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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 60-68

Development of practical approach of Sattvavajava Chikitsa for depressive disorders


Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India

Date of Submission23-Jul-2021
Date of Acceptance04-Oct-2021
Date of Web Publication23-Dec-2021

Correspondence Address:
Dipinti Singh
Department of Kayachikitsa, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jras.jras_17_21

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  Abstract 

In today’s modern world, most people are confronted with mental illness at some point in their lives. Depression is a widespread problem that has a detrimental impact on a person’s ability to function and sense of well-being. It has become a worldwide public health concern. Sattvavajava Chikatsa (SC) is an Ayurvedic psychotherapy and psycho-spiritual therapy that promotes mental wellness as well as prevention, management, and treatment of mental disorders. SC works on five basic principles, i.e., promotion of spiritual knowledge, scriptural knowledge, patience, memory, meditation in any patient whenever needed. The concepts of SC are scattered throughout classical texts, making it difficult for Ayurvedic physicians to understand how to practice. This could be due to the fact that psychological diseases are less common than physical illnesses. The goal of this review is to describe and briefly explain the concept of SC, as well as to establish a practical approach/tools based on it, with a particular focus on the management of major depressive disorder (MDD). It will aid in a holistic knowledge of the SC principle, as well as a practical approach based on SC for the management of MDD.

Keywords: Ayurveda, major depressive disorder, psychotherapy, Sattvavajava Chikitsa


How to cite this article:
Singh D, Tripathi JS. Development of practical approach of Sattvavajava Chikitsa for depressive disorders. J Res Ayurvedic Sci 2021;5:60-8

How to cite this URL:
Singh D, Tripathi JS. Development of practical approach of Sattvavajava Chikitsa for depressive disorders. J Res Ayurvedic Sci [serial online] 2021 [cited 2022 Sep 27];5:60-8. Available from: http://www.jrasccras.com/text.asp?2021/5/2/60/333536




  Introduction Top


Major depressive disorder (MDD) is a common mental disorder and affects approximately 322 million people, which is equivalent to 4.4% of the world’s population.[1] One in every five women and one in every eight men experience a major depressive episode over the course of their life.[2] From 1990 to 2010, major depression increased from 15 to 11 in terms of global burden of disease measured in Disability-Adjusted Life Years (DALYs) and is the second most common cause of Years Lived with Disability (YLDs) in all groups of age when comparing all medical diseases.[3] It has been reported that approximately 50% of people who die by committing suicide suffered from depression or another mood disorder.[4] In American Psychiatric Associations Diagnostic and Statistical Manual five (DSM-5), depression is coded as a mood disorder.[5] Depression is characterized by a prominent and relatively persistent depressed mood or loss of interest that must be present for at least 2 weeks in most situations, which is relatively more painful for real circumstances or even exists without any external causes of sadness. MDD negatively affects a person’s functioning area and sense of well-being.[5] The clinical presentation of depression may vary from mild to severe and symptoms can be classified into four domains: cognitive (feelings of hopelessness, helplessness, and worthlessness), behavioral (delayed movement and slow speech, agitation, pacing, restlessness, unnecessary movements), neurovegetative (sleep and appetite disturbance, weight loss or gain, and loss of sexual drive), and physical (heaviness in the head, body aches, and pain).[6]


  Review Results Top


Sattvavajava Chikitsa (Ayurvedic psychotherapy)

Ayurveda views life as a four-dimensional entity consisting of the body, senses, mind, and soul or self. The balance between these dimensional entities is regarded as perfect health, and anything that disrupts this equilibrium leads to disease.[7]Sattvavajaya Chikitsa (SC) is a non-pharmacological approach used especially in the case of psychiatric and psycho-somatic disorders. Satvavajaya constitutes two words: 'Satva' that refers to mind and 'Vajaya' that means to conquer, which implies that satvavajaya means to have control over mind. SC refers to the development of mental control over the factors responsible for causing psychic disturbance.[8] SC consists of five fundamental principles/approaches of management which are given below.[9]

  1. Gyan: Gyan is a term that refers to the dissemination of spiritual knowledge. Its purpose is to assist in the development of vision of oneself and understanding of the external world through the application of various philosophical conundrums. As a result, the patient learns inner skills to manage his/her concerns.[10]


  2. Vijnana: Vijnana refers to the promotion of scriptural knowledge. It also comprises all commercially available scientific knowledge that has been demonstrated to be practical and valuable. Its goal is to educate the person so that they can better comprehend the nature of the problem and the condition, as well as to assist them in improving their coping abilities.[10]


  3. Dhairya: Dhairya refers to the promotion of patience. Dhairya also means fortitude and courage. In the face of unpleasant events and internal conflicts, it aims to preserve mental equilibrium and to improve impulse control and coping skills (such as calm, acceptance, compassion, or tolerance).[10]


  4. Smriti: Smriti refers to the promotion of memory. It aids the patient in recalling positive memories while simultaneously assisting him/her in neglecting all negative, stressful, and traumatic recollections. The objective is to recall the object of past experience, understand the exact nature of the object, and to uncover the hidden conflict which is the primary source of disease.[10]


  5. Samadhi: Samadhi is a term used to describe the advancement of meditation, which includes all techniques that promote attention, focus, and so on. It contains all eight yoga components. It also includes reducing the attraction toward material objects, meditation on the spiritual aspects of one’s identity, and achieving a higher level of awareness.[10]


Assurance, replacement of emotions, regulation of mental process, re-framing of ideas, channelization of presumptions, correction of objectives and ideals are among some of the elements of SC. The common requirements such as proper counseling for making the best decisions, along with proper patience monitoring, are needed while treating psychological conditions.[11] The process of implementation of SC involves steps such as promotion of self-introspection, correction of negative thoughts, increasing tolerance and exercising control over misleading passions/behaviors, establishment of positive goals and ideals, identifying the do’s and don’ts, removing bad thoughts from the mind by resorting to studying philosophy, and removal of ignorance by using all possible methods of enlightening.[12]

SC is a psycho-spiritual therapy that focusses on self-realization, assists in changing the inner state (thoughts, emotions, and feelings) of the person, and is intended to provide purpose and hope in life as well as leads to a more productive and meaningful life. Thus, the objective of this conceptual review is to develop a practical approach/tools of SC for the management of MDD. In the light of this context and considering the symptoms of MDD, here we have investigated some principles and developed a practical approach/tools of SC based on them, with a special focus on the management of MDD upon which a psycho-therapist performing SC should focus on. The following are the important principles and procedures.


  Principle 1: Promotion of knowledge Top


Knowledge is the way of self-realization, which develops a connection and belief within oneself and also gives confidence and direction to establish a better relationship with all dimensions of life (work, family, health, etc.). Knowledge allows mind to develop a harmonious state in negative circumstances and help resolve internal conflicts while leading a meaningful and purposeful life. Knowledge is an important key in any kind of action, before indulging one should have complete knowledge and mechanism about a particular work, equipment, and action. Without the right knowledge, one cannot move forward and get confused about what to do or not to do.[13] Without even realizing who one is, what are his or her inner strengths, values, and beliefs, one may become trapped in situations and acquire feelings of incompetence, helplessness, and pessimism, which are characteristic symptoms of MDD. The research study has also shown that depression reduced hope,[14] and it is also postively corelated with low self-esteem[15],[16] and lack of meaning of life.[15],[16]

According to Indian classical thought, one should raise oneself via self-introspection and solve problems with own’s mind. Excessive connection with emotions and worldly life should not be used to devalue or degrade oneself, or to establish an inferiority complex in oneself, because one’s conscience is his best friend and if it is not handled properly it can become an enemy.[17] MDD and other mental health disorders can develop when a person’s attention is constantly drawn to the outside world while ignoring their own strengths, abilities, and values.

Because of a lack of meaning and purpose in life, a person suffering from MDD may experience feelings of hopelessness, helplessness, and low self-esteem.[18] Promoting self-knowledge can assist patients have a better understanding of themselves, as well as boost their self-esteem and hope and give their lives meaning.


  Technique I: Developing a core understanding of self within the patient and guide the patient to reach their true self Top


The purpose of the psychotherapist at this stage is to educate the MDD patients and help them create a core awareness of themselves through spiritual knowledge as well as to encourage them to examine themselves. The psychotherapist may ask the patient to evaluate and examine himself and to write down or speak about (in whatever way they feel comfortable) himself like who is he and what are his strength, abilities, values, beliefs, etc. When the patient is investigating his own views and values about himself, the psychotherapist should make it obvious to him that he should not link himself with external identities (goals, responsibilities, etc.) or limits (labels provided by his own or others’ perception). The MDD patient can comprehend that the bad life conditions, difficulties, and circumstances are not the main issues; rather, it is the person’s own understanding of the situation, which is determined by the ability or inability to look at the situation with either ignorance or full awareness.


  Technique II: Promotion of self-introspection Top
[12]

Self-introspection is the process that allows the mind to see and evaluate the inner self (thoughts, emotions, and feelings) and helps identify negative beliefs and attitudes [Table 1]. Knowing one’s strength, values and beliefs are important to elevate oneself, exactly like this knowing one’s negative beliefs and attitudes (e.g., I’m incompetent, I can’t…, No one love me, etc.) are also important, because it hinders growth and success and reduces person’s self-esteem which leads to MDD.[15],[16] In the same way that bad food ruins our bodies, incorrect information contaminates our minds. Patients who have the necessary knowledge not only build self-confidence, but they are also able to recognize their own limitations, which act as a barrier to their personality and self-development. Self-introspection can help to uncover the negative assumption and beliefs that the patient has developed out of his previous experiences which have become obstacle in the present time and reduce hope and self-esteem.[14],[15],[16] To encourage introspection, the psychotherapist should ask the patient questions like: Is the situation bothering him/her, or is the way he/she views the situation bothering him/her? What is the most important goal in his/her life that he/she wants to achieve? Is he/she doing the same thing in his/her life that really matters to him? etc. This form of inquiry aids in the connection of the mind to one’s internal reality, allowing the person to comprehend his true problem and altering incorrect perceptions of himself and the world around him.
Table 1: Principle and technique for utilization of SC

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  Technique III: Psycho-educate the patient about the working patterns of mind (vigyan)/promotion of scriptural knowledge Top


Many MDD patient sufferers are unaware of the nature of their condition. In this situation, the psychotherapist’s role is to provide accurate information about the problem as well as to psycho-educate the patient about how the mind works so that patient understands the nature of his problem. Just as if someone wants to learn how to drive a car, he must understand every minute function of it because he cannot drive a car without first understanding its basic operations (such as what a clutch does, what a dashboard base/control systems are, and so on). Similarly, without understanding how our minds work and what their nature is, one cannot properly process one’s own mind. Because the mind serves as a link between the body and the soul, it becomes increasingly crucial to comprehend it. Though sense objects are received by their unique sense organ, awareness or identification of these sense objects is only attainable when the mind is in contact with the sense organ, according to Ayurveda. Later, the intellect fully comprehends or determines objects in terms of their excellent or evil attributes, which are also enabled by the mind.[19],[20]


  Principle 2: Significance of action in life (Karma Pradhanya) Top


The psychotherapist’s responsibility is to advance the therapy session to the next level after the MDD patient is aware and able to differentiate what is appropriate or wrong for him. The purpose of the psychotherapist at this stage is to assist the patient in engaging in a suitable and balanced way in the worldly life, as patients with MDD not only feel hopeless, powerless, and useless,[21] but also reduce their activity, performance, and behavior. The job of the psychotherapist prior to the active involvement of MDD patients in worldly life is to educate patients about the necessity of action, because wrong action is the root cause of mental diseases, including MDD.

In Indian Classical texts, the importance of action is also highlighted, with the statement that no one can exist without working or doing action, even for a time. Action encompasses all acts performed by the mind, body, and tongue and does not merely refer to labor or earning money.[22]


  Principle 3: Theory of action (Karma Yoga) Top


Patients with MDD may have negative thoughts and feelings of guilt, such as: “I’m not where I want to be,” “Nothing has happened in my life the way I want it to,” “I’ve done many wonderful things for my loved ones, but they don’t appreciate me,” and so on. This form of negative thinking and guilt demonstrates that the main source of discontent is unrealistic expectations of oneself/others, but when these expectations are not satisfied, it causes pressure, demands, disappointment, and conflict in relationships, which lead to MDD.[23] Expectations might limit behavior in some situations and prevent people from considering other options. What is the best way to carry out any action? How should we plan to achieve our objectives or fulfill our responsibilities? All of our deeds should be selfless, according to the Classic Indian book Bhagwat Geeta, when a person performs his duty with detachment from the results. It enables people to perform more effectively without worrying and to remain content even in the face of failure.[23] As a result, it is critical for psychotherapists to assist patients with comprehending false expectations by educating them on the value of action and its principle.


  Technique IV: Educate the patient on the importance of action and its principle Top


At this point, the psychotherapist’s role is to investigate how the patient’s expectations affect many elements of life and to educate the patient on the necessity of action and its principle. This will assist the patient in understanding the fundamental reasons of their difficulties as well as changing their perception of the circumstance to one that is more intellectual. For example, after these sessions, the patient’s thinking becomes more unselfish, and he recognizes that his responsibilities or achieving a goal is more essential to him; his purpose is not to acquire results, but to do his responsibilities better and grow as a whole human being.


  Principle 4: Balancing different aspects of life and promotion of behavior in a wholesome way Top


Acharya Charak mentioned three fundamental goals/purposes of life that engage a person in worldly life and following the virtue, material wealth and action in balanced way leads to prevention and treatment of mental diseases and brings about a sense of satisfaction.[24] A person with MDD must grasp what is healthy and what is unhealthy for him. Balancing diverse parts of life can improve a patient’s sense of fulfillment and help them overcome MDD. Dissatisfaction in life has also been linked to mood disorders, according to research.[25],[26] Because there is no enjoyment or sadness in the world without these three elements, a person should attempt to indulge in virtue, material wealth, and activity in a wholesome way and not pursue the path of the unwholesome in these three aspects. As a result, this should be practiced: efforts should be made to maintain contact with mental illness experts such as psychotherapists and psychiatrists, as well as to gain a thorough understanding of oneself, one’s surroundings, one’s family, the passage of time, one’s mental strength and ability, and so on.[27]

Virtue

Virtue encompasses virtuous aspects of life, including all responsibilities and obligations. It is our job to carry them out in a righteous and sincere manner. Everyone receives a variety of material and intangible benefits from the society, and it is one’s primary responsibility to give back to the world in some way and contribute to society’s well-being without expectations or attachments. The fundamental and ultimate purpose of practicing Virtue Dharma is to gain the ability to intelligently choose one’s path. When a person fulfills his job with integrity and without expectations or attachments, it not only boosts his self-esteem but also builds strong emotional resilience in the face of adversity, which acts as a psycho-immune element in the prevention of mental illnesses. A psychotherapist’s job is to help patients not just cope with the symptoms of MDD and feel better, but also to exercise and grow these values. So that the patient is aware of his responsibilities and can make informed decisions about his life.

Material Wealth

All of the materialistic goods that are necessary for survival are classified as wealth. It is also a significant life aim for a person to acquire money in order to live comfortably. If one is affluent, he can achieve most of his desires/dreams and contribute to society’s welfare, which increases one’s sense of fulfillment and self-worth. It is a simple medium that allows you to decide what to do with it without feeling attached or possessive. It is vital to work in order to gain money and maintain one’s level of living because one cannot satisfy one’s desires or pursue righteousness without income. In contrast, those who forget or overlook virtue in pursuit of wealth and/or spend it inappropriately suffer negative repercussions, which impair their sense of satisfaction and well-being, which is one of the primary causes of MDD.

Desires/sensory pleasure

Desires can be sensory and physical (desires for delicious food, intimate or passionate relationships, to be fit and look good, and so on), emotional (desires for healthy relationships, good family and social connections, and so on), intellectual (desire to acquire knowledge and so on), and spiritual (desire for spiritual elevation, and so on) (self-actualization). These desires guide and motivate us to work hard in order to fulfill them, and they help to connect individuals in worldly life in order to maintain human existence and a sense of fulfillment. However, when a person chooses unrealistic desires or focusses solely on completing desires in an inefficient manner while ignoring the other two goals, a person’s existence and sense of satisfaction are jeopardized. It causes extreme mental conflict, anxiety, tension, and discontent, as well as MDD and other mental health issues. These three aspects of life are complementary to each other and they are the part of everyone’s all life activities and therefore objective is to make a balance in these three aspects, one should not indulge any one of them excessively or disproportionately. When a patient does not indulge their worldly life in a wholesome way, it may cause MDD and other mental health problems.


  Technique V: Evaluate problematic aspects of the patient’s life Top


The psychotherapist can determine the problematic areas of the patient’s life and the extent to which they affect the patient’s life by having a clear account of the patient’s symptoms and how they affect his everyday functioning. Once the psychotherapist has assessed these factors, the results will aid in identifying problem areas in the patient’s life and their complexity, as well as determining the therapeutic session’s direction and forming a collaborative alliance with the patient.


  Technique VI: Developing awareness/insights in patients about virtue, wealth, and desire and its purpose Top


Psychotherapist is expected to educate and define importance of all these aspects of life and help the patients to develop awareness/insights about life and its purpose. Patient awareness is important in understanding their problem in a realistic way and will be helpful in enabling patients to discover which aspects of their life are currently unbalanced and which aspects of life they are indulging in improper way. Questioning should focus on the parts of the patient’s life that are now out of balance. This type of questioning will increase awareness. For instance, a psychologist could inquire “How content is he/she with his/her sexual, social, and family relationships and fulfilling important desires?” or “How satisfied is he/she with his/her personal wealth, career or education, and other materialistic gain?” Is he/she aware of his/her personal, ethical, and moral duties to his/her family, friends, society, and country? Is he/she able to fulfill his/her desires in a virtuous manner while adhering to socially accepted norms? Each MDD sufferer may have a unique approach to achieving balance in various areas of life. At this point, the psychotherapist’s responsibility is to raise patient awareness and encourage them to participate in worldly life in a healthy way.


  Principle 5: Insertions of moral and ethical values and promotion of good conduct Top


The codes of good behavioral and dietary conduct of human life are based on the same principles that deal with the prevention of disease and the promotion of health. Ayurveda has provided various principles of behavioral regime that are related with social relations, mental faculties, personal hygiene, religion and worship, suppressible urges, diet, speech, behavior, study, workplace, women, and copulation.[28] These principles clearly state what we should and should not do so that we can control our sensory organ and maintain our health. It works as a preventative measure and plays an important role in promoting one’s mental well-being.[28] When these behavioral regimes govern a person’s actions, it can help us make better decisions, set our priorities in a virtuous manner, and make us more authentic, useful, and meaningful. As a result, promoting the behavioral regime is critical for the holistic improvement of patients. Only those principles relating to the promotion of mental and behavioral conduct have been included in this protocol.

Values related with mental health

A person should be fair and treat all living beings equally, try to appease the anger of the angry person, to overcome the fear and apprehension of the anxious person, to take care of the person who is suffering, to always tell the truth, to be peaceful, to tolerate harsh words of others, and to avoid factors that cause anger, jealousy, greed, etc.[29] The person should not be impatient, does not have an uncontrolled mind, not cut the salary of that person who depends on him, not doubt his loved ones, not try to be happy alone, share the joy with others, one should not involve himself in painful actions, should not trust or be suspicious of others, and not constantly engage in thoughts of day dreaming.[30]

Values related with social, ethical, and moral behavior

One should follow the path of renunciation, knowledge, charity, compassion, happiness, detachment, and harmony.[31] One should not wish for others money, wife, or wealth. One should not have conflicting relationships or enmity. One should not commit sins or misbehave with the person who indulges in sinful acts.One should not blame others, should not tell anyone’s secret, and should not interact with bad people.[32]

The psychotherapist’s responsibility in this phase is to assist patients in implementing and maintaining these behavioral regimens. In light of the aforementioned ideas, the psychotherapist should employ these strategies to promote a code of good behavior.


  Technique VII: Promote the practice of do’s and don’ts in relation to healthy lifestyle Top


At this point, the psychotherapist’s goal is to teach the patient about the do’s and don’ts of a behavioral regimen while also attempting to instil in the patient general knowledge of the importance of living a healthy lifestyle. The psychotherapist might use it in the form of daily life practices to promote these behavioral regimes on a regular basis. It can assist the patient in following a code of conduct as well as develop the patient’s basic values, assist them in making decisions in difficult situations, and shield them from mental pain. The patient’s ongoing feedback and review should be recorded by the psychotherapist and monitored and supervised in order to further integrate these ideals into the person’s life.


  Discussion Top


Depression is a widespread illness that has become a global public health concern. It has a negative impact on a person’s thought process and functioning regions and is linked to suicide.[4] SC is Ayurvedic psychotherapy as well as psycho-spiritual therapy that works on five basic principles, i.e., promotion of spiritual knowledge, scriptual knowledge, patience, memory, meditation, for any patients suffering from psychiatric and psychosomatic disorders.[9] In the light of this background of SC and keeping in view of symptoms of depression, we have explored and developed five practical principles and its derived techniques of SC based on them with special focus on the management of MDD.

In the first principle, promotion of self-knowledge and its derived techniques aim to identify the patient’s negative thought patterns and to change the patient’s thought process through the method of developing core understanding of the self and the process of self-introspection, which will help the patient develop belief in himself and change false perception of himself and the world.[19],[20] The second principle describes the necessity of action in life; it is critical to teach the patient about the importance of action prior to their active participation in worldly life.[22] Theory of action[23] (Karma) is to educate on the right approach to action as per classical knowledge of mind and its functioning.[19],[20] The main goal of the derived technique is to assist the patient in understanding the root causes of his problems and in seeing the situation in an intellectual light, which will allow the patient to know the best way to plan and execute any action in order to achieve any ambitions, goals, or responsibilities. The fourth principle, balancing different aspects of life and promoting wholesome behavior and the techniques that follow it, aims to carefully evaluate the problematic aspects of the patient’s life that affect daily functioning and to develop awareness in the patient about the key aspects of life, such as virtue and wealth.[24] These strategies will assist the patient in becoming more actively involved in life circumstances in a healthy way, allowing him to reach a better balance in his life.

The SC has also added the fifth principle, which is the insertion of moral ethical principles and promotion of good action, once the unwholesome objects have been removed from the patient’s consciousness.[28] This idea and its associated technique are intended to assist patients in exercising and nourishing certain behavioral routines in relation to a healthy lifestyle, which will aid in the development of strong emotional resilience in difficult situations and the prevention of mental diseases.


  Conclusion Top


The reviewed five practical concepts built the practical technique resulting from them after examining research articles, journals, and classical Ayurvedic literature. All of these principles, as well as the approaches generated from them, aid in the modification of cognitive processes and behaviors in MDD patients, as well as their focus on promoting healthy activities that would work as a preventive and promotion measure for general mental health. While SC research is still in its early stages, additional in-depth studies are required to better understand the nature and mechanism of SC.


  Clinical significance Top


A practical approach for applying SC for the management of MDD has been created in this paper, which is urgently needed to make this vital kind of therapy more practical and therapeutically useful. This will be beneficial not only in the treatment of MDD, but also in the treatment of all psychiatric, psychosomatic, and some prolonged somatic issues.

Acknowledgments

We are very grateful to the Central Council of Research in Ayurvedic Sciences (AYUSH PhD Fellowships) for this important research work.

Financial support and sponsorship

This work was supported by the Central Council of Research in Ayurvedic Sciences [AYUSH PhD Fellowship (JRF)].

Conflicts of interest

There are no conflicts of interest.



 
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Abstract
Introduction
Review Results
Principle 1: Pro...
Technique I: Dev...
Technique II: Pr...
12]
Technique III: P...
Principle 2: Sig...
Principle 3: The...
Technique IV: Ed...
Principle 4: Bal...
Technique V: Eva...
Technique VI: De...
Principle 5: Ins...
Technique VII: P...
Discussion
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Clinical signifi...
Technique II: Pr...
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