Autoimmune diseases are a collective group of disorders that plague nearly 50 million people in the United States today. When a person suffers from an autoimmune disease it means their own immune system is attacking the body and altering or destroying the tissues. Autoimmune diseases include things like rheumatoid arthritis, lupus, Crohn’s disease, pernicious anemia, multiple sclerosis, irritable bowel disease and Parkinson’s disease.

Conventional medicine can diagnose 100 different autoimmune conditions. Unfortunately, the treatments available to people with these disorders is not as plentiful through conventional medicine. It typically involves the use of pharmaceuticals that can have side effects that are as bad, if not worse, than the symptoms of the disease itself. And even worse, many people are told they have no options. This is where Traditional Chinese Medicine can be beneficial.

Acupuncture treatments are completely customizable. Traditional Chinese medicine practitioners don’t treat based on the Western medical diagnosis. They attack the disease based on its diagnosis in Chinese medicine. This means that they not only want to treat the symptoms, but also get to the root of the problem. This is much different from Western medicine with its one-size-fits-all type of treatments. The ability to treat each person as an individual with their own unique diagnosis is why traditional Chinese medicine is so successful. 

Many factors play into an autoimmune disease. Traditional Chinese Medicine looks at the body as a whole, allowing the patient to get a more complete treatment, usually with better results. Since autoimmune diseases are thought to be a deficiency in people’s immune-system responses, TCM practitioners will work to restore and rejuvenate the factors that are vital for good immunity. These things include blood and the energetic life force known as qi (pronounced “chee”). There can also be underlying genetic factors involved in autoimmune diseases, so acupuncturists may also work on building up a patients essence or jing. Research has shown that acupuncture causes responses in nerve cells, as well as in parts of the brain. By utilizing acupuncture, those suffering from an autoimmune disease can, over time, reprogram their brains and cells to perform as intended.

The use of electroacupuncture may prove useful for people suffering from autoimmune diseases too. Electroacupuncture emits mild electrical stimulation to acupuncture needles. These light shocks trigger the body to produce hormones that suppress pain and inflammation. This helps raise endorphins circulating in the bloodstream. Endorphins are the body’s natural painkillers.

Chinese herbal formulas can also be very effective in the treatment of autoimmune diseases. Chinese herbs have specific qualities that can help boost blood, qi and jing. When acupuncture and Chinese herbs are combined, the effects can be quite favorable. The herbs will actually compliment the acupuncture treatments by extending the effects of the needles. Many times this will shorten the number of treatments required, as the patient will start to see results sooner.

Many people dealing with autoimmune diseases also experience high levels of stress because of their disorder. It can be very stressful trying to lead a “normal” life with severe pain and other symptoms. Studies show acupuncture is very relaxing, and it helps reduce excess cortisol levels in the brain that contribute to chronic stress.

As autoimmune sufferers start to see improvements with acupuncture treatments and herbs, they may also be able to do things they couldn’t before, like exercise. Exercising not only improves blood flow, but it also increases immunity. Exercise also increases the amount of endorphins in the body. So just by receiving regular acupuncture treatments and herbal supplements, those suffering from autoimmune diseases may be able to lead a much more normal life with a lot less pain and suffering.

If you are dealing with some type of autoimmune disease, consider giving Traditional Chinese Medicine a chance. The outcomes may be life changing.

If you feel like you experience seasons where you just can’t catch a break and continuously fall ill, there’s likely a few areas you may be shortcutting yourself and your immune system and a worse-than-usual flu season may not be, solely,where the blame should lie.

​Below are 4 ways you could be weakening your immune system and how to combat that.

Vitamin D Deficiency
Not only is Vitamin D helpful in staving off or reducing your chances of getting cancer, it also guards against colds and flu as well as helping to combat risk of infection.

So how do you get more Vitamin D if you feel like you’re not getting enough? From the sun! Not only does it provide our bodies with an adequate amount, but it also helps to balance Qi which helps nourish our Kidney Yang. This helps to give our body warmth, thus keeping our tissues and organs functioning properly.

Not enough sun? Not to worry! There is a large variety of Vitamin D supplements that can be taken, but be sure to consult with us and your doctor before use.

Lacking In Sleep
The National Heart Blood and Lung Institute states that "during sleep, your body is working to support healthy brain function and maintain your physical health. In children and teens, sleep also helps support growth and development. The damage from sleep deficiency can occur in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk for some chronic health problems, including an improper balance of Cytokines. Cytokines are inflammation and infection targeting proteins both produced and released during sleep. In short, skipping the shut eye can affect how well you think, react, work, learn, and even get along with others.

The National Sleep Foundation suggests the following sleep range based on your age:
Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)

Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)

Adults (18-64): Sleep range is 7-9 hours (new age category)

Older adults (65+): Sleep range is 7-8 hours (new age category)

Washing Your Hands
Washing your hands is key in preventing illness or infection. Not only does the act of washing your hands matter, but the duration of how long you’re washing them for is important too!

We have some disturbing statistics for you that will hopefully encourage you to take more time in the realm of hygiene. A few studies from the American Society of Microbiology and Michigan State University found the following:

• 83% of women washed their hands after using a public restroom 
• 74% of men washed their hands after using a public restroom
• 95% of us don’t wash our hands well enough to kill bacteria
• 1 in 3 people use soap when washing their hands

Stress
One of the ways that your body heals itself is by producing T cells (a substance in your blood that fights infection). There’s a lot that’s impacted within your body when you become stressed. At a basic level, your body will release cortisol, which impairs T cell production and the ability to fight infection from foreign invaders. Being stressed directly impacts your immune system, so it’s important to find ways to relax!

Another way to combat stress is by using Traditional Chinese Medicine and Acupressure points!  Yes! Acupuncture can absolutely alleviate stress and anxiety!

By activating specific points known to address these problems, we can actively affect positive change in ones emotional and mental wellbeing! Here are a couple points that can be used:

Ear Shen Men -
This point, Heart 7, is also called Shen Men meaning Spirit Gate. This point reduces excesses that disturb the spirit and the balance of yin/yang. This point is so powerful that TCM practitioners often praise Shen Men as being the most calming and relaxing point in the body, while also being highly accessible.

Union Valley (LI 4)-
The point is known reduce stress, headaches, and neck pain. It’s also used to treat swelling and pain of the eye, nasal obstruction, sore throat and much more. This point is located on the back of the hand at the apex of the webbed triangle between the thumb and the index finger. 

CV 17 -
Conception Vessel 17 (CV 17) is a great self-help point for many reasons. Conception Vessel 17 is easy to find, and matches the location for the heart chakra, at the center of the sternum. With this point you will find potent stress and anxiety relief, as well as an opening of the chest and relief of acid indigestion.

For more educational content, follow us on social media or favorite our blog in your browser to stay up-to-date on the latest Traditional Chinese Medicine news and education.

If you’re ready to start living a healthier lifestyle with Acupuncture and TCM, don’t wait, reach out and schedule an appointment today!

We’re getting closer to the cold and flu season, and this year it’s a HOT topic for many of us with COVID-19 lurking. But fear not, there are things that you can do, right now, from the comfort of your home.

The following are different at-home Immune Optimizing recipes that you can make to help your body navigate this season of cold, flu and virus.

SINUS & NASAL IRRIGATION
Ingredients: 8 oz squeeze bottle, 1 tsp sea salt, water
Preparation: Warm the water and salt (ensure it’s not too warm or this may cause nasal irritation) Setting: Bend over your sink and look straight down at the sink basin while turning your head to a 45 degree angle. Tip the squeeze bottle into your nostril until the liquid runs through your sinuses and leaves the other nostril. (Search Neti Pot Instructions online for clearer instructions). 

CAYENNE, HONEY & LEMON TEA
Ingredients: 1 whole lemon, 1 tsp cayenne pepper, 1 tbsp honey, 3 ½ cups water
Preparation: Boil the above ingredients together for upwards of 10 minutes and strain when finished
Setting/Frequency: Drink this tea three times per day.

DANDELION SMOOTHIE
Ingredients: 1 head of cabbage, 2 cucumbers, 2 oranges and 1 cup of dandelion greens.
Preparation: Juice the above ingredients and pour into a glass
Setting/Frequency: Drink 3 glasses daily

ANTIOXIDANT-RICH NUT MIX
Ingredients: Pine nuts, goji Berries, blueberries (dried) and Brazil nuts
Preparation: Mix together each ingredient to taste preference
Setting/Frequency: Eat once daily as a snack, keep recommended calorie count in mind with consumption of this mixture. 

Keep in mind that there are various ways you can take care of your body in order to bolster your immune health the best chance at fighting illnesses and functioning properly. These include avoiding smoking and taking drugs (that aren’t prescribed by a doctor), which are known for depleting the body's qi and weakens it. Additionally, keep your emotions in check, negative emotions, stress and anxiety can suppress immune function. Do your best to remain optimistic and keep a positive attitude with everything going on in the world around us. Start with the basics - exercise, eat right, sleep and stay hydrated to maintain your body’s balance. 

2020 has proven to be a year of trials and growth for all of us. With a new school year in full swing (as full as it can be at this time...), it’s important to have an open dialogue with our children about what to expect, how to stay safe and how they can express themselves even with certain restrictions. 

GET THEM A MASK THEY CAN BE EXCITED ABOUT
Children don’t have the full scope-of-understanding about this virus like us adults do. They may be confused, find it frustrating that they have to cover half of their face (which is a means of self-expression) and not be able to function in a way that they’re used to.

Getting your child a mask that they enjoy may encourage their desire to wear it, thus keeping them and others around them more safe. Affordable and unique masks can be found on sites such as Etsy and can range anywhere from $5-15. I have masks in my office and can make them to order as well, just ask!

Private sellers make masks with anything from floral print, to superheroes and video game characters such as Spider Man or Fortnite. I favor Marvel, Star Wars and Harry Potter for the kids myself.

RECESS GAMES AT A DISTANCE
Depending on your governing state and the rules that they apply when it comes to COVID-19, you may find your child becoming antsy not being able to play with their friends at recess like they used to. Here are some fun socially-distanced activities that you can incorporate so that kids can still enjoy their play time.

Fitness Relay: Set up into teams of 3 (ensuring everyone is at least 6 feet from one another). Set up cones in front of each team in a straight line to distinguish the start and finish areas. The leader will call out an exercise (jumping jacks, pushups, toe-touches, etc.) and when the leader yells “go!” The first players of each team will run to the cone and perform that exercise. Then, they run back to the starting cone and the next person goes. The first team to have all players finished, wins!

Mirror, Mirror: Players pick a partner and face each other keeping at least 6 feet of distance. One child is deemed the leader, and the others must mirror their movements. Talking and/or giving hints isn’t allowed! So pay close attention. The leader tries to come up with as many movements as possible while the others follow along. Switch leaders after 2 minutes.

MOBILE APPS AND GAMES
There are some mobile apps that can be downloaded on cell phones to help kids stay connected while social distancing. Of course, we encourage family discussions before a game is downloaded to ensure that it lines up with online safety as well as family values.

That being said, a few apps that we have found to be fun include Online Uno (a classic card game), Animal Crossing: Pocket Camp and even Pokemon Go!

With the Covid19 pandemic still among us, we all walk a little weary into the back-to-school season. The good news is, Traditional Chinese Medicine (TCM) can help. Consider a TCM perspective for not only those anxious feelings, but also as a modality to keep the immune system functioning optimally. Here are 4 ways to optimize your immune system this season to reduce your family’s chances of catching the Coronavirus, and other unwanted illnesses.

1.    Focus on Your Circadian Rhythm
The circadian rhythm (CR) govern’s the body’s natural cycles and helps to regulate appetite, sleep and mood - this cycle is influenced and controlled by light from the sun. There is an entire field of study called Chronomedicine that focuses on illnesses and disorders that occur when the body’s biological clock is disturbed, such as Jetlag, which you’ve likely experienced.

Biochemical changes are known to occur when behavioral patterns are altered due to the division of night and day. We bring this topic to light (pun intended) because of the current Pandemic at hand. Many work, school and daily schedules are altered due to the fact that the majority of the population is unemployed and don’t have to abide by a schedule.

We encourage you to try and maintain at least a bedtime/wake-up time so that your body can function the way it’s meant to. The more inconsistent a sleep schedule, the more your life can be affected.

2.    Optimize Your Immune System
Cold and flu season is just around the corner, which means our chances of catching the CoronaVirus and/or another illness increases drastically as we head into the Fall months. These types of illnesses have a higher incidence rate in school kids, the immunocompromised and in the elderly September onward, so it’s best to keep our bodies healthy and in the best condition possible heading into the new seasons. This can be done by consuming food and drink that help to optimize your body’s immune system functions such as the home remedy below.

A healthy tea that you can drink to help stave away colds is as follows:

• 1 clove garlic
• 3 slices ginger
• 1 chopped scallion
• basil
• pinch of cinnamon
• 3 cups water

Boil the above for up to 5 minutes, strain and then consume it just before bed. This recipe suggests that you will sweat quite a bit as it’s intended to open the pores in order to release trapped pathogens. 

3. Keep a Balanced Lifestyle
Eating properly isn’t enough to stave off the CoronaVirus, but having a balanced lifestyle increases your chances of fighting off COVID-19.

The following are several important items that can help keep your body healthy and balanced when fighting off any illness.

• Keep a healthy weight
• Keep an active exercise schedule
• Limit alcohol consumption
• Limit your fast food intake, red meats and processed foods 
• Limit the amount of sugar you consume

4.    Exercise and Water Consumption
If you’re following the above steps, eating healthy foods and taking your vitamins, none of it will matter if you’re not properly hydrated, especially if we’re exercising.

Did you know that your body loses water through simple actions such as digestion, breathing and sweating? Water also helps your body dissolve vitamins, minerals, and other nutrients from the food you consume. It then delivers these vitamin components to the rest of your body for use.

If you maintain a balanced amount of exercise and water consumption, you’re helping to give your body the tools it needs to fight off illnesses. Remember the importance of rehydrating by drinking fluids and eating foods that contain water.

​I understand that these are challenging times, and, the best chance we have to get through this is, by taking care of our bodies, minds, and supporting our overall well-being, with a variety of  tools and techniques - reach out if you have questions, I can help.

The United States is in the middle of an epidemic like no other. We are currently losing almost 100 people per day as a consequence of the current opioid crisis. The opioid crisis is due to the addiction and abuse of both prescription and illegal opioid substances like Vicodin, Oxycontin, and the illicitly manufactured Fentanyl. 

The opioid crisis started in the 1990s and has escalated every year since. A large part of this increase is due to pharmaceutical companies and conventional medical doctors.  

During this period of time, medical doctors were being pressured to treat chronic pain more aggressively. In response to this pressure, doctors began prescribing long-term use of opioids for the pain. At the same time, the pharmaceutical companies were touting opioids as non-addictive and not harmful. The end result is that doctors were prescribing drugs at higher rates and more people were finding themselves addicted. 

Despite what the pharmaceutical companies said, opioids are highly addictive substances and alter the way the body responds to pain. 
            
The standard method of treating opioid addiction is to send the person to rehab or to have them quit cold turkey. In a rehab facility, the addict is taught how to address their addiction and use other methods in place of taking the drugs. Success rates at rehab facilities vary, and ultimately, if the addict is not surrounded by supportive people and activities, the chances they will return to using opioids after leaving the rehabilitation facility are much higher. But this is not the only option for those suffering from opiate addiction.
            
Acupuncture is an alternative treatment method that can be very beneficial in treating not only addiction to opioids but also the underlying reasons why a person may begin taking pain medications in the first place. 

Acupuncture is part of an ancient medical system known as Traditional Chinese Medicine and it can be used to treat a host of issues.
            
Specifically, there is a technique known as the NADA (National Acupuncture Detoxification Association) protocol that has shown to decrease cravings during opiate withdrawals. This protocol uses five acupuncture points in the ear to modulate the neurotransmitters in the body, stimulating the endocrine system, which allows for relaxation and a “resetting” of the body overall. 
            
These five points address different symptoms that can be associated with addiction and withdrawals. The lung point helps maintain a steady breathing pattern, which also helps address grief and sadness that can sometimes be associated with withdrawals. The Shen Men point addresses anxiety, stress, and depression. The autonomic point works on balancing the nervous system. The liver and kidney points help with detoxification, while also addressing anger and fear.
            
This addresses the opioid addiction itself, while other acupuncture points on the body can treat the underlying pain that may have led to the opioid addiction in the beginning.  Acupuncture has a great track record for treating pain and decreasing inflammation.  There are also points on the body that can help with all the emotional stuff that often accompanies addiction. Studies show acupuncture can also improve mood and sleep while decreasing the need for pharmaceuticals. 
            
Opioid addiction is a serious matter and not something to be ignored. Be sure to discuss any alternative treatment methods with your physician or counselor, in order to get the best treatment tailored to meet your specific needs. Adding acupuncture to any conventional treatments can increase the odds of a successful release from opioid addiction.


https://www.pacificcollege.edu/news/blog/2017/07/13/how-acupuncture-can-help-opioid-crisis-infographic
https://kaplanclinic.com/videos/acupuncture-opioid-epidemic/
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

When most people hear the word acupuncture, they don’t immediately think of relaxation. They most likely question how inserting tiny needles into their body could be considered a form of relaxation. When you consider that acupuncture is part of a medical system that has been around for over 2500 years, you have to understand that this is one heck of a track record and it has more properties and benefits than one may realize.

One thing that is important to know about acupuncture is that unlike modern medicine, which focuses on the symptoms of a disease and addressing it externally to alleviate those symptoms, acupuncture looks at solving problems within the body much differently.

Acupuncture focuses on the root cause of the problem, utilizing the body’s own ability to heal itself when it is given the proper tools. Just like doing long division, when we’re out of practice, we sometimes need a nudge to get back in the groove, our bodies work the same way. Think of it this way, when you have a sore muscle, you compensate by using other muscles or shifting your weight so that that area of your body doesn’t have to bear the entire load, which can then lead to pain in another area. The brain just has to be reset and reminded of the right way to actually function, and that’s what acupuncture is used for.

A key principle of acupuncture is something called qi (pronounced “chee”). Qi is most frequently translated into energy and according to Traditional Chinese Medicine, it is the vital force that resides within all of us and everything that surrounds us. Qi moves throughout the body via pathways called meridians. According to TCM theory, there are 14 main meridians and 12 of those correspond to specific organ systems in the human body and the other 2 meridians run up the front and back of the body. 

Along these pathways are points known as acupoints. Acupoints tend to have high concentrations of nerve endings that are all capable of triggering biochemical and physiological changes throughout the body. These changes can occur instantaneously or over time, depending on the individual. When a needle is inserted into an acupoint, sensory receptors are stimulated and a chain reaction occurs. The sensory receptor stimulates the nerve, which then transmits impulses to the brain, specifically the hypothalamic-pituitary-adrenal system. This interaction between the hormones, glands and your brain create a powerful reaction that regulates bodily processes and brings about homeostasis. 

Licensed acupuncturists go through several years of schooling, training and national testing to earn the privilege of treating and healing people. Most states require the completion of approximately 2500-3500 hours of formal education from an accredited acupuncture institution. This leads to a four year Master’s Degree in Traditional Oriental Medicine and acupuncturists can even go on to pursue an advanced doctoral degree, if they choose.
 
If you have never tried acupuncture, I encourage you to! Even if you have no known illnesses, aches, or pains, acupuncture can still be beneficial overall. We all have stress and over time, stress can make people sick. Acupuncture can fight stress and help prevent disease. You won’t believe how incredible you feel after a good acupuncture treatment. 

Feel free to reach out to us and schedule an appointment to talk about the benefits of acupuncture!

https://www.mindbodygreen.com/0-14752/acupuncture-101-what-you-need-to-know.html 

Acupuncture is part of Traditional Chinese Medicine (TCM) and is practiced in many different forms which include herbal remedies, cupping, and massage, which have all been used for thousands of years. The basis of TCM is the idea of qi, the body’s vital energy. 

TCM treatments promote the movement of qi throughout the body in order to help bring balance back to the body. The goal of acupuncture is to correct this imbalance which can cause a variety of ailments and conditions that you may currently have. 

Acupuncture uses very thin needles (which have been compared to being as small as cat whiskers) that stimulate pressure points and other areas of your body. It stimulates qi by placing needles in specific spots, often along meridians. Meridians are the channels that qi travels in the body. 

Acupuncture can help with many health conditions, including:

• Arthritis
• Chronic pain, including joint pain
• Depression
• Headaches and migraines
• Improving Immunity
• Trouble sleeping and insomnia
• Nausea and digestive trouble
• Neck Pain
• Back pain and sciatica
• Stress and anxiety
• Women's Health Issues such as PMS, Menopause, Infertility, Pregnancy Support

Below are the top five ways that acupuncture can help 
​
1. Relieves Pain
Acupuncture can help alleviate many types of pain that may range from headaches and migraines to neck and back pain. These studies have shown its effectiveness in treating lower back pain, migraines, tension headaches, and knee pain. Acupuncture works differently for everybody. For some, a single treatment can alleviate symptoms for several months while others need a more routine treatment schedule. 

2. Improved Sleep
Another thing that Acupuncture can help improve is sleep and insomnia. Scientists believe that acupuncture increases the production of brain chemicals that promote relaxation, thus allowing for better sleep. 

3. Uplift Mood
Acupuncture can help with improving mood, including helping with depression, stress, and anxiety. The needles from acupuncture treatment release endorphins in the body. Endorphins are hormones that provide a boost in mood, encouraging happiness and relaxation. 

4. Help the Heart
Acupuncture is also good for your heart due to the relaxation and stress reduction that one achieves from the treatments, which are also known to reduce blood pressure. Stress and high blood pressure are commonly related to heart attacks and heart disease. 

5. Support the Immune System
Research has shown that acupuncture can boost immune system function. The placement of acupuncture needles can release immune-boosting cytokines. Cytokines are messenger cells that regulate the body’s immune response. By triggering the immune system, acupuncture can help fight infections or illnesses like colds and the flu.

​If you deal with any of the above symptoms or think that acupuncture may be right for you- schedule an appointment with us! We’d be happy to support you in achieving your health care goals!

Traditional Chinese medicine (TCM) is a system that seems quite foreign to many in the Western world. However, this medical system has been around for over 3,500 years, in comparison to the Western medical system, which has been around since the 19th century. One of the concepts of TCM is that of the meridian or energetic pathways. This article will explore this concept a little more deeply.
            
What is a meridian? This is something that every acupuncture student asks when they begin their training. The simplest definition is that a meridian is an energetic highway in the human body. Meridians allow for the flow of energy, known as Qi (pronounced “chee”), to circulate throughout the body. Meridians exist in corresponding pairs and each meridian has multiple acupuncture points along the pathway. While it is tempting to think of meridians in the body the same way we think of the circulatory system, this would be incorrect. According to TCM, the meridian pathways are responsible for the “distribution” of the substances throughout the body, but physically, meridians have yet to be identified. Therefore, it is more logical to view the meridian system as an energetic distribution network. 
            
All together there are fourteen main meridians throughout the body. One that runs up the center of the body on the front, another that runs along the spine and the other 12 run from head to toe along the rest of the body. Each limb is traversed by six channels, three that are considered yin in nature and three that are considered yang in nature.  Yin channels are located on the inside surfaces and the yang channels are located on the outside surfaces. Each meridian is a yin yang pair, meaning that each yin organ (lung, heart, kidney, liver, spleen) is paired with its corresponding yang organ (large intestine, stomach, small intestine, bladder, gallbladder). In every living thing, there is yin and yang. Yin corresponds to water, darkness and cold, while yang corresponds to fire, daylight and heat. For the body to function properly, there must be balance between the yin and yang. 
            
In addition to the main meridians, there are other meridians called “Extraordinary” meridians that are not associated with the major organ systems. These meridians have very specific functions.  They act as reservoirs for Qi and blood. They circulate “substances” around the body, as they have a strong connection to the kidneys. They help circulate Wei Qi, which acts as the immune system. And they provide connections between the 12 regular channels. 
            
When the Qi flows freely, the body remains healthy. However, due to outside causes like stress, the body’s meridians can become clogged or stagnant. When a blockage occurs along the meridians, illness can take hold.
            
Acupuncture is a wonderful way to unclog the meridians. Acupuncture points, herbal formulas, exercise and proper dietary habits all work in conjunction to keep the body aligned and functioning properly. To learn more, give us a call, we’d love to help!.