灸膏肓俞穴法》《备急灸法》，元代有《痈疽神秘灸经》，清代有《太乙神针》《神灸经纶》等。
灸法治病，最初古人多采用直接灸，且艾炷较大，壮数（艾炷的计数单位）较多，如《太平圣惠方》指出：“灸炷虽然数足，得疮发脓坏，所患即差；如不得疮发脓坏，其疾不愈。”《医宗金鉴•刺灸心法要诀》也说：“凡灸诸病，火必足气到，始能求愈。”同时古人非常推崇应用化脓灸进行身体保健和预防疾病。现代灸法则有了长足发展，为了减轻患者接受灸疗的痛苦，多采用小艾炷少壮灸，并衍化出多种灸法，如艾条灸、药条灸（包括太乙神针灸、雷火神针灸等）、温灸器灸、温针灸、天灸、灯火灸等。根据病情不同，
