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|title=Chikitsaprabhritiya Adhyaya

|title=Chikitsaprabhritiya Adhyaya

|titlemode=append

|titlemode=append

|keywords=Chikitsaprabhrita (equipped physician), bahudosha (signs of aggravated dosha), samshodhana (purification therapy), vishuddha koshtha (purified bowel), svabhavoparamavada (theory of natural destruction),Panchakarma, patient care, assessment criteria of purification

|keywords=Chikitsaprabhrita (equipped physician), bahudosha (signs of aggravated dosha), samshodhana (purification therapy), vishuddha koshtha (purified bowel), svabhavoparamavada (theory of natural destruction),Panchakarma, patient care, assessment criteria of purification,Ayurveda, Indian system of medicine, charak samhita.

|description=Sutra Sthana Chapter 16. Assessment and care in Panchakarma therapies

|description=Sutra Sthana Chapter 16. Assessment and care in Panchakarma therapies

}}

}}

<big>'''Sutra Sthana Chapter 16. Assessment and care in [[Panchakarma]] therapies'''</big>

<big>'''Sutra Sthana Chapter 16. Assessment and care in [[Panchakarma]] therapies'''</big>

{{Infobox

{{Infobox

|label5 = Other Sections

|label5 = Other Sections

|data5 = [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data5 = [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

=== Introduction ===

== Introduction ==

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In continuation of the preceding [[Upakalpaniya Adhyaya]] this chapter elaborates on the remaining aspects of purification processes and their prerequisites which were not fully dealt there.The word ''prabhrita'' is derived from the verbal root ''bhr'' which suggests the sense of supporting, nourishing and offering. The term, ''chikitsaprabhrita'' is applied to mean that physician who is well equipped in terms of qualities and instruments and who can play proper supporting role in the management of diseases. The chapter emphasizes upon the need for a proficient and well equipped physician to ensure flawless treatment. The patient is also expected to be intelligent enough to be able to identify a good physician. The word ''virechana'' is used often for ''vamana'' and ''samshodhana'' as well. Clinical features of ''samyak yoga'' (appropriate application of a procedure), ''ayoga'' (under application) and ''atiyoga'' (over application), and their management, have also been described. Diseases, their therapeutic response (so that they do not reoccur) and management of post-therapy cachexia have also been addressed in this chapter. ''Svabhavaparamavada'' is a phenomenon of natural destruction of health and disease.  There is a continuous process of degeneration and regeneration of body tissues. The process of regeneration is known to great extent but the cause of degeneration and death is not known.

In continuation of the preceding [[Upakalpaniya Adhyaya]] this chapter elaborates on the remaining aspects of purification processes and their prerequisites which were not fully dealt there.The word ''prabhrita'' is derived from the verbal root ''bhr'' which suggests the sense of supporting, nourishing and offering. The term, ''chikitsaprabhrita'' is applied to mean that physician who is well equipped in terms of qualities and instruments and who can play proper supporting role in the management of diseases. The chapter emphasizes upon the need for a proficient and well equipped physician to ensure flawless treatment. The patient is also expected to be intelligent enough to be able to identify a good physician. The word [[virechana]] is used often for [[vamana]] and ''samshodhana'' as well. Clinical features of ''samyak yoga'' (appropriate application of a procedure), ''ayoga'' (under application) and ''atiyoga'' (over application), and their management, have also been described. Diseases, their therapeutic response (so that they do not reoccur) and management of post-therapy cachexia have also been addressed in this chapter. ''Svabhavaparamavada'' is a phenomenon of natural destruction of health and disease.  There is a continuous process of degeneration and regeneration of body tissues. The process of regeneration is known to great extent but the cause of degeneration and death is not known.

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===Sanskrit text, Transliteration and English Translation===

==Sanskrit text, Transliteration and English Translation==

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Now, we shall expound the chapter on the “Duties of a qualified physician.” [1-2]

Now we shall expound the chapter "Chikitsaprabhritiya" (Assessment and care in [[Panchakarma]] therapies).” Thus said Lord Atreya.[1-2]

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A qualified physician is the one who is well acquainted with the principles of treatment, is learned and skilled in the practice of  [[Ayurveda]], and is known for promptness of action. A patient obtaining treatment in the form of emesis or purgation from such a physician, becomes healthy and attains happiness. On the other hand, if the patient receives treatment from a pretentious & ignorant physician, he subjects himself to potential complications because of excessive or inadequate treatment. [3-4]

A qualified physician is the one who is well acquainted with the principles of treatment, is learned and skilled in the practice of  [[Ayurveda]], and is known for promptness of action. A patient obtaining treatment in the form of emesis or purgation from such a physician, becomes healthy and attains happiness. On the other hand, if the patient receives treatment from a pretentious & ignorant physician, he subjects himself to potential complications because of excessive or inadequate treatment. [3-4]

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==== Signs of proper purification ====

=== Signs of proper purification ===

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Weakness, lightness, fatigue, attenuation of diseases, improved taste perception, restoration of the functioning of heart, improved complexion, proper appetite and thirst, timely passage of natural urges, feeling of cleanliness in intellect, sense organs and mind, proper movement of ''vata'', and proper digestion (including metabolic activities) are the signs and symptoms of correctly administered purification therapy. [5-6]

Weakness, lightness, fatigue, attenuation of diseases, improved taste perception, restoration of the functioning of heart, improved complexion, proper appetite and thirst, timely passage of natural urges, feeling of cleanliness in intellect, sense organs and mind, proper movement of [[vata]], and proper digestion (including metabolic activities) are the signs and symptoms of correctly administered purification therapy. [5-6]

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==== Signs of inadequate purification ====

 

=== Signs of inadequate purification ===

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Spitting or drooling, abnormal functioning of heart, precipitation (''utklesha'') of ''shleshma'' and ''pitta'', distension of  abdomen , anorexia, vomiting, debility, absence of lightness (heaviness or sluggishness), laxity in calf muscles and thighs, drowsiness , feeling as if covered with a wet hide (''staimitya''), onset of rhinitis and impediment to the function of ''vata'' are the signs and symptoms of inadequate purification. [7-8]

Spitting or drooling, abnormal functioning of heart, precipitation (''utklesha'') of ''shleshma'' and [[pitta]], distension of  abdomen , anorexia, vomiting, debility, absence of lightness (heaviness or sluggishness), laxity in calf muscles and thighs, drowsiness , feeling as if covered with a wet hide (''staimitya''), onset of rhinitis and impediment to the function of [[vata]] are the signs and symptoms of inadequate purification. [7-8]

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==== Signs of excess purification therapy ====

 

=== Signs of excess purification therapy ===

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Elimination of feces, ''pitta, kapha,'' and ''vata'' in succession, excessive discharge of blood that looks like fat and flesh (washed), supernatant  water or watery excretion of black colored blood without ''shleshma'' and ''pitta'', excessive thirst affliction with vitiated ''vata'' and fainting are the signs and symptoms of overpurgation. [9-10]

Elimination of feces, [[pitta]], [[kapha]], and [[vata]] in succession, excessive discharge of blood that looks like fat and flesh (washed), supernatant  water or watery excretion of black colored blood without [[kapha]]  and [[pitta]], excessive thirst affliction with vitiated [[vata]] and fainting are the signs and symptoms of overpurgation. [9-10]

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In case of excessive administration of emesis, the symptoms are identical to that observed in the case of purgation. In addition, overemesis may result in diseases of ''vata'', affecting the upper part of the body and also causing impediment of speech. One should therefore approach such a qualified and well-versed physician for the administration of any purification therapy. [11-12]

In case of excessive administration of emesis, the symptoms are identical to that observed in the case of purgation. In addition, overemesis may result in diseases of [[vata]], affecting the upper part of the body and also causing impediment of speech. One should therefore approach such a qualified and well-versed physician for the administration of any purification therapy. [11-12]

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==== Signs of excess aggravated ''dosha'' and indications of purification therapy ====

 

=== Signs of excess aggravated [[dosha]] and indications of purification therapy ===

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Indigestion, anorexia, corpulence, anemia, heaviness, exhaustion, eruption of pimples and wheals (bumps or itchy sores), pruritis, sluggishness, indolence, weakness, foul smell of the body, lassitude, precipitation (''utklesha'') of ''kapha'' and ''pitta'', sleeplessness or excessive drowsiness, impotency, impediment to intelligence, inauspicious dreams, and loss of strength and complexion in spite of taking nourishing diet and right therapy are the signs and symptoms of patients having excess of morbid doshas. An experienced, skilled physician would advise and administer purification therapy taking into consideration the ''dosha'' status and strength of the patient . [13-16]

Indigestion, anorexia, corpulence, anemia, heaviness, exhaustion, eruption of pimples and wheals (bumps or itchy sores), pruritis, sluggishness, indolence, weakness, foul smell of the body, lassitude, precipitation (''utklesha'') of [[kapha]] and [[pitta]], sleeplessness or excessive drowsiness, impotency, impediment to intelligence, inauspicious dreams, and loss of strength and complexion in spite of taking nourishing diet and right therapy are the signs and symptoms of patients having excess of morbid [[dosha]]. An experienced, skilled physician would advise and administer purification therapy taking into consideration the [[dosha]] status and strength of the patient . [13-16]

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==== Benefits of purification therapy ====

=== Benefits of purification therapy ===

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Administration of therapies, leading to elimination of vitiated ''doshas'', results in the following effects: enhancement of digestion / metabolism, pacification of diseases, restoration of normal health, improvement in clarity of sense organs, mind, intellect and complexion, promotion of strength, plumpness, progeny and virility, delayed ageing, and longevity. Therefore, one should take recourse to a skillfully administered purificatory therapy at an appropriate time. [17-19]

Administration of therapies, leading to elimination of vitiated [[dosha]], results in the following effects: enhancement of digestion / metabolism, pacification of diseases, restoration of normal health, improvement in clarity of sense organs, mind, intellect and complexion, promotion of strength, plumpness, progeny and virility, delayed ageing, and longevity. Therefore, one should take recourse to a skillfully administered purificatory therapy at an appropriate time. [17-19]

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==== Prevention of recurrence of disease ====

 

=== Prevention of recurrence of disease ===

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Morbid ''doshas'' relieved by fasting and digestive drugs may sometimes get aggravated again, but those that are evacuated by purification therapies do not recur. ''Doshas'', like plants, if not uprooted completely, would recur or relapse almost certainly. [20-21]

Morbid [[dosha]] relieved by fasting and digestive drugs may sometimes get aggravated again, but those that are evacuated by purification therapies do not recur. [[Dosha]], like plants, if not uprooted completely, would recur or relapse almost certainly. [20-21]

==== Post purification measures ====

=== Post purification measures ===

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For those weakened by purification therapy, restoration of one’s health could be done by prescribing a nourishing diet regimen that would include ''ghee'', relishing soup (including preparations with meat), and milk. The patient should also be advised massage, bath, and evacuative and unctuous enema. This process of purification followed by rejuvenation or restoration of one’s health bestows happiness and longevity to the patient. [22-23]

For those weakened by purification therapy, restoration of one’s health could be done by prescribing a nourishing diet regimen that would include ''ghee'', relishing soup (including preparations with meat), and milk. The patient should also be advised massage, bath, and evacuative and unctuous enema. This process of purification followed by rejuvenation or restoration of one’s health bestows happiness and longevity to the patient. [22-23]

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==== Treatment of excess and inadequate purification therapy ====

=== Treatment of excess and inadequate purification therapy ===

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In cases of inadequate administration or application, one should be given oleation therapy followed by evacuative therapy again, considering the dose, time, strength of the patient and factors responsible for inadequate cleansing earlier. Management of disorders arising out of improper oleation, fomentation and purification therapies as well as post- purification dietetic regimen program is described subsequently in [[Siddhi Sthana]] (i.e., the Siddhi section of this treatise). [24-26]

In cases of inadequate administration or application, one should be given oleation therapy followed by evacuative therapy again, considering the dose, time, strength of the patient and factors responsible for inadequate cleansing earlier. Management of disorders arising out of improper oleation, fomentation and purification therapies as well as post- purification dietetic regimen program is described subsequently in [[Siddhi Sthana]] (i.e., the Siddhi section of this treatise). [24-26]

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==== ''Swabhavoparama vada'' (theory of natural destruction) ====

=== Swabhavoparama vada (theory of natural destruction) ===

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Discordance of the causative factors results in disequilibrium of the tissue elements (''dhatus'') of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors. However, the resolution / destruction of the existing always happens naturally in the course of time. [27]

Discordance of the causative factors results in disequilibrium of the tissue elements ([[dhatu]]) of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors. However, the resolution / destruction of the existing always happens naturally in the course of time. [27]

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There is always a cause for the manifestation of beings but none exists for their annihilation. However, some scholars are of the opinion that the noncontinuance of their causative factors is the very cause of their annihilation. [28]

There is always a cause for the manifestation of beings but none exists for their annihilation. However, some scholars are of the opinion that the noncontinuance of their causative factors is the very cause of their annihilation. [28]

==== Query by Agnivesha ====

=== Query by Agnivesha ===

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The master having thus given his version Agnivesha inquired- if the natural resolution (of disorders) be in the very nature of things then what is the necessity of a qualified physician? Which discordant body elements are harmonized by the physician by means of therapy? After all what does the treatment amount to? And what is its objective? [29-30]

The master having thus given his version Agnivesha inquired- if the natural resolution (of disorders) be in the very nature of things then what is the necessity of a qualified physician? Which discordant body elements are harmonized by the physician by means of therapy? After all what does the treatment amount to? And what is its objective? [29-30]

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==== Explanation by Punarvasu ====

=== Explanation by Punarvasu ===

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There is neither a cause for things to perish nor there is a possibility of bringing out a change in the innate tendency of destruction. [33]

There is neither a cause for things to perish nor there is a possibility of bringing out a change in the innate tendency of destruction. [33]

==== Definition of ''chikitsa'' and the duty of a physician ====

=== Definition of ''chikitsa'' and the duty of a physician ===

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==== Summary ====

=== Summary ===

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Here also ends the fourth tetrad on the “Therapeutical Processes.”

Here also ends the fourth tetrad on the “Therapeutical Processes.”

=== ''Tattva Vimarsha'' / Founding Principles ===

== Tattva Vimarsha (Fundamental Principles) ==

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*A skillful physician is critical to the successful administration of a [[Panchakarma]] therapy and a patient who can identify such a physician is of equal importance.

*A skillful physician is critical to the successful administration of a [[Panchakarma]] therapy and a patient who can identify such a physician is of equal importance.

*The proper administration of purification therapy is important to achieve positive health benefits, uprooting the disease and preventing recurrence.  

*The proper administration of purification therapy is important to achieve positive health benefits, uprooting the disease and preventing recurrence.  

*Discordance of the causative factors results in disequilibrium of the tissue elements (''dhatus'') of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors.  

*Discordance of the causative factors results in disequilibrium of the tissue elements ([[dhatu]]) of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors.  

*The resolution / destruction of the existing always happen naturally in the course of time.  

*The resolution / destruction of the existing always happen naturally in the course of time.  

*There is always a cause for the manifestation of beings, but there is no cause for their annihilation.  

*There is always a cause for the manifestation of beings, but there is no cause for their annihilation.  

*Ayurvedic treatment is aimed towards creating balance in ''dosha'' and ''dhatus'' and sustaining it.  

*Ayurvedic treatment is aimed towards creating balance in [[dosha]] and [[dhatu]] and sustaining it.  

*The skilled physician should make all efforts to normalize the tissues of the body.

*The skilled physician should make all efforts to normalize the tissues of the body.

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=== ''Vidhi Vimarsha'' / Applied Inferences ===

== Vidhi Vimarsha (Applied Inferences) ==

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*The physician should be especially skilled in ''vamana'' and ''virechana'' procedures.

*The physician should be especially skilled in therapeutic emesis [[vamana]] and therapeutic purgation [[virechana]] procedures.

*If the patient develops weight loss and debility after purification therapy, he should be given a rejuvenation treatment in the form of a nourishing dietary regimen that includes ''ghrita'' (clarified butter), meat soup, milk, appetizing broth, massage and medicated enema.

*If the patient develops weight loss and debility after purification therapy, he should be given a rejuvenation treatment in the form of a nourishing dietary regimen that includes ghee, meat soup, milk, appetizing broth, massage and medicated enema.

*Treatment for ''atiyoga'' involves a regimen of medicated ''ghrita'' and an oleation enema with oil prepared from ''jeevaniya dravya'' (vitality enhancer drugs).

*Treatment for condition of excess purification (atiyoga) involves a regimen of medicated ghee and an oleation enema with oil prepared from vitality enhancer drugs (jeevaniya dravya).

*Treatment for ''ayoga'' considers analysing mistakes made in the earlier procedure and repeating the procedure with correct doses or measures of drugs,  while factoring in seasonal effects,  and the physical constitution of the patient.

*Treatment for condition of insufficient/less purification (ayoga) considers analyzing mistakes made in the earlier procedure and repeating the procedure with correct doses or measures of drugs,  while factoring in seasonal effects,  and the physical constitution of the patient.

*Details of the procedures are given in [[Siddhi Sthana]].

*Details of the procedures are given in [[Siddhi Sthana]].

*The purpose of understanding ''svabhaavaparamavada'' is to understand the cause and effect relationship between health and disease. The factors that cause abnormality in tissues, when removed, lead to a healthy state. ''Ahara'' (diet) with the same qualities as those of the tissues enhance or strengthen the qualities of the tissues, while diet with opposite qualities will decrease it. Regeneration and degeneration of body tissues is a continuous process. Healthy diet and other regimen help in maintaining longevity. However, the cause of death is unknown.

*The purpose of understanding the theory of natural destruction of causative factors of disease (svabhaavaparamavada) is to understand the cause and effect relationship between health and disease. The factors that cause abnormality in tissues, when removed, lead to a healthy state. Diet ([[Ahara]]) with the same qualities as those of the tissues enhance or strengthen the qualities of the tissues, while diet with opposite qualities will decrease it. Regeneration and degeneration of body tissues is a continuous process. A healthy diet and other regimens help in maintaining longevity. However, the cause of death is unknown.

*At the end of the chapter, qualities of a physician skilled in therapeutics are described. Such a physician helps in maintaining the normal tissues and provides a healthy life with longevity so that a person can achieve ''dharma, artha, kama'' and ''moksha''.

*A skilled physician helps in maintaining the normal tissues and provides a healthy life with longevity. This helps in attaining four objectives of life viz. virtue(dharma), wealth (artha), gratification(kama) and emancipation(moksha).

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=== Further reading ===

=== Further reading ===

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#Charak, [[Charak Samhita]], [[Sutra Sthana]] 16, [[Ayurveda]] Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

#Sushruta, Sushruta Samhita,  Nibadha Samgraha commentary by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997 quotations from Sutra Sthana chapter 41/6, chapter 21, chapter 6/13

#Charak, [[Charak Samhita]], [[Sutra Sthana]] 16/34, [[Ayurveda]] Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi  

#Kashyapa, Kashyapa Samhita, Khila Sthana 5/6-7, Chaukhamba Orientalia, Varanasi

#Vagbhata, Ashtanga Hridaya, , Chaukhamba Amarabharati Prakashan, 2nd  edition, Varanasi Sutra Sthana 12/ 24

#Susruta, Susruta Samhita, Sutrasthana 41/6, Nibadhasangraha commentry by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997  

#Charak, [[Charak Samhita]], [[Sutra Sthana]] 16/16, [[Ayurveda]] Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

#Charak, Charak Samhita, Vimana Sthana 8/89-90, [[Ayurveda]] Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi

#Susruta, Susruta Samhita, Sutrasthana 21, Nibadhasangraha commentry by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997 #Kashyapa, Kashyapa Samhita, Khilasthana 5/6-7, Chaukhamba Orientelia, Varanasi

#Susruta, Susruta Samhita, Sutrasthana 6/13, Nibadhasangraha commentry by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997

#Vagbhata, Ashtanga Hridaya, Sutrasthana 12/ 24, Chaukhamba Amarabharati Prakashan, 2nd  edition, Varanasi

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