FOOD ALLERGY AND CHINESE HERBS

An allergy is the over-reaction of natural bodily defenses in response to a particular substance. Potential exposure to allergy-provoking substances takes place through our interaction with the world around us: by breathing, ingesting foods, or by the contact of allergens with skin and mucus membranes. Mild to moderate allergic conditions may cause symptoms such as hives, eczema, redness of the skin, itchy mouth and throat, nasal congestion or a runny nose, sneezing, eye irritation and other related symptoms. Severe allergic responses may involve obstructive swelling of the lips, tongue, and/or throat, trouble swallowing, and shortness of breath or wheezing. Allergies may progress with these and more symptoms, while some allergic responses are immediate and emergency-level anaphylaxis, a serious and potentially life-threatening state that requires immediate treatment.

Major categories of food allergies include milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, soybeans, and wheat, which together account for over 90% of food allergies, according to the Food and Drug Administration (FDA). In addition, it is estimated by the Centers for Disease Control (CDC) that food allergies affect 4 to 6% of children and 4% of adults.

While these individuals may know of their food allergies, they are not likely to know that they may have allergies to Chinese herbs that are the same substance as or related to their food allergy triggers. Therefore, practitioners of TCM must inquire as to the known allergies for each patient, and identify which Chinese herbs and formulas pose actual or potential risk to induce direct allergic response or cross allergy (from a substance similar in content to their primary allergen). Prudent action by the practitioner in this way will minimize and prevent allergic reactions to Chinese herbs, and facilitate smoother progress in care.

Listed below are the major categories of allergens, including their relationship with Chinese herbs and formulas in general, and suggested substitutes for the potential allergen where possible.

MILK

Approximately 2 to 3% of children under 3 years of age are allergic to cow’s milk and dairy products. Fortunately, 20% of children outgrow this allergy by age 4, and 80% of children outgrow it by age 16.

Cow’s milk is not used in Evergreen herbs and formulas, nor are dairy products.

EGG

Approximately 2% of children are allergic to eggs and the proteins in egg whites or yolks. Fortunately, 70% of children with an egg allergy outgrow this condition by age 16.

Eggs are not used in Evergreen herbs and formulas.

Note: Though Ji Zi Huang (Galli Vitellus), literally ‘egg yolk’, has been listed in the Chinese materia medica in the past, it is rarely used today as herbal medicine, more likely to be discussed as nutritional options.

FISH

Allergy to fish affects adults much more often than children. The risk of cross allergy is relatively low with fish, as having an allergy to one type of fish (i.e., bass, flounder, or cod) does not mean there will be cross allergy to other types of fish (i.e., tuna) or shellfish (shrimp, crab and lobster).

Fish is not used in Evergreen herbs and formulas.

CRUSTACEAN SHELLFISH

The general category ‘shellfish’ includes both crustacea and mollusks. Approximately 0.5 to 2.5% of the general population is allergic to shellfish.

  1. Crustacea:
    • Crustacea is a type of shellfish that has a hard shell and no backbone, such as crabs, crayfish, lobster, prawns and shrimp. For those who are sensitive to this, crustaceans carry high risk of provoking food allergy.
    • Crustaceans are not used in Evergreen herbs and formulas.
  2. Mollusks:
    • Mollusks are shellfish that have hinged two-part shells, such as clams, mussels, oysters and scallops, as well as various types of octopus, snails and squid. (Octopus and squid have internalized their shells, so do not completely resemble their company in the mollusk family.)
    • Mollusks usually are associated with low risk of allergic responses, and there is only a minor risk of cross allergy to mollusks for those who are allergic to crustacean shellfish.

Chinese herbs or formulas that contain substances from mollusk shellfish are listed in the following table.

Table 1. Chinese Herbs that contain Mollusk Shellfish

Single HerbsSuggested Replacements
Ge Qiao (Concha Meretricis seu Cyclinae) Gan Cao (Radix et Rhizoma Glycyrrhizae)
Hai Piao Xiao (Endoconcha Sepiae) Gan Cao (Radix et Rhizoma Glycyrrhizae)
Mu Li (Concha Ostrae) Jue Ming Zi (Semen Cassiae) and
Wu Wei Zi (Fructus Schisandrae Chinensis)
Shi Jue Ming (Concha Haliotidis) Jue Ming Zi (Semen Cassiae)
Zhen Zhu (Margarita) Dan Nan Xing (Arisaema cum Bile)
Zhen Zhu Mu (Concha Margaritiferae) Long Gu (Os Draconic)

Table 2. Chinese Formulas that contain Mollusk Shellfish

FormulasSuggested Replacements
An Zhong San (Fennnel & Galanga Formula) 2 Ping Wei San (Magnolia & Ginger Formula)
Chai Hu Jia Long Gu Mu Li Tang (Bupleurum & Dragon Bone Combination) 2 Jia Wei Xiao Yao San (Bupleurum & Peony Formula)
Chai Hu Jia Long Mu Tang (without Da Huang) (Bupleurum & Dragon Bone Combination (Minus Rhubarb)) 2 Jia Wei Xiao Yao San (Bupleurum & Peony Formula)
Jin Suo Gu Jing Wan (Lotus Stamen Formula) 2 Sang Piao Xiao San (Mantis Formula)
Ming Mu Di Huang Wan (Rehmannia Vision Formula) 3 Liu Wei Di Huang Wan (Rehmannia Six Formula)
Tian Ma Gou Teng Yin (Gastrodia & Gambir Combination) 3 Tian Ma (Gastrodia)
Zhen Gan Xi Feng Tang (Hematite & Scrophularia Combination) 2 Tian Ma (Gastrodia)
Calm (ES) 2 Calm
Calm (Jr) 2 Calm
Gastrodia Complex 3.4 Tian Ma (Gastrodia)
Gentiana Complex 3,4 V-Support
GI Care 1 Pinellia Complex
Kidney DTX 2 Herbal DTX
Resolve (Lower) 2 Zhe Chong Yin (Cinnamon & Persica Combination)
Shine 2 Calm ZZZ
Thyrodex 2 Qing Hao Bie Jia Tang (Artemisia Annua Decoction)

1 contains Hai Piao Xiao (Endoconcha Sepiae)
2 contains Mu Li (Concha Ostrae)
3 contains Shi Jue Ming (Concha Haliotidis)
4 contains Zhen Zhu Mu (Concha Margaritiferae)

PEANUTS

Peanut allergy is linked with anaphylaxis – which is, as mentioned above, a serious and potentially life-threatening condition that requires immediate treatment. About 20% of children who have peanut allergies eventually outgrow it, according to the National Institutes of Health.

Note: A peanut is a legume (in the same family as soybeans, peas and lentils), not a tree nut.

Peanuts are not used in Evergreen herbs and formulas, but may be mentioned in therapeutic recipes in Chinese nutrition.

TREE NUTS

Tree nuts come in many shapes and sizes. Though delicious, tree nuts may also be linked to anaphylaxis. Tree nut allergies often last a lifetime, and the chances of outgrowing tree nut allergies is less than 10 percent. Tree nuts associated with high risk of food allergy include: almonds, beech nuts, brazil nuts, butternuts, cashews, chestnuts, chinquapins, coconut, hazelnuts, gingko nuts, hickory nuts, lichee nuts, macadamia nuts, pecans, pine nuts, pili nuts, pistachios, shea nuts, and walnuts.

Chinese herbs that have high risk of triggering related tree nut allergy include ginkgo nuts and lichee nuts.

Chinese herbs that have low association with risk of tree nut allergies include peach seeds, Chinese dwarf cherry seeds, Chinese arborvitae seed and bitter apricot seeds.

Table 1. Chinese Herbs that contain Tree Nuts with High Risk Allergy

Single HerbsSuggested Replacements
Bai Guo (Semen Ginkgo) Wu Wei Zi (Fructus Schisandrae Chinensis)
Li Zhi He (Semen Litchi) Ju He (Semen Citri Reticulatae)

Table 2. Chinese Formulas that contain Tree Nuts
with High Risk Allergy

FormulasSuggested Replacements
Dissolve (GS) 5 Yin Chen Hao Tang (Artemisia Combination)

Table 3. Chinese Herbs that contain Tree Nuts with Low Risk Allergy

Single HerbsSuggested Replacements
Bai Zi Ren (Semen Platycladi) n/a
Ku Xing Ren (Semen Armeniacae Amarum) n/a
Shen Qu (Massa Fermenta) n/a
Tao Ren (Semen Persicae) Hong Hua (Flos Carthami)
Yu Li Ren (Semen Pruni) n/a

Table 4. Chinese Formulas that contain Tree Nuts
with Low Risk Allergy

FormulasSuggested Replacements
Ban Xia Bai Zhu Tian Ma Tang (Pinellia & Gastrodia Combination) 8 Tian Ma Gou Teng Yin (Gastrodia & Gambir Combination)
Bao He Wan (Citrus & Crataegus Formula) 8 Ping Wei San (Magnolia & Ginger Formula)
Bu Yang Huan Wu Tang (Astragalus & Peony Combination) 9 Juan Bi Tang (Notopterygium & Turmeric Combination)
Da Huang Mu Dan Tang (Rhubarb & Moutan Combination) 9 GI Harmony
Ge Xia Zhu Yu Tang (Tangkuei & Corydalis Combination) 9 Xue Fu Zhu Yu Tang (Persica & Carthamus Combination)
Gui Zhi Fu Ling Wan (Cinnamon & Hoelen Formula) 9 Zhe Chong Yin (Cinnamon & Persica Combination)
Ju He Wan (Citrus Seed Formula) 9 Ju He (Semen Citri Reticulatae)
Ma Xing Gan Shi Tang (Mahuang & Apricot Seed Combination) 7 Zhi Sou San (Platycodon & Schizonepetae Formula)
Ma Zi Ren Wan (Apricot Seed & Linum Formula) 7 Xiao Cheng Qi Tang (Minor Rhubarb Combination)
Qing Fei Tang (Platycodon & Fritillaria Combination) 7 Zhi Sou San (Platycodon & Schizonepetae Formula)
Qing Fei Yin (Clear the Lung Drink) 7 Zhi Sou San (Platycodon & Schizonepetae Formula)
Qing Qi Hua Tan Wan (Pinellia & Scute Formula) 7 Er Chen Tang (Citrus & Pinellia Combination)
Qing Shu Yi Qi Tang (Astragalus & Atractylodes Combination) 8 Huo Xiang Zheng Qi San (Pogostemon Formula)
Qing Zao Jiu Fei Tang (Eriobotrya & Ophiopogon Combination) 7 Bai He Gu Jin Tang (Lily Combination)
Run Chang Wan (Linum & Rhubarb Formula) 7,9 Xiao Cheng Qi Tang (Minor Rhubarb Combination)
Sang Ju Yin (Morus & Chrysanthemum Combination) 7 Zhi Sou San (Platycodon & Schizonepetae Formula)
Shen Tong Zhu Yu Tang (Cnidium & Notopterygium Combination) 9 n/a
Sheng Hua Tang (Tangkuei & Ginger Combination) 9 Si Wu Tang (Tangkuei Four Combination)
Shu Gan Tang (Bupleurum & Evodia Combination) 9 Xiao Yao San (Tangkuei & Bupleurum Formula)
Shu Jing Huo Xue Tang (Clematis & Stephania Combination) 9 n/a
Tao Hong Si Wu Tang (Tangkuei Four & Persica Carthamus Combination) 9 Si Wu Tang (Tangkuei Four Combination)
Tao He Cheng Qi Tang (Persica & Rhubarb Combination) 9 Xiao Cheng Qi Tang (Minor Rhubarb Combination)
Tian Wang Bu Xin Dan (Ginseng & Zizyphus Formula) 6 Suan Zao Ren Tang (Zizyphus Combination)
Tong Qiao Huo Xue Tang (Persica & Cnidium Combination) 9 n/a
Xiang Sha Ping Wei San (Cyperus Cardamon & Atractylodes Formula) 8 Ping Wei San (Magnolia & Ginger Formula)
Xiao Qing Long Tang (Minor Blue Dragon Combination) 7 Gui Zhi Tang (Cinnamon Combination)
Xue Fu Zhu Yu Tang (Persica & Carthamus Combination) 9 n/a
Yang Xin Tang (Astragalus & Zizyphus Combination) 6 Suan Zao Ren Tang (Zizyphus Combination)
Yue Ju Tang (Cyperus & Atractylodes Combination) 8 Xiao Yao San (Tangkuei & Bupleurum Formula)
Zhe Chong Yin (Cinnamon & Persica Combination) 9 n/a
Circulation (SJ) 9 Shui Zhi (Hirudo)
Enhance Memory 6 Gui Pi Tang (Ginseng & Longan Combination)
Flex (NP) 9 Herbal ANG
Flex (TMX) 9 Herbal ANG
Gentle Lax (Deficient) 6,7,9,10 Xiao Cheng Qi Tang (Minor Rhubarb Combination)
Gentle Lax (Excess) 9 GI DTX
GI Care 8 Calm (ES)
GI Care (HMR) 10 Zhen Ren Huo Ming Yin (Angelica & Mastic Combination)
GI Care II 8 Ge Gen Huang Qin Huang Lian Tang (Pueraria Coptis & Scute Combination)
Knee & Ankle (AC) 9 Du Huo Ji Sheng Tang (Tuhuo & Taxillus Combination)
LPS Support 9 Dermatrol (Dry)
Mense-Ease 9 Herbal ANG
Neck & Shoulder (CR) 9 Neck & Shoulder (AC)
P-Support 9 Astringent Complex
Pinellia XPT 7 Pinellia Complex
Resolve (Lower) 9 Shao Fu Zhu Yu Tang (Fennel Seed & Corydalis Combination)
Respitrol (CF) 7 Zhi Sou San (Platycodon & Schizonepetae Formula)
Respitrol (Cold) 7 Gui Zhi Tang (Cinnamon Combination)
Respitrol (Deficient) 7 Cordyceps 3
Respitrol (Heat) 7 Herbal ABX
Shine 8 Calm
Shine (DS) 8 Calm
V-Support 9 Gentiana Complex

5 contains Li Zhi He (Semen Litchi)
6 contains Bai Zi Ren (Semen Platycladi)
7 contains Ku Xing Ren (Semen Armeniacae Amarum)
8 contains Shen Qu (Massa Fermenta)
9 contains Tao Ren (Semen Persicae)
10 contains Yu Li Ren (Semen Pruni)

SOYBEANS

Soy is a common ingredient in infant formulas and many other processed foods. Allergy to soy is most common in infants and children under 3 years of age. Fortunately, most children outgrow soy allergy by age 10.

Some Chinese herbs are derived from soy or are processed with soy beans or soya-bean oil.

Table 1. Chinese Herbs that contain or may be processed
with Soybeans

Single HerbsSuggested Replacements
Dan Dou Chi (Semen Sojae Praeparatum) Bo He (Herba Menthae)
E Jiao (Colla Corii Asini), if soya-bean oil is used to thicken glue Dang Gui (Radix Angelicae Sinensis)
Gui Ban Jiao (Colla Plastrum Testudinis), if soya-bean oil is used to thicken glue Gui Ban (Plastrum Testudinis)
Lu Jiao Jiao (Colla Cornus Cervi), if soya-bean oil is used to thicken glue Lu Jiao Shuang (Cornu Cervi Degelatinatum)
Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata), if processed with black soybean Dang Gui (Radix Angelicae Sinensis)

Table 2. Chinese Formulas that may contain or may be processed
with Soybeans

FormulasSuggested Replacements
Dang Gui Yin Zi (Tangkuei & Tribulus Combination) 15 Wen Qing Yin (Tangkuei & Gardenia Combination)
Qi Bao Mei Ran Wan (Seven Treasures Formula) 15 Si Wu Tang (Tangkuei Four Combination)
Qing Zao Jiu Fei Tang (Eriobotrya & Ophiopogon Combination) 12 Bai He Gu Jin Tang (Lily Combination)
Wen Jing Tang (Tangkuei & Evodia Combination) 12 Menatrol
Yin Qiao San (Lonicera & Forsythia Formula) 11 Sang Ju Yin (Morus & Chrysanthemum Combination)
You Gui Wan (Eucommia & Rehmannia Formula) 14 Ba Wei Di Huang Wan (Rehmannia Eight Formula)
Zhi Gan Cao Tang (Licorice Combination) 12 Circulation
Zhu Ling Tang (Polyporus Combination) 12 Wu Ling San (Hoelen Five Herb Formula)
Zuo Gui Wan (Cyathula & Rehmannia Formula) 13,14 Liu Wei Di Huang Wan (Rehmannia Six Formula)
Blossom (Phase 2) 12 Liu Wei Di Huang Wan (Rehmannia Six Formula)
Cholisma 15 Jiao Gu Lan (Gynostemma)
Dermatrol (PS) 15 Xiao Feng San (Tangkuei & Arctium Formula)
Flex (MLT) 15 Flex (SC)
Gentle Lax (Deficient) 15 Run Chang Wan (Linum & Rhubarb Formula)
GI DTX 15 Gentle Lax (Excess)
Kidney Tonic (Yin) 13 Liu Wei Di Huang Wan (Rehmannia Six Formula)
Lonicera Complex 11 Herbal ABX
Neuro Plus 15 Tian Wang Bu Xin Dan (Ginseng & Zizyphus Formula)
Osteo 8 12 Liu Wei Di Huang Wan (Rehmannia Six Formula)
Polygonum 14 15 Si Wu Tang (Tangkuei Four Combination)
Vital Essence 15 Huan Shao Dan (Lycium Formula)

11 contains Dan Dou Chi (Semen Sojae Praeparatum)
12 contains E Jiao (Colla Corii Asini)
13 contains Gui Ban Jiao (Colla Plastrum Testudinis)
14 contains Lu Jiao Jiao (Colla Cornus Cervi)
15 contains Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata)

WHEAT

Wheat allergies develop when the body’s immune system becomes sensitized and overreacts to wheat protein. Allergic reactions affect many parts of the body, including skin (i.e., rash or eczema), nose (i.e., stuffy nose, runny nose), lung (i.e., asthma), and others.

Some Chinese herbs are derived from wheat or contain wheat.

Table 1. Chinese Herbs that contain Wheat

Single HerbsSuggested Replacements
Ban Xia Qu (Rhizoma Pinelliae Massa Fermentata) Ji Nei Jin (Endothelium Corneum Gigeriae Galli)
Fu Xiao Mai (Fructus Tritici Levis) Mu Li (Concha Ostreae)
Shen Qu (Massa Fermentata) Ji Nei Jin (Endothelium Corneum Gigeriae Galli)
Xiao Mai (Fructus Tritici) Suan Zao Ren (Semen Ziziphi Spinosae)
Yi Tang (Maltosum) Gan Cao (Radix et Rhizoma Glycyrrhizae)

Table 2. Chinese Formulas that may contain Wheat

FormulasSuggested Replacements
Ban Xia Bai Zhu Tian Ma Tang (Pinellia & Gastrodia Combination) 18 Gastrodia Complex
Bao He Wan (Citrus & Crataegus Formula) 18 GI Harmony
Gan Mai Da Zao Tang (Licorice & Jujube Combination) 19 Suan Zao Ren Tang (Zizyphus Combination)
Gui Qi Jian Zhong Tang (Tangkuei Astragalus & Peony Combination) 20 Si Jun Zi Tang (Major Four Herb Combination)
Huang Qi Jian Zhong Tang (Astragalus Combination) 20 Si Jun Zi Tang (Major Four Herb Combination)
Huo Xiang Zheng Qi San (Pogostemon Formula) 16 Ping Wei San (Magnolia & Ginger Formula)
Qing Shu Yi Qi Tang (Astragalus & Atractylodes Combination) 18 Gardenia Complex
Xiang Sha Ping Wei San (Cyperus Cardamon & Atractylodes Formula) 18 Ping Wei San (Magnolia & Ginger Formula)
Yang Xin Tang (Astragalus & Zizyphus Combination) 16 Suan Zao Ren Tang (Zizyphus Combination)
Yue Ju Tang (Cyperus & Atractylodes Combination) 18 Calm
Balance (Heat) 17,19 Qing Hao Bie Jia Tang (Artemisia Annua Decoction)
Calm ZZZ 19 Suan Zao Ren Tang (Zizyphus Combination)
GI Care 18 Ping Wei San (Magnolia & Ginger Formula)
GI Care II 18 Ge Gen Huang Qin Huang Lian Tang (Pueraria Coptis & Scute Combination)
Shine 18 Calm
Shine (DS) 18 Calm

16 contains Ban Xia Qu (Rhizoma Pinelliae Massa Fermentata)
17 contains Fu Xiao Mai (Fructus Tritici Levis)
18 contains Shen Qu (Massa Fermentata)
19 contains Xiao Mai (Fructus Tritici)
20 contains Yi Tang (Maltosum)

GLUTEN

Gluten is a protein found in wheat, barley and rye. Hypersensitivity to gluten may cause general signs and symptoms (i.e., diarrhea, constipation, abdominal pain or fatigue) and specific illness (i.e., celiac disease in which the lining of the small intestine is damaged).

Some Chinese herbs are derived from wheat, barley and rye, and may contain gluten.

Table 1. Chinese Herbs that contain Gluten

Single HerbsSuggested Replacements
Ban Xia Qu (Rhizoma Pinelliae Massa Fermentata) Ji Nei Jin (Endothelium Corneum Gigeriae Galli)
Fu Xiao Mai (Fructus Tritici Levis) Mu Li (Concha Ostreae)
Mai Ya (Fructus Hordei Germinatus) Ji Nei Jin (Endothelium Corneum Gigeriae Galli)
Shen Qu (Massa Fermentata) Ji Nei Jin (Endothelium Corneum Gigeriae Galli)
Xiao Mai (Fructus Tritici) Suan Zao Ren (Semen Ziziphi Spinosae)
Yi Tang (Maltosum) Gan Cao (Radix et Rhizoma Glycyrrhizae)

Table 2. Chinese Formulas that may contain Gluten

FormulasSuggested Replacements
Ban Xia Bai Zhu Tian Ma Tang (Pinellia & Gastrodia Combination) 23,24 Gastrodia Complex
Bao He Wan (Citrus & Crataegus Formula) 24 GI Harmony
Gan Mai Da Zao Tang (Licorice & Jujube Combination) 25 Suan Zao Ren Tang (Zizyphus Combination)
Gui Qi Jian Zhong Tang (Tangkuei Astragalus & Peony Combination) 26 Si Jun Zi Tang (Major Four Herb Combination)
Huang Qi Jian Zhong Tang (Astragalus Combination) 26 Si Jun Zi Tang (Major Four Herb Combination)
Huo Xiang Zheng Qi San (Pogostemon Formula) 21 Ping Wei San (Magnolia & Ginger Formula)
Qing Shu Yi Qi Tang (Astragalus & Atractylodes Combination) 24 Gardenia Complex
Xiang Sha Ping Wei San (Cyperus Cardamon & Atractylodes Formula) 23,24 Ping Wei San (Magnolia & Ginger Formula)
Yang Xin Tang (Astragalus & Zizyphus Combination) 21 Suan Zao Ren Tang (Zizyphus Combination)
Yue Ju Tang (Cyperus & Atractylodes Combination) 24 Calm
Zhen Gan Xi Feng Tang (Hematite & Scrophularia Combination) 23 Gastrodia Complex
Balance (Heat) 22,25 Qing Hao Bie Jia Tang (Artemisia Annua Decoction)
Calm ZZZ 25 Suan Zao Ren Tang (Zizyphus Combination)
GI Care 24 Ping Wei San (Magnolia & Ginger Formula)
GI Care II 24 Ge Gen Huang Qin Huang Lian Tang (Pueraria Coptis & Scute Combination)
GI Care (UC) 23 GI Harmony or Astringent Complex
Shine 24 Calm
Shine (DS) 24 Calm

21 contains Ban Xia Qu (Rhizoma Pinelliae Massa Fermentata)
22 contains Fu Xiao Mai (Fructus Tritici Levis)
23 contains Mai Ya (Fructus Hordei Germinatus)
24 contains Shen Qu (Massa Fermentata)
25 contains Xiao Mai (Fructus Tritici)
26 contains Yi Tang (Maltosum)

Reference

a. Food Allergies: What You Need to Know by US Food and Drug Administration.
https://www.fda.gov/food/resourcesforyou/consumers/ucm079311.htm
b. Food Allergy by National Institute of Health. https://www.niaid.nih.gov/diseases-conditions/food-allergy
c. Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations by Centers for Disease Control & Prevention
https://www.cdc.gov/nchs/products/databriefs/db10.htm
d. Allergens by Food Allergy Research and Education.
https://www.foodallergy.org/home
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