Hunan Science and Technology Press, 2009
an overview of
wine Zha Bei Chinese and Western medicine with the same name, refers to the tip of the nose and the nose on both sides of skin flushing, papules, pustules, and even the nose increased thickening of the damage as the main manifestation of skin disease. The etiology is unknown, may be related to parasitic mites. Patients were mostly men, often in middle age onset.
Chinese medicine, nose to the lung of the orifices is blood poly-place, and the nose as they are Pitu outside, so the diagnosis and treatment of this disease often from lung, spleen (stomach) or blood sub Yu Yu hot hot knowledge-based, also hot and humid fumigation, Yin Yu on the dry heat, yin deficiency heat fumigation, and alpine dry nasal orifices within the depression on the other.
Second, the magic bullet trick analytical
1. blood heat stagnation, fumigation nasal orifices
Zhu Renkang Cases
(1) medical record review: Cui a, female, nearly 40 years. Great body and health, eating spicy Feigan. Red Nose disease has been suffering from more than 10 set. Shiny red nose on both sides since the beginning, then gradually expanded gradually over the batch issued by the red spot the size of the red papules and pustules needles, accompanied by telangiectasia, skin flushing, seborrhea, pore expansion. Yan menstrual period, and more Zihei blood clots, particularly in the spirit of the tight. Smooth pulse number, red tongue thin yellow card is blood heat. Governance to be cooling Siwutang: Rehmanniae 30g, red peony drugs, Chuanxiong, Angelica tail, skullcap, licorice, saffron, dried tangerine peel the 10g, day 1. External speckle Paste. The rule in January and more, the water was normal. (Fang Rehmanniae, TPG drug Qingreliangxue; Chuanxiong, Angelica tail, saffron blood circulation; nose and lungs are awakened to skullcap Qingfei; dried tangerine peel and stomach qi to help the blood; liquorice reconcile various drugs. All parties combined, played a total of heat and cooling blood, promoting blood circulation of power. Pu Mou Tsai
Experience
(1) medical record review: Xu, female, adult. Incidence of 3 years, repeated rule is invalid. Check both sides of its head and nose, dark purple standards, thin yellow tongue, tongue with red thorns, while purple, pulse string breakdown. Impose a cooling Siwutang Modified: Angelica, Rehmannia glutinosa, Paeonia medicine, red Poria, honeysuckle each 10g, Chuan Xiong, Huang Qin, gardenia, orange peel, safflower, Wulingzhi the 6g. Apply topical nasal tone reversal loose tea. The top 15 after serving nearly cured, no further medication, continued to reverse more than a month and more topical powder. (Fang Angelica, Rehmannia glutinosa, Paeonia drugs, Chuanxiong cooling blood; safflower, Wulingzhi blood circulation; skullcap, gardenia, red Poria heat, cooling blood to help former drug help honeysuckle detoxification; dried tangerine peel and stomach qi to help blood circulation. Scattered outside the government reverse the blood circulation, detoxification of insecticide, local treatment, in order to make the rule less.
Jiangshu An Experience
(1) medical record review: Xiong, female, 19 years old. The patient began 4 months before the nose and the two nose redness, itching associated with partial burning, and gradually increased. Now nose was dark red, local skin hypertrophy, greasy surface bright lubrication, like a small grain of rice pus head, with burning pain, itching, thirst, thin yellow fur, rapid pulse. Zha Bei diagnosed as alcohol mid-governance in order to detoxify, cooling blood, organs with blood stasis Decoction: Rehmanniae, peach kernel of the 10g, safflower 3g, angelica, peony all drugs 10g, Citrus aurantium, Bupleurum, Chuanxiong, Campanulaceae the 6g, Achyranthes, honeysuckle, violet the 10g, licorice 6g, Japan 1. The top eight and more. (Jiang Shuan, Governance in order to heat toxin, cooling blood. Fang Rehmanniae, peach kernel, safflower, angelica, peony drugs, Chuanxiong, Achyranthes cooling blood circulation; Campanulaceae Su-lung, Citrus aurantium, Shugan Qi, to help blood circulation; honeysuckle, violet , licorice Qingrejiedu.
2. Yu-lung and stomach heat, fumigation nasal orifices
Zhao Bingnan Cases
(1) medical record review: Zhao, M, 40 years old. V. nasal erythema is 3-4 years. 3-4 years ago, appears on both sides of the nose and nasal flushing, and gradually expanded until the development of two zygomatic, forehead, of a grain of rice from red pimples, nasal tip with their names, and consciously micro itching, usually dry stool. Permanently. Charles See nasal flushing, and telangiectasia significantly expand the hole and hair follicles, nasal scattered around the face like a large grain of rice, sorghum, and slightly red papules of hard nodules. Thin white fur, the pulse string. Card is a plot lung and stomach heat, blood stasis Accumulation. Governance in order to cooling heat, blood stasis: Health gardenia, Salvia, trichosanthin the 12g, Rehmannia glutinosa, Paeonia medicine, Scutellaria, madder root, Lithospermum the 9g, leaves, Atractylodes the 15g, violet 6g, safflower 4.5g. After serving over 10 colors of nasal erythema slowed, softened the original hard nodules, erythema, abscess see on the absorption, reduce itching. Continued service at the top, and with Gardenia Golden balls, balls, alternately taking rhubarb insects, nose to reverse the bulk water to paint. After two weeks marked improvement of nasal erythema, color became normal, telangiectasias disappear. Then vote Yangyinqingfei cream, Golden Gardenia pill, topical cream Pu Yu continued rule in January, the basic recovery. (Governance in order to cool blood heat, blood stasis. Fang Rehmanniae, TPG drugs, Salvia, safflower, madder root, Lithospermum cooling blood stasis; Health gardenia, skullcap, TCS to clear heat Xiefei gastric fluid; Viola detoxification; loquat Su-lung; Atractylodes and spleen, to prevent the bitter cold Shang Wei. Gardenia Golden pill detoxification; rhubarb pill bug blood circulation.
Experience in different countries where
(1) medical record review: Zhang, F, 43 years old. Red nose 4 years ago, the first private prosecution, from time to time, after persistent red, and the emergence of a small lump over two years. Recently, red to deep, small lumps extended face, nose and mouth drying conscious, upset, face burning, tight, dry stool, urine yellow. Check the Department of Dermatology meeting was red, slightly swollen, green beans around the needle to the size of papules, pus some point, the pressure of the fading with pain. Buccal lesions under the chin to the nose weight. Yellow tongue coating slightly dry, the pulse number of powerful. Yun-Fei Wei card is hot, due to blood stasis. Governance in order to Xiefei heat, cooling blood detoxification, blood circulation. Zha drink wine with the self: leaves, Morus alba, Chuanxiong, baicalin the 10g, tangerine peel, peach kernel, safflower, peony medicine, licorice all 9g, Gardenia 10g, Rehmanniae, gypsum and the 15g, honeysuckle, dandelion , Viola of the 30g. After the pus points above the 15 disappeared, some papules subsided. To the honeysuckle, dandelion, violet, plus moutan 10g, Rhizoma Imperatae 30g, 15 剂 and more. (What with the country, Governance in order to Xiefei heat, cooling blood detoxification, blood circulation. Fang Zhongsheng gypsum, Morus alba, gardenia, skullcap Qingxie lung and stomach; Chuanxiong, peach kernel, safflower, peony drugs, Rehmanniae cooling blood; honeysuckle, dandelion, violet, licorice Qingrejiedu; loquat Vision lung, dried tangerine peel and stomach qi to help blood circulation. Moutan cooling circulation; Rhizoma Imperatae cooling fluid.
Lei Guolian Cases
(1) medical record review: Zoumou, female, 37 years old. Nose skin flushing six months ago, when the time is now hidden, then after persistent. At the same time there have been sporadic small acne-like pustules, face is bleeding. Self-inductance of a slight itching. Have increased in recent January, seriously affecting the face, the western medicine is not effective. Patient see the nose accurate, cheeks, especially in the nose can be seen at telangiectasia, shaped like their names wound, skin purple brown. Card is on the steam heat to lung and stomach, governance in order to Shufeng Xuanfei, clearing away heat: white moss leather 9g, dandelion 10g, Rehmannia 10g, honeysuckle 10g, Guanzhong 15g, Rhizoma 9g, sea breeze rattan 9g, MA pocket Ling 9g, littoralis 9g, malt 9g. Second diagnosis: the top six after the self itching disappeared, no longer appears pustules. Prescription: the top to the honeysuckle, dandelion, Ghassan leaves 10g, Chuan Xiong 10g, even serving 26 and more. (Lei Guolian, nasal awakened awareness. Governance in order to Shufeng Xuanfei, clearing away heat. Fang Notopterygium, white moss skin, the sea breeze rattan Shufeng itching; dandelion, honeysuckle, Guanzhong, aristolochic Qingrejiedu; Rehmannia, glehnia YangYinShengJin; malt spleen. Mulberry leaf powder declared Hyperactivity, Chuanxiong qi and blood circulation. Li Zhi prison
Experience
(1) medical record review: Zhang, F, 40 years old. 3 years ago in the nose were red, and gradually extended to the middle plane, eat spicy and mental stress is drama. With constipation, red urine, irregular menstruation, dark color quantity. Zheng Jian nose and cheeks Department of quasi-dark skin color, have herpes, the surrounding telangiectasia. Red thin yellow tongue coating, slippery pulse number. Yu-lung and stomach card is hot, block context. Governance in order to cool blood stasis, with the cooling Siwutang Modified: Angelica, Rehmannia glutinosa, red skin of Poria 15g, Chuan Xiong, TPG drugs, skullcap, orange peel, safflower the 9g, Wulingzhi 12g, licorice 6g, 6g Magnolia , the system rhubarb 9g. Even serving the top 40 and more. (Li Zhi prison and so on, stasis as a rule. Fang angelica, Rehmanniae, Chuanxiong, TPG medicine cooling blood; system rhubarb Qingwei diarrhea fever, but also help safflower, Wulingzhi blood circulation; with baicalin Qingfei Xiere; dried tangerine peel and stomach qi to help blood circulation; Poria Pillay urinary red heat; Magnolia Tom Lee nasal orifices, cited by drugs directly to patients; licorice reconcile the various drugs.
3. stomach Yu heat, fumigation, King Tan nasal orifices book
Experience
(1) medical record review: Huang, female, aged 42, teacher. V. nasal red, dry, heat, itching for two years, bad breath, insomnia, menstruation. See the tip of the nose and the wings at the Charles telangiectasia, skin thickening. Red tongue, yellow coating,UGG boots cheap, slippery pulse string. Card is upside spleen accumulated heat, external nose blood stasis, prescription: gypsum, Millettia the 20g, Rhubarb 2g (bubble server), baicalin, Anemarrhena, Angelica tail, Chuanxiong 10g, red peony drugs, Rehmanniae , kelp the 15g, safflower 3g. Powder coated reversed. Serving the top 16, red red nose disappeared, local skin dryness, scaling, nose at the red red, thickening also decreased, slightly slip slow pulse string. Yu has less heat, stasis is not mitigated, and see signs of vaginal dryness. Recipe: Huang Qin, Anemarrhena, peach kernel of the 10g, gypsum 20g, Angelica tail, red peony root of all drugs 15g, Chuan Xiong 6g, safflower 3g, licorice 6g, Rehmanniae, oysters 30g. For external use with the former. Third consultation: intermittent service over 36, and insists governance, Zhu Zheng substantially improved, smooth skin, nose, only the nose at the little blood vessels to dilate, faintly visible. When the existing abdominal pain, food satisfied slightly reduced, thin white tongue fur, pulse slow. Yu heat has been cleared, stomach Deficiency, to be Qi and spleen, qi and blood circulation: Codonopsis, Atractylodes, Bupleurum, Citrus aurantium, peach kernel, angelica tail, Chuanxiong, TPG drugs, Rehmanniae the 10g, Coix seed 20g, safflower 5g. External treatment with the former, work continued revenue service 15. (Li Fan, Fang Zhongsheng gypsum, rhubarb, skullcap, Anemarrhena Qingxie stomach heat; Angelica Mei, Chuan Xiong, TPG drugs, Rehmanniae, safflower, Millettia qi and blood circulation, circulation collaterals; kelp Endometriosis. The second patient, the depression has less heat, stasis is not mitigated, and see the signs of vaginal dryness, so use the skullcap, Anemarrhena, gypsum, licorice heat; peach seed, angelica tail, red peony drugs, Chuanxiong, safflower, Rehmanniae blood circulation ; oysters Endometriosis. Three clinics, the former drug has been serving more than 50 agents, Yu heat has been clear, very bitter cold of the spleen and stomach from the spleen qi, qi and blood circulation as a rule. Fang Codonopsis, Atractylodes, Coix spleen Qi; Bupleurum, Citrus aurantium qi, to help Peach, Angelica tail, Chuanxiong, TPG drugs, Rehmanniae, safflower blood circulation. Reversed scattered external blood circulation, detoxify pesticides.
Chen Taiquan Experience
(1) medical record review: Hemou, male, 45 years old. Zha Bei 20 years suffering from alcohol, long treatment cured. Consultation see: the external nose is red, greasy light, accompanied by scattered small pustules spread to both sides of the face. Nasal dryness, irritability, easy to hunger, dry stools, yellow urine, red tongue, thin yellow tongue coating, floating pulse. Recipe: Coptis 10g, Scutellaria, Gardenia the 20g, Kochia scoparia, fresh white skin, soil Fuling the 15g, fried rhubarb 6g, Puhuang, gypsum, Jiao Huangbai the 30g, 6 agent. External Treatment: After routine disinfection of skin with a sterile needle puncture pustules, discharge of pus and blood, and then apply alcohol chloramphenicol (chloramphenicol injection 20ml, 75% ethanol 50ml), 1 day sooner or later. Second diagnosis: Zhu Zheng better, only eat less. The original parties to the rhubarb, gypsum, add yam 15g, 6 agent. Waicha medicine with the former. Third diagnosis: Zhu Zheng disappeared, only a small part left scattered in the rose-colored points and scar with pigmentation. Recipe: Jiaohuang Bo, Ban Langen each 20g, Huang Qin, fresh white skin, soil Fuling the 15g, dandelion 30g, Kochia scoparia, TPG drug the 12g. After the stop taking the top five, external paint fresh tomato juice, 1 night. Consecutive January and more. (Chen Taiquan and so on, Fang Coptis, Scutellaria, Gardenia, fried rhubarb, gypsum, Jiaohuang Bai Qing Xie triple burner on the middle and lower heat; Kochia scoparia, fresh white skin Qufeng cleansing; soil Fuling detoxification Sanjie; Puhuang cooling circulation. Yam and medicine spleen. All parties combined, played a total heat purging fire, detoxifying Sanjie achievements. Three clinics Fang, skullcap, Jiaohuang Bo heat; Ban Langen, dandelion Qingrejiedu; fresh white skin, cleansing heat Kochia scoparia; soil Fuling detoxification Sanjie; TPG medicine cooling blood.
4. hot and humid Yu, Hung Hing fumigation nasal orifices
down Experience
(1) medical record review: Zhou, male, 51 years old. Body stout, 5 years ago, appears on both sides of the nose and nasal flushing bright, then gradually extended to the cheeks,UGG boots clearance, and the occurrence of a large grain of rice, red papules, both slightly larger than the number of hard nodules, nose and see their names on four prospective cloth. Often feel dry and itchy nose, nose clip when the blood. Tongue is pink, has a thin yellow coating. Modified Qingfeiyin fine: loquat, TCS, mulberry each 10g, herb, Scutellaria the 8g, Coix Seed 30g, licorice 3g, every other day one. External Coptis catechu powder (Coptis, Phellodendron, catechu, indigo, Gefen, calcined gypsum of the 3g, realgar, light pink, dragon's blood of the 2g, dry alum, borneol the 1.5g, musk 0.3g, 20 flowers bloom ) cold water transfer coating, before going to sleep at 2 or 1. 1 month after the treatment significantly improved Zhu Zheng. Stop taking the medicine, continued to use external treatment, between days 1, 4-5 times more. (Hung Hing down, spleen; licorice reconcile various drugs. Insecticide detoxification for external use, to fill less than the rule. Pathogenesis of the patients to doctors who use the herb, Yiyiren meaning, when the heat from the lung and spleen know fumigation nasal orifices, but the clinical syndrome of Zheng Xiang
Experience
(1) medical record review: Zhang, male, 24 years old. 1 year ago found that the buccal and nasal tip from the nose and a red rash, and gradually extended to the face, had drinks with loquat Qingfei, tetracycline, chloroquine and vitamin drugs taken orally, and topical sulfur preparations, hormones, and had no obvious effect, each of stimulation due to food foods sicker, with constipation. Check see the forehead, cheeks, chin, nasal tip and alar scattered on both sides of erythema, papules, pustules, blackheads, atrophic scars, nose in the capillary expansion. Trichocryptosis direct examination positive. Card is a stomach heat, complex sense of evils. Governance in order to heat and dampness, spleen Huazhuo: capillaris, hawthorn the 30g, wild chrysanthemum, plum the 20g, Campsis, Salvia the 15g, gardenia, rhubarb the 10g. Even serving the top 20 and more. (Zheng Xiang, TRADITIONAL CHINESE MEDICINE spleen, but also help Campsis, Salvia blood circulation; Doctor from the stomach of patients with heat pathogenesis, complex sense of awareness of evils, the management can be established, but the clinical syndrome of
5. Yin Yu heat, fumigation nasal orifices (Gu Bohua Cases)
(1) medical record: Kang, M, 30 years old. The patient was 5 years ago and the two sides of the nose between the eyebrows frequent miliary large boils, and sometimes into septic ulceration, over and over again. Then thicken nasal pores, skin discoloration red. Repeated treatment is not effective. Often dry stools, dry mouth, dry lips. See the two eyebrows search near greasy scales, telangiectasia tip of the nose wings, large open pores, oily nature of powder may be out of juice. Cheeks red papules scattered, and there are two folliculitis. Rapid pulse, red tongue sting, thin yellow tongue coating. Card is a ferrite Yin, Yun-lung and stomach on the accumulated heat. Relaxing the rule to clearing away heat, clearing away heat and impose self-flavored soup: Scrophulariaceae, gypsum, Biota orientalis, Health Hawthorn the 12g, Rehmanniae 15g, diffusa 30g, Huang Qin, the system rhubarb, mulberry root bark of the 9g . External reverse deposited bulk transfer to tea. 1 month and above the drug markedly, medication 2 months and more. (Relaxing the rule to clearing away heat. Fang Zhongsheng gypsum, skullcap, made rhubarb, Morus alba Qingxie lung and stomach; Scrophulariaceae, Rehmanniae Yin heat; Oriental Arborvitae cooling; Health Hawthorn OPHTHALMOLOGY; diffusa Jieduhuayu.
6. deficiency heat, fumigation nasal orifices (Class Experience in raising the peak)
(1) medical record review: Bu a, female, 52 years old. Nasal Red, urinary urgency and 6 years, nearly half of the month to increase. Patients met the red eyes be red, swollen nose, red red, upset, insomnia, backache pain, hardship, loss of appetite, urinary frequency intended to distress, less Sechi, there is no sense of pleasure and pain. Red tongue without coating, rapid pulse. Card is a ferrite Yin, hot and humid and the next invasion of coke. Governance in order to Ziyinqingre dampness, with Polyporus Decoction: Polyporus, Poria, talc the 12g, Alisma 18g, donkey-hide gelatin 9g. The top three and efficiency, and then into six markedly, and continued serving 10 and more. After conditioning with Liu Wei Di Huang Wan in March. (Class support peak, Governance in order to Ziyinqingre dampness. Fang Polyporus, Poria, talc, Alisma heat dampness; Jiao Yin. Kidney Yin Liu Wei Di Huang Wan.
7. dampness within the depression, the dry nasal orifices (Xin group of cattle Cases)
(1) medical record review: Humou, female, 30 years old. Suffering from alcohol Zha Bei 8 years, despite multiple treatment effect not significant. See the nose when the patient has cystic bulge undulating, red red nose, nose Liangbang, on both sides of mouth, lower jaw and zygomatic skin changes to varying degrees, the surface smooth, scattered telangiectasia. Four things I have used a decoction for treatment of more than a month, no achievements, and many seek treatment after the patient is not effective. Patients six months after the treatment because of stomach discomfort, abdominal swelling of the liver clinic when the abdominal swelling, food odor, vaginal discharge Qingxi, pale mouth tired mouth, dizziness, pale tongue, greasy moss, pulse slightly. The combination of vein disease, syndrome is a block in the alpine coke gasification negative, lifting is not shipped. To dampness spleen, adjusting qi for the law, imitation Pingwei Modified: herb 30g, tangerine peel 10g, Magnolia 30g, Baked Licorice 10g, Gui, cinnamon each 10g, Pinellia 15g, Poria 20g, 5g of Alpinia , Akebia 10g, Coix seed 30g. After serving six above the swelling of the liver with reduced inflation, reduced vaginal discharge, Taste of food, less dizzy. Continued serving four and recovered. Surprisingly, the color red into pink nasal tip, flattening the basic cystic bulge, other parts of the colors have faded. Continued after serving 18 nasal skin color, etc. are back to normal. 1 year after the two wings and a slight red nose, the patient kept the original prescription from the purchase of medicines, even serving eight and more, has more than 3 years without recurrence. (Xin group of cattle, nasal awakened awareness. Governance in the spleen dampness, adjusting qi. Fang Atractylodes, Citrus, Pinellia, grass cardamom, magnolia bark, spleen dampness Zhigancao; Gui Zhi, cinnamon yang to help Poria, wood dampness through diuresis; coixenolide Jianpihuashitang. Spleen and stomach health, dampness of the Qing-liter cloud drop, blood Cheong, rhinopathy since removed. The case for the governance of wine Zha Bei distinguished from ideas, Zhennai diagnosis and treatment of Miaoguan also.
Third, note
ancient wine Zha nose on the rich literature. cable fire, fire by heart. Yuan Zhu Danxi in the service, efficiency. and with the tung oil into the berberine, in days hanging vines, burning oil is hot, apply to. Heart Surgery Tips
literature from ancient and modern look, the treatment of this disease, the general rule is within the service with the foreign law. Because this book is purely external treatment of the medical record is not included, so the majority of cases the two methods are combined rule, and the minority within the rule to take effect.
close this section of the case, according to the majority of its symptomatology than obvious. The main rule is: Differentiation for the blood heat stagnation, fumigation nasal orifices of the 3 cases, Chu case of basis. Yu bowel syndrome as heat, fumigation nasal orifices of the 6 patients, mainly Hyperactivity, stomach Yu (product) heat, in addition to Ray's case based on lack of differentiation, the other 5 patients had dry stool of the disease on, he is a lung nasal orifices of the reason, which is the main basis for differentiation. The other four cards, in addition to hot and humid Yu, fumigation certificate nasal orifices lack of differentiation based on other, significantly more than card basis can be identified.
Herbal Prescription, including aspects of governance, based on analysis of ancient and modern literature, the main laws are:
1, blood heat stagnation, fumigation certificate nasal orifices, multiple governance in order to heat and cooling blood, blood circulation,UGG boots, the use of cooling Si Wu Tang (Angelica sinensis, Rehmannia glutinosa, Chuanxiong, TPG drugs, skullcap, red Poria, Citrus, flowers, licorice, ginger, wine adjustment Wulingzhi), blood organs Xi (Achyranthes, peach kernel, safflower, angelica, Chuanxiong, TPG drugs, Rehmanniae, Citrus aurantium, Bupleurum, Campanulaceae, licorice) addition and subtraction. Recorded in medical records in this section, the more honeysuckle, violet and the like to heat detoxification.
2, entrails Yu heat, fumigation certificate nasal orifices, more treatment to clear Xiefei stomach, cooling blood, common side such as strict with the Song and Gardenia Ren for the end of melting yellow wax, etc. into balls), CHEN Shi Gong , dried arrowroot, TCS, forsythia, flowers, skullcap, mint), Qing Dynasty, and so on. Medical records in this section, the doctor sent with the card and more drugs, clearing the lungs with a skullcap, gardenia, leaves, Morus alba; Qingwei plaster, Anemarrhena, TCS, rhubarb and the like; cooling blood with Taohongsiwutang , Salvia, Millettia,UGGs, madder, Lithospermum and the like.
3, hot and humid Yu, nasal orifices fumigation certificate, in the clear on the basis of Xiefei stomach medication, plus dampness Huazhuo of the goods, such as herb, Coix Seed, capillaries and the like.
4, Yin Yu heat, yin deficiency heat, fumigation certificate nasal orifices, Experience in 1 case each column to Yangyinqingfei soup, like Liu Wei Di Huang Wan Yin, along with the clear Xiefei Stomach Commodities Qing Yu heat, or light penetration benefits of water products, such as Polyporus, Poria, Alisma Huazhuo like dampness.
5, alpine in depression, dry nasal orifices on the card, this was undoubtedly the uncommon cards, prescriptions, such as medical record.
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