Torticollis
斜颈 · xié jǐng+4 other namesHide other names
Also known as: Twisted Neck, Wry Neck, Sternocleidomastoid Muscle Spasm, Spasm Of The Sternocleidomastoid Muscle
Not every twisted neck is the same condition. The cold-triggered stiff neck, the stress-induced forceful spasm, and the chronic weak twisting from deficiency are three different patterns - each with its own treatment, and most respond within weeks when the pattern is correctly identified.
About this page · what it is and isn't
What this is. A plain-English synthesis of how classical TCM and modern clinical research describe torticollis. Patterns and herbs come from canonical TCM sources; clinical claims are cited in the Evidence section.
What it isn't. A diagnosis. Me&Qi is an editorial team, not a licensed clinic. The pattern quiz is a thinking tool — pulse and tongue still need a person in the room. Anything in the Safety section should send you to a doctor, not a herb.
Last reviewed Jun 2026.
Educational content about Traditional Chinese Medicine — not medical advice. See a qualified practitioner for diagnosis and treatment.
Torticollis isn't a single condition in TCM - it's a family of six distinct patterns, each with its own root cause and its own treatment. Whether it's a sudden stiff neck after catching a chill, a chronic twisting from deep deficiency, or a forceful spasm born from Liver Fire, TCM identifies the underlying imbalance driving the muscles to seize. By matching herbs, acupuncture, and lifestyle guidance to the correct pattern, the goal is not just to relax the neck but to restore the internal conditions that let it stay relaxed.
Torticollis, or wry neck, refers to a condition where the neck muscles contract involuntarily, causing the head to twist, tilt, or turn to one side. Acute torticollis often comes on suddenly - from sleeping in an awkward position, a minor injury, or a cold draft - and usually resolves within days. Chronic spasmodic torticollis is a neurological movement disorder in which the brain sends abnormal signals to the neck muscles, leading to sustained twisting and jerking movements that can be painful and disabling.
Diagnosis is typically made through a physical exam and a review of symptoms. Imaging like X-rays or MRI may be used to rule out structural problems, infections, or other underlying conditions. Conventional treatment focuses on symptom relief, but the root cause of the abnormal muscle signals often remains unclear.
Conventional treatments
Acute torticollis is usually managed with over-the-counter pain relievers, muscle relaxants, heat therapy, gentle stretching, and sometimes a short course of physical therapy. For chronic spasmodic torticollis, botulinum toxin (Botox) injections into the overactive muscles are the most common medical treatment, temporarily weakening them to reduce twisting. Oral medications such as anticholinergics or benzodiazepines may be prescribed, and in severe, medication-resistant cases, deep brain stimulation surgery is sometimes considered.
Where conventional treatment falls short
Conventional treatments are valuable for symptom control, but they rarely address the underlying imbalances that make a person susceptible to torticollis. Botox injections must be repeated every few months and can cause muscle weakness or difficulty swallowing. Oral medications often bring side effects like drowsiness, dry mouth, or cognitive dulling. Perhaps most importantly, the conventional approach does not differentiate between a cold-induced stiff neck, a stress-fueled spasm, and a chronic twisting rooted in deep deficiency - each of which, from a TCM perspective, requires a fundamentally different strategy to heal.
How TCM understands torticollis
In TCM, the neck is a crossroads where many vital channels pass - the Bladder, Gallbladder, and Small Intestine channels all traverse it, making it vulnerable to both external invasions and internal disharmonies. The Liver, which governs the sinews and ensures smooth flow of Qi and blood, plays a central role. When the Liver's blood or Yin is deficient, the sinews become dry and tight, prone to spasm. When Liver Fire or rising Yang stirs internal Wind, that Wind can surge upward and seize the neck muscles, causing forceful twisting.
External pathogens are another major factor. Wind and Cold can invade the body's surface, especially at the back of the neck - the 'Wind Gate.' Cold contracts and tightens the channels, leading to sudden, painful rigidity that makes it hard to turn the head. This is the classic acute wry neck that appears after sleeping in a draft or exposure to cold weather.
Chronic cases often involve deeper obstructions. Phlegm-Dampness, formed when the body fails to transform fluids, can lodge in the neck's channels and muscles, creating a heavy, fixed stiffness and sometimes palpable lumps. Long-standing stagnation of Qi and Blood can further congeal into Blood Stasis, producing sharp, stabbing pain and hard knots that lock the neck in a twisted position. Each of these mechanisms - Wind, Phlegm, Stasis, or Deficiency - produces a different type of torticollis, which is why a single treatment cannot fit all.
「诸痉项强，皆属于湿。」
"All convulsive diseases with neck stiffness are attributed to dampness. This foundational statement links neck rigidity and spasm to the pathogenic influence of dampness obstructing the sinews and channels."
How a TCM practitioner diagnoses torticollis
Inside the consultation
A TCM practitioner first asks about the quality of the neck tension and what makes it better or worse. Sudden, forceful twisting that worsens with stress or heat points toward internal wind, while a heavy, stiff neck that feels worse in damp weather suggests phlegm or cold obstructing the channels. The tongue and pulse are then checked to confirm which pattern is dominant.
If the neck spasms are strong, the head is pulled to one side, and the face looks flushed with a red tongue and a wiry, rapid pulse, this is Liver Wind agitating Internally due to Liver Fire. The practitioner sees this as rising heat and wind from the liver, which needs to be calmed and subdued.
When the neck feels heavy, stiff, and as if wrapped in a wet towel, with a slimy white tongue coating and a slippery pulse, Phlegm in the Channels is the key pattern. The phlegm-dampness clogs the collaterals, preventing the smooth flow of Qi and blood through the neck muscles.
A sudden stiff neck that appears after exposure to cold or wind, with a pale tongue and a tight pulse, indicates Wind-Cold invasion. The cold contracts the sinews and blocks the channels, causing acute rigidity and pain that eases with warmth.
If the pain is fixed, stabbing, and you can feel hard knots or nodules in the neck muscles, along with a purplish tongue or stasis spots and a choppy pulse, Blood Stagnation is the likely cause. Long-term blockage has led to local blood stasis that must be moved to release the spasm.
In chronic cases where the spasms have lasted a long time, the person may also feel extremely tired, look pale, and have a weak or thready pulse. This points to Qi and Blood Deficiency, where the body lacks the resources to nourish and relax the sinews, so the neck remains tight and weak.
When the spasms worsen at night, and there is dizziness, tinnitus, a red tongue with little or no coating, and a thin, rapid pulse, Kidney and Liver Yin Deficiency is driving internal wind. The yin is too depleted to anchor the yang, allowing wind to stir and pull on the neck muscles.
TCM Patterns for Torticollis
In TCM, the aim is to address the root cause, not just the symptom — it calls that root cause a “pattern.” The same torticollis can come from several different patterns, each treated differently. The quickest way to find yours is the quiz below.
Find your pattern
Tap any sign that fits how yours feels.
- 1Your signs
- 2What makes it worse
- 3What helps
Which signs match your experience?
It is common to see a mix of patterns, especially when torticollis has been present for a while. For example, an underlying Qi and Blood Deficiency can make the neck vulnerable to Wind-Cold attacks, or long-standing Blood Stagnation may coexist with Phlegm obstruction. These overlaps reflect how the body’s imbalances can layer on top of one another.
To narrow down which pattern is most active right now, notice the dominant sensation and what triggers it. A neck that stiffens sharply in cold weather and feels better with a warm scarf leans toward Wind-Cold, while a heavy, foggy-headed stiffness that gets worse after eating greasy food points to Phlegm. A stabbing, fixed pain that doesn’t change with weather suggests Blood Stagnation.
Pay attention to your energy level and other body signals. If you feel drained, look pale, and have a weak pulse, deficiency patterns like Qi and Blood Deficiency or Yin Deficiency are likely in the mix. A flushed face, irritability, and a rapid pulse suggest more excess heat or wind. These clues help you understand your constitution, but they don’t replace a professional diagnosis.
Because torticollis often involves multiple patterns and the neck is a delicate area, a TCM practitioner can combine tongue and pulse diagnosis with a physical exam to identify the root cause. If the twisting is severe, rapidly worsening, or accompanied by numbness, fever, or loss of balance, see a doctor promptly before attempting any self-treatment.
Wind-Cold
Blood Stagnation
Qi and Blood Deficiency
Kidney and Liver Yin Deficiency
Treatment
Four ways to address torticollis in TCM — explore each, or take the quiz to see what fits you first.
Formulas traditionally used for torticollis
7 formulas across the patterns above. The right one depends on your pattern — start with the quiz if you're unsure which fits.
A modern formula designed to calm an overactive Liver and settle internal Wind, used for headaches, dizziness, and insomnia caused by rising Liver Yang. It works by calming the Liver, clearing Heat, promoting healthy blood circulation, and strengthening the Liver and Kidneys at their root. It is one of the most widely used formulas in TCM for high blood pressure with a pattern of Liver Yang rising.
A classical formula designed to relieve dizziness, vertigo, and headache caused by a buildup of internal dampness and phlegm combined with internal Wind. It works by dissolving phlegm, calming the Liver, and strengthening the digestive system to stop new phlegm from forming. It is especially well suited for people who experience spinning dizziness with nausea, a heavy head, and a sensation of fogginess or fullness in the chest.
A classical formula that both nourishes and invigorates the Blood, used to address menstrual irregularities, period pain, and other conditions caused by Blood stagnation combined with Blood deficiency. It builds on the famous Si Wu Tang (Four-Substance Decoction) by adding Peach Kernel and Safflower to strengthen its ability to move stagnant Blood and promote healthy circulation.
A classical formula for the early stages of colds and flu with chills, body aches, and stiffness of the neck and upper back. It works by releasing the body surface to expel cold, while generating fluids to relax tense muscles and sinews. Also commonly used for diarrhea that occurs alongside cold symptoms.
A classical formula designed to improve blood circulation in the chest, relieve pain, and ease emotional tension. It is widely used for chronic chest pain, stubborn headaches, insomnia, and irritability caused by poor blood flow and stagnation in the upper body.
A classical formula that simultaneously replenishes both Qi and Blood, created by combining two famous prescriptions: Si Jun Zi Tang (for Qi) and Si Wu Tang (for Blood). It is commonly used for people who feel chronically tired, look pale or sallow, have a poor appetite, experience dizziness or heart palpitations, and feel generally run down due to dual deficiency of Qi and Blood.
A classical formula for severe Yin depletion causing internal wind, which can manifest as muscle spasms, tremors, exhaustion, and a sense of bodily collapse. It works by deeply replenishing the body's fluids and Yin to calm involuntary movements caused by this deficiency. Originally designed for the late stages of febrile illness where prolonged heat has consumed the body's vital fluids.
Acute Wind-Cold torticollis often resolves dramatically within 1-3 acupuncture sessions and a few days of herbs. Excess patterns like Liver Wind or Phlegm obstruction typically show meaningful improvement in 2-4 weeks of consistent treatment. Deficiency patterns - Qi and Blood or Yin Deficiency - require a longer commitment, often 2-3 months, to rebuild the body's reserves and stabilize the neck. Chronic Blood Stagnation may take the longest, as it involves untangling deeply lodged blockages.
Treatment principles
Across all patterns, TCM treatment of torticollis focuses on relaxing the sinews, unblocking the channels, and extinguishing internal Wind. The method, however, shifts dramatically depending on the root cause. For acute Wind-Cold invasion, the priority is to dispel the pathogen with warm, dispersing herbs and acupuncture points that release the exterior. When Liver Wind rises from Fire or Yang hyperactivity, the strategy turns to calming the Liver, subduing Yang, and clearing Heat. Phlegm and Blood Stagnation require transforming obstructions and invigorating the blood to reopen the clogged channels. Deficiency patterns call for nourishing Qi, Blood, or Yin to restore proper sinew nutrition and prevent Wind from stirring in the first place.
Many chronic cases present with mixed patterns - for instance, underlying Blood Deficiency combined with Phlegm obstruction - so herbal formulas are often carefully tailored combinations. Acupuncture point selections include both local neck points to directly affect the spasming muscles and distal points on the arms and legs to treat the organ-level imbalance driving the condition.
What to expect from treatment
Treatment typically involves weekly acupuncture sessions, often combined with daily herbal formulas taken as teas, powders, or pills. For acute torticollis, you may feel significant relief after the first visit. Chronic conditions require a steadier pace: you can expect a gradual reduction in spasm frequency and intensity over the first 4-8 weeks, with improvements in sleep, mood, and energy often appearing before the neck fully settles. Some patients notice a temporary mild aggravation of symptoms as the body adjusts; this usually passes quickly and is followed by deeper relief. Long-term, the goal is not just a relaxed neck but a more resilient constitution that is less easily thrown off balance by stress, cold, or fatigue.
General dietary guidance
Keep the neck warm and avoid cold, raw foods and icy drinks, which can constrict the channels and worsen stiffness. Favor warm, cooked meals that are easy to digest. To prevent the buildup of Phlegm and Dampness, limit greasy, fried, and dairy-heavy foods as well as alcohol and excessive sweets. Nourishing foods that support the sinews - such as bone broth, black sesame, leafy greens, and moderate amounts of high-quality protein - are beneficial for most patterns. Staying well-hydrated with warm fluids helps keep the body's internal environment fluid and unblocked.
Combining TCM with conventional treatment
TCM can generally be used alongside conventional torticollis treatments, but open communication between your providers is essential. If you are receiving botulinum toxin injections, schedule acupuncture sessions so they do not over-relax the already weakened muscles. Herbs that invigorate blood, such as Dan Shen or Tao Ren, may interact with anticoagulant or antiplatelet medications - always inform your prescribing doctor. Sedative herbs should be used cautiously with muscle relaxants or other central nervous system depressants. Never stop prescribed medications abruptly; work with your doctor to adjust dosages as your condition improves with TCM.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Safety & special considerations
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Sudden severe neck pain with fever and headache — Could indicate meningitis - a medical emergency.
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Neck stiffness after a fall, accident, or direct injury — Possible fracture or spinal cord injury - needs immediate imaging.
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Loss of bladder or bowel control with neck pain or twisting — May signal spinal cord compression - urgent neurological evaluation required.
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Difficulty breathing or swallowing with neck swelling — Could be anaphylaxis or a severe infection - seek emergency care right away.
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Sudden onset of neck twisting with confusion, slurred speech, or vision changes — These may be signs of a stroke - call emergency services immediately.
Audience-specific guidance — open what applies to you
During pregnancy, the safety of the fetus is paramount. Many herbs commonly used for torticollis are contraindicated because they move Blood, strongly drain downwards, or are toxic. For example, Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), and Chuan Niu Xi (Cyathulae Radix) in Blood Stagnation patterns can stimulate uterine contractions and risk miscarriage. Similarly, strong wind-extinguishing substances like Quan Xie (Scorpio) or Wu Gong (Scolopendra) are avoided. Instead, treatment leans heavily on acupuncture with carefully selected, pregnancy-safe points, avoiding those known to induce labor such as LI4 (Hegu), SP6 (Sanyinjiao), and BL60 (Kunlun).
The most common patterns in pregnancy shift toward deficiency. As the growing fetus draws on the mother's Qi and Blood, Qi and Blood Deficiency or Kidney and Liver Yin Deficiency become more prominent, leading to a dull, persistent neck stiffness rather than a forceful spasm. Gentle nourishing formulas like Ba Zhen Tang (Eight Treasure Decoction), modified to exclude any potentially risky herbs, can be used under strict professional guidance. Gentle tuina and moxibustion on the neck are safe and effective adjuncts.
Bitter, cold herbs that clear Liver Fire, such as Long Dan Cao (Gentianae Radix) and Huang Qin (Scutellariae Radix), can pass into breast milk and may cause loose stools or digestive discomfort in the nursing infant. For a breastfeeding mother with Liver Fire causing torticollis, the practitioner will often choose milder, sweet-cool herbs like Ju Hua (Chrysanthemi Flos) or use acupuncture as the primary modality. Acupuncture is generally safe during lactation and avoids any risk of herb-drug transfer.
Formulas that strongly nourish Yin and Blood, such as Da Ding Feng Zhu (Major Arrest Wind Pearl), are usually well-tolerated and can support both the mother's recovery and milk production, provided they are free of heavy minerals or animal products that might be unsuitable. The key is close monitoring of the baby's digestion and mood; any sign of colic or rash warrants immediate formula adjustment. As always, treatment must be individualized by an experienced TCM practitioner.
In infants and children, congenital muscular torticollis is the most common presentation. TCM views this as a combination of birth trauma causing local Blood Stasis in the neck sinews and an underlying Spleen weakness that fails to nourish the muscles. A palpable, olive-shaped mass in the sternocleidomastoid muscle is a hallmark. Treatment is primarily non-herbal: pediatric tuina (Chinese therapeutic massage) is the first-line approach, using gentle kneading and stretching techniques to soften the fibrotic knot and restore range of motion. Acupuncture, if used, employs very fine, shallow needles retained for only seconds, or non-insertive tools like Shonishin.
Acquired spasmodic torticollis in older children is rare and often linked to emotional stress or post-infectious processes. Patterns like Liver Wind or Phlegm obstruction may appear, but dosages of any prescribed herbs must be reduced to a fraction of the adult dose (typically 1/4 to 1/2, depending on age and weight). Because children's Qi is pure and responsive, treatment courses are usually shorter, and lifestyle adjustments-reducing screen time, ensuring adequate sleep, and managing stress-play an outsized role in recovery.
In the elderly, torticollis is almost always rooted in deficiency. Kidney and Liver Yin Deficiency or Qi and Blood Deficiency predominate, as the aging body's reserves of Yin and Blood naturally dwindle. The neck spasm tends to be a chronic, dry stiffness that worsens at night and is accompanied by other signs of aging like dizziness, tinnitus, and weak lower back and knees. Treatment must be gentle and nourishing; aggressive wind-extinguishing or blood-moving formulas can deplete the patient further.
Herb dosages are typically reduced to about two-thirds of the standard adult dose, and the treatment timeline is extended. Polypharmacy is a significant concern, so the practitioner must carefully screen for interactions with Western medications. Acupuncture is often the safest and most effective core therapy, with points like Taixi (KI-3) and Sanyinjiao (SP-6) used to build Yin, while local neck points like Fengchi (GB-20) are needled with mild stimulation. Gentle daily neck stretches and adequate hydration are essential home care instructions.
Evidence & references
The evidence base for TCM treatment of torticollis, particularly spasmodic torticollis (cervical dystonia), is still developing. Most publications are case reports, case series, and small uncontrolled trials. A 2014 systematic review of acupuncture for cervical dystonia identified only a handful of studies and concluded that while acupuncture appears safe and shows promising results in reducing pain and spasm severity, the overall quality of evidence is low. Larger, sham-controlled randomized trials are needed before firm conclusions can be drawn.
Chinese herbal medicine is widely used in China for this condition, with numerous formula variations like Tian Ma Gou Teng Yin and Ban Xia Bai Zhu Tian Ma Tang reported to be effective. However, these reports are predominantly in Chinese-language journals and often lack rigorous methodology. The heterogeneity of TCM pattern differentiation makes standardization difficult. Despite these limitations, the consistent clinical observation that TCM can reduce muscle spasm and improve quality of life with few side effects supports its use as an adjunctive therapy, especially for patients who do not tolerate or respond fully to botulinum toxin injections.
Key clinical studies
A systematic review of randomized controlled trials and observational studies evaluating acupuncture for cervical dystonia. The analysis found that acupuncture, alone or combined with Western medicine, significantly improved clinical symptoms and reduced pain compared to controls. However, the authors noted the included studies had small sample sizes and high risk of bias, calling for more rigorous research.
Acupuncture for cervical dystonia: a systematic review and meta-analysis
Lee JH, Kim JI, Lee MS, et al. Acupuncture for cervical dystonia: a systematic review and meta-analysis. J Altern Complement Med. 2014;20(8):607-614.
10.1089/acm.2013.0320This pilot study investigated the feasibility and preliminary efficacy of acupuncture in 16 patients with cervical dystonia. After 12 sessions, patients showed significant improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores, with reductions in both motor severity and pain. No serious adverse events were reported, suggesting acupuncture is a safe and potentially beneficial complementary therapy.
Acupuncture in the treatment of cervical dystonia: a pilot study
Park JJ, Lee MS, Kong JC, et al. Acupuncture in the treatment of cervical dystonia: a pilot study. Evid Based Complement Alternat Med. 2012;2012:608342.
10.1155/2012/608342A clinical observation of 30 patients with spasmodic torticollis treated with acupuncture and moxibustion. After a course of treatment, the total effective rate was 86.7%, with significant reductions in neck muscle spasm and pain. The study used points like Fengchi (GB-20), Tianzhu (BL-10), and local Ashi points, combined with moxibustion to warm the channels and dispel cold.
Efficacy of acupuncture and moxibustion in treating spasmodic torticollis: a clinical observation of 30 cases
Wang X, Li Y. Efficacy of acupuncture and moxibustion in treating spasmodic torticollis: a clinical observation of 30 cases. Chin Acupunct Moxibustion. 2009;29(9):709-711.
Classical text references
One quote is featured above in the Understanding section — the rest are listed here for the classically inclined.
「病者身热足寒，颈项强急，恶寒，时头热，面赤目赤，独头动摇，卒口噤，背反张者，痉病也。」
"When the patient has fever, cold feet, stiffness and tension of the neck, aversion to cold, occasional heat in the head, red face and eyes, shaking of the head only, sudden lockjaw, and arched back, this is convulsive disease. This classic description encompasses the clinical picture of severe torticollis and generalized spasm, providing a diagnostic framework that TCM practitioners still reference today."
Jin Gui Yao Lue (Synopsis of the Golden Chamber)
Chapter 2, Pulse, Symptom Complex and Treatment of Convulsive Disease, Dampness and Heat Stroke
Frequently asked questions
Common questions about using Traditional Chinese Medicine for torticollis.
Yes. Acupuncture can directly relax the overactive muscles by unblocking the local channels and calming the nervous system. For acute torticollis from Wind-Cold, many patients feel substantial relief during or right after the first session. For chronic spasmodic torticollis, regular acupuncture reduces the frequency and intensity of spasms over time, especially when combined with herbal medicine that addresses the underlying pattern.
Acute cases may improve noticeably within 1-3 treatments. Chronic patterns require more patience: most patients begin to feel some easing of tightness and fewer spasm episodes within 2-4 weeks of weekly acupuncture and daily herbs. Full stabilization of a chronic condition often takes several months, as TCM works to correct the deeper imbalance that allowed the problem to develop.
Yes, many patients use TCM alongside conventional care. It is important to inform both your TCM practitioner and your prescribing doctor about all treatments you are receiving. Acupuncture should be timed carefully around Botox injections to avoid over-relaxing the muscles. Some herbs that move blood or calm wind may enhance the effects of muscle relaxants or blood-thinning medications, so coordination between your providers is essential for safety.
For a simple, acute stiff neck after cold exposure, a warm tea made with fresh ginger and scallion whites can help dispel Wind-Cold and relax the surface. However, chronic or severe torticollis should not be self-treated with herbs. The wrong formula - for example, using warming herbs for a Liver Fire pattern - can make the spasms worse. A proper TCM diagnosis is the safest and most effective starting point.
Yes, TCM offers gentle, non-invasive options for children, especially those with congenital muscular torticollis. Pediatric tuina (therapeutic massage) and very shallow acupuncture or acupressure are commonly used to release tight sternocleidomastoid muscles and improve neck range of motion. Always seek care from a practitioner experienced in pediatric TCM.
TCM aims to resolve the root imbalance, not just mask the spasm, so recurrence is less likely than with purely symptomatic treatments. However, if the original triggers - chronic stress, poor diet, exposure to cold, or overwork - continue unchecked, the pattern can rebuild. Many patients choose periodic maintenance treatments and lifestyle adjustments to stay balanced.
Keep the neck warm and protected from drafts. Gentle, slow stretches - never forced - can help maintain mobility between sessions. Stress management is crucial, as emotional tension directly tightens the Liver Qi and can trigger spasms. Your practitioner may also recommend specific dietary changes based on your pattern, such as reducing greasy foods to clear Phlegm or adding moistening foods to nourish Yin.
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