Guest guest Posted May 13, 2000 Report Share Posted May 13, 2000 From the pulse diagnosis article: Rapid (shuo) & Slow (chi) The normal or balanced pulse is four beats per breath. A Rapid pulse is more than 4 beats per breath; a Slow pulse is less than 2 beats per breath. A pulse can become Rapid due to a " deficiency of yin and an excess of yang " energy. The Slow pulse results from " a deficiency of yang and an excess of yin " (13). In general, the Slow pulse indicates cold energy and Rapid pulse indicates hot energy. If the pulse moves faster than 6 beats or slower than 2 it is an extremely critical sign, usually indicative of death; yang and yin no longer communicate with each other and are about to be cut. I was taught in school that 4-6 beats per breath is normal. I teach rudimentary pulse diagnosis to about 60 students per year, and after their first exercise, we compile the results on frequency. the first class I did this in had a perfect bell curve between 4-6, and three of 20 individuals at 7 or eight, and these were exhausted and had quite visible deficiency heat. In subsequent years, I now find a cluster around 4-6, with increasing numbers of students between 7 and all the way to 10, perhaps a mark of the pregressive exhaustion and stimulant plaguing the country. One year a huge cluster -- a third of the class -- was between 9-12, and I later discovered that the beverage tea prepared for the class was some sort of commercial energy tea that contained ma huang. Despite the comments in the article, the pulse above 6 beats per breath can hardly be " indicative of death " because none of them have died. Is this based on the classic or on Dr Ramholz's observations? If on the classics it points to the weakness of relying on them as final authorities of reality. This may have been true of a population that engaged in manual labor and was in " good shape " in general, and rested adequately, especially during the winter months. I've never found an American student or patient below 4. The only anomaly I notice is that trained distance runners have non-pathological pulses around 4. Does this match your experience? -- Paul Bergner Editor, Medical Herbalism Clinical Program Director, Rocky Mountain Center for Botanical Studies Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2000 Report Share Posted May 13, 2000 Dear Paul, Obviously, we have all seen very rapid pulses without death ensuing, though I wonder how many have seen a 2 count pulse. I would suspect the fatal concern over a very fast pulse would be in two circumstances: An acute illness with actual high fever; we don't treat such cases usually. the second I could imagine as a sustained chronic fast pulse, not transient due to drug stimulation or anxiety, etc. Of course, drug stimulation can also lead to sudden death as in several college athletes, notably Len Bias, a 1980's college basketball star. Personally, I think so many factors alter the pulse on a moment's notice, I do not consider it a very useful clinical sign. Classical texts recommended a specific time of day and a peaceful setting to feel the pulse, neither of which can be accommodated in modern practice. In addition, I get the sense from reading classics and observing Chinese teachers that the value of the 28 pulse system is hardly universally accepted in TCM herbalism, now or historically, and that many herbalists seem to have relied on a much more simplified methodology. , Paul Bergner <bergner@m...> wrote: Despite the comments in the article, the > pulse above 6 beats per breath can hardly be " indicative of death " because > none of them have died. Is this based on the classic or on Dr Ramholz's > observations? If on the classics it points to the weakness of relying on > them as final authorities of reality. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 14, 2000 Report Share Posted May 14, 2000 You made a statement below I want to talk about. - <herb-t Saturday, May 13, 2000 12:48 PM Re: Does this match your experience? Dear Paul, .... <Personally, I think so many factors alter the pulse on a moment's <notice, I do not consider it a very useful clinical sign. Classical <texts recommended a specific time of day and a peaceful setting to <feel the pulse, neither of which can be accommodated in modern practice. .... This is a curious notion. My first thought is, " Why? " I'm not sure what passage in which classical text you refer to here, but I don't question that such statements do indeed appear in the classical literature. Why is it, however, that you find that such advice could not be accommodated in modern practice? The Nei Jing suggests that treating patients who are already ill with herbs and needles is like waiting until you are thirsty to dig a well. Can that be accommodated in modern practice? What I find of interest in all of this is the whole process of extracting useful data form ancient sources. How do we proceed to cull and edit? How do we choose this datum and not that one? On the basis of what do we determine what it is in the classics that is valueable and that can be accommodated to modern practice? Such questions become all the more complicated when we turn to the classics and find that Chinese have been dealing with this kind of problem for centuries. What we call " classics " can be understood as the solutions and answers that Chinese doctors and scholars have accumulated over the years. Something you wrote in your post about nettiquette pertains here as well. Throughout virtually the entire span of the literary traditions of Chinese medicine, the work of compiling and reissuing the classics has been conducted by individuals and institutions with definitely vested interests and with particular agendas. It has been a fairly common method of Chinese scribes and compilers to recast ancient texts to reflect their own " modern sensibilities. " We find ourselves in a complex terrain. As we move through it, I think it is important that we examine our presumptions as to what we find applicable and what we choose to dispense with. The Chinese themselves, at least the Nationalist Government that ruled China from 1911 through 1949, managed to find that so much of Chinese medicine could not be accomodated in modern practice that they outlawed the whole subject and forbade its instruction in public schools! I look forward to hearing your thoughts on this. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2000 Report Share Posted May 15, 2000 > > This is a curious notion. My first thought is, " Why? " > I'm not sure what passage in which classical text you > refer to here, but I don't question that such statements > do indeed appear in the classical literature. The only yellow emperor's classic I have at arm's length is Ilza Veith's horrible translation, but the pulsetaking time appears in the su wen, chapter 17 in his book. I won't quote veith, but I have heard this expressed numerous times. Why is it, > however, that you find that such advice could not > be accommodated in modern practice? Well, I cannot see all my pateints at 7 am, so the question really is whether it is necessary or not. Perhaps it is my pulsetaking skils (Or lack thereof) that is the true culprit, but I take this passage to heart because by the time my patients have raced around for half the day, eating poorly, etc., they all seem to present with slightly fast and wiry qualities. I find that if I take the pulse AFTER acupuncture, I often get a clearer picture of the patient's baseline for herbal prescribing, but this is not always possible. > > The Nei Jing suggests that treating patients who are already > ill with herbs and needles is like waiting until you are thirsty > to dig a well. Can that be accommodated in modern practice? no, not really, but I feel that underscores MY point > > What I find of interest in all of this is the whole process of > extracting useful data form ancient sources. me too. I don't accept the whole kit and kaboodle as some ancient mystical science. Vested interests have affected what is preserved and mainstreamed since the han dynasty. We must test the validity of these ideas in several ways. I am influenced by philosopher Ken Wilber's thinking on this subject. We can verify the empirical evidence using modern scientific methods. But we can only verify the validity of mental concepts by having an expert community of commentators discuss these things. Dialogue is the way experts verify mental concepts (and meditation is the way seekers verify spirtual concepts, but that's another part of the story). We can only dialogue after we have a common terminology to share our ideas. and that terminology has to be conceptually faithful to its sources. It does not have to be easy on the tongue or the ears. No jargon is easy on the tongue or ears. but again, we can still speak common speak to our patients and the public. Consider anthropology. We all know a little about this field and all think we are qualified to speculate on it. Yet, this field is actually based upon several generations of expert dialogue and cannot be just dismissed by outsiders. The dialogue has produced methods of interpretation that have testable validity by anyone who deeply pursues the study. How do we > proceed to cull and edit? How do we choose this datum > and not that one? On the basis of what do we determine > what it is in the classics that is valueable and that can be > accommodated to modern practice? The pulse is very difficult to adapt at all to modern practice. typically, intern supervisors will disagree radically about pulse qualities on the same patient in the same moment of time. Students are even advised not to take notice of such things, because it puts the chinese profs on the spot. So if no one can agree at the training level and the accuracy is questionable, even at the professional level, what is one to think? > > Such questions become all the more complicated when we > turn to the classics and find that Chinese have been dealing > with this kind of problem for centuries. What we call " classics " > can be understood as the solutions and answers that Chinese > doctors and scholars have accumulated over the years. that is also my point. the value of the 28 pulses is not open and shut. > > Something you wrote in your post about nettiquette pertains here > as well. Throughout virtually the entire span of the literary traditions > of Chinese medicine, the work of compiling and reissuing the > classics has been conducted by individuals and institutions with > definitely vested interests and with particular agendas. It has been > a fairly common method of Chinese scribes and compilers to > recast ancient texts to reflect their own " modern sensibilities. " > Your point here is well taken. I just feel that unlike ancient and communist china, the vested interests I speak of are rather transparent. The publishers sell books, the schools sell classes, practitioners sell medical services, etc. So when publishers and editors and teachers and administrators who prefer one terminology or another makes his case, I think we can be safely assured that part of the motivation is vested economic. However, the folks I disagree with most on these issues are usually the accredited schools. Yet, much to my chagrin, I am forced to admit that in my personal contact with school administrators, I believe they are NOT evil and they all really believe what they are doing is right. So, I'm not sure what purpose it serves to regularly point out these vested interests in such a small profession. It seems too personal, since many of us actually know each other. In any event, a good argument can be made by a vested interest and I prefer to focus on how to verify the validity of the argument, rather than explore the motives of the arguer. for example, pharmaceutical companies have an interest in saying their drugs are safe. We all know that is their interest, so we (as a society) go to some length to independently verify this. We cannot deny that many vested interests have produced high quality data throughout history. we just need to be ever vigilant and never just take things on faith, not in medicine. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2000 Report Share Posted May 15, 2000 herb-t wrote: We must test the validity of > these > ideas in several ways. I think of medical knowledge on the four-directions model: Traditions | > Intuition -- -- Formal science | Personal observation (And that of contemporary colleagues) I don't think anyone in any discipline can pracice completely out of any one direction. Paul Bergner Editor, Medical Herbalism Clinical Program Director, Rocky Mountain Center for Botanical Studies Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2000 Report Share Posted May 15, 2000 I like to divide traditions into professional/written and oral/folk, because they are so different inmany ways. todd > Traditions > > | > > > Intuition -- -- Formal science > > | > Personal observation > (And that of contemporary colleagues) > > I don't think anyone in any discipline can pracice completely out of any one > direction. > > Paul Bergner > Editor, Medical Herbalism > Clinical Program Director, Rocky Mountain Center for Botanical Studies Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 17, 2000 Report Share Posted May 17, 2000 Hi I find this post of yours quite thought provoking. In fact, I seem to be writing an essay in reply. It will be done in few days and I'll simply post a url where those interested in reading it can find it. Best, Ken - <herb-t Monday, May 15, 2000 11:35 AM Re: Re: Does this match your experience? > > > > > > This is a curious notion. My first thought is, " Why? " > > I'm not sure what passage in which classical text you > > refer to here, but I don't question that such statements > > do indeed appear in the classical literature. > > The only yellow emperor's classic I have at arm's length is Ilza > Veith's horrible translation, but the pulsetaking time appears in the > su wen, chapter 17 in his book. I won't quote veith, but I have > heard > this expressed numerous times. > > Why is it, > > however, that you find that such advice could not > > be accommodated in modern practice? > > Well, I cannot see all my pateints at 7 am, so the question really is > whether it is necessary or not. Perhaps it is my pulsetaking skils > (Or > lack thereof) that is the true culprit, but I take this passage to > heart because by the time my patients have raced around for half the > day, eating poorly, etc., they all seem to present with slightly fast > and wiry qualities. I find that if I take the pulse AFTER > acupuncture, > I often get a clearer picture of the patient's baseline for herbal > prescribing, but this is not always possible. > > > > The Nei Jing suggests that treating patients who are already > > ill with herbs and needles is like waiting until you are thirsty > > to dig a well. Can that be accommodated in modern practice? > > no, not really, but I feel that underscores MY point > > > > What I find of interest in all of this is the whole process of > > extracting useful data form ancient sources. > > me too. I don't accept the whole kit and kaboodle as some ancient > mystical science. Vested interests have affected what is preserved > and > mainstreamed since the han dynasty. We must test the validity of > these > ideas in several ways. I am influenced by philosopher Ken Wilber's > thinking on this subject. We can verify the empirical evidence using > modern scientific methods. But we can only verify the validity of > mental concepts by having an expert community of commentators discuss > these things. Dialogue is the way experts verify mental concepts > (and > meditation is the way seekers verify spirtual concepts, but that's > another part of the story). We can only dialogue after we have a > common terminology to share our ideas. and that terminology has to > be > conceptually faithful to its sources. It does not have to be easy on > the tongue or the ears. No jargon is easy on the tongue or ears. > but > again, we can still speak common speak to our patients and the public. > > Consider anthropology. We all know a little about this field and all > think we are qualified to speculate on it. Yet, this field is > actually > based upon several generations of expert dialogue and cannot be just > dismissed by outsiders. The dialogue has produced methods of > interpretation that have testable validity by anyone who deeply > pursues > the study. > > How do we > > proceed to cull and edit? How do we choose this datum > > and not that one? On the basis of what do we determine > > what it is in the classics that is valueable and that can be > > accommodated to modern practice? > > The pulse is very difficult to adapt at all to modern practice. > typically, intern supervisors will disagree radically about pulse > qualities on the same patient in the same moment of time. Students > are > even advised not to take notice of such things, because it puts the > chinese profs on the spot. So if no one can agree at the training > level and the accuracy is questionable, even at the professional > level, > what is one to think? > > > > Such questions become all the more complicated when we > > turn to the classics and find that Chinese have been dealing > > with this kind of problem for centuries. What we call " classics " > > can be understood as the solutions and answers that Chinese > > doctors and scholars have accumulated over the years. > > that is also my point. the value of the 28 pulses is not open and > shut. > > > > > Something you wrote in your post about nettiquette pertains here > > as well. Throughout virtually the entire span of the literary > traditions > > of Chinese medicine, the work of compiling and reissuing the > > classics has been conducted by individuals and institutions with > > definitely vested interests and with particular agendas. It has been > > a fairly common method of Chinese scribes and compilers to > > recast ancient texts to reflect their own " modern sensibilities. " > > > > Your point here is well taken. I just feel that unlike ancient and > communist china, the vested interests I speak of are rather > transparent. The publishers sell books, the schools sell classes, > practitioners sell medical services, etc. So when publishers and > editors and teachers and administrators who prefer one terminology or > another makes his case, I think we can be safely assured that part of > the motivation is vested economic. However, the folks I disagree > with > most on these issues are usually the accredited schools. Yet, much > to > my chagrin, I am forced to admit that in my personal contact with > school administrators, I believe they are NOT evil and they all > really > believe what they are doing is right. > > So, I'm not sure what purpose it serves to regularly point out these > vested interests in such a small profession. It seems too personal, > since many of us actually know each other. In any event, a good > argument can be made by a vested interest and I prefer to focus on > how > to verify the validity of the argument, rather than explore the > motives > of the arguer. for example, pharmaceutical companies have an > interest > in saying their drugs are safe. We all know that is their interest, > so > we (as a society) go to some length to independently verify this. We > cannot deny that many vested interests have produced high quality > data > throughout history. we just need to be ever vigilant and never just > take things on faith, not in medicine. > > > > ------ > Big Groups = big savings @ beMANY! > http://click./1/4112/9/_/542111/_/958415715/ > ------ > > Chronic Diseases Heal - Chinese Herbs Can Help > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2000 Report Share Posted May 20, 2000 I just wanted to make a comment about the training in pulse diagnosis, which is fairly nonexistent in the schools. Pulses wouldn't be " very difficult to adapt to modern practice " if it was actually included in the curriculum. When I asked my students what training they've gotten, it's usually one or two days at their school, and a few have taken a weekend workshop. Learning to read pulses is akin to learning how to play a musical instrument. It takes time and training. In music, while different styles and types of music may be prefered, the song should still recognizable from any of them. That's why I followed the example of the way Leon Hammer teaches (I don't teach Hammer's system) and offered more extensive training. My class is 60-hours. The 60 hours cover the basic classical material from the Nan Jing and Li Shi-zhen, then we apply it to case studies and clinical practice in class. In the future, a second semester will get into the more advanced work and, later, the Dong Han material. While the Nan Jing and Li Shi-zhen systems seem very different, they can be integrated very effectively. And, by using various ideas from the Nan Jing, such as " front and back " and 3 or 5 levels, we can integrate it into contemporary perspectives (even Western). Nothing should be left out of your training. Otherwise, it would be like the 3 blindmen arguing about the elephant. The classics are actually the starting point for study and research, not the accumulation or final arbiter of what can be known. , herb-t@s... wrote: > > > > The pulse is very difficult to adapt at all to modern practice. > typically, intern supervisors will disagree radically about pulse > qualities on the same patient in the same moment of time. Students > are even advised not to take notice of such things, because it puts the > chinese profs on the spot. So if no one can agree at the training > level and the accuracy is questionable, even at the professional > level, > what is one to think? > > > > Such questions become all the more complicated when we > > turn to the classics and find that Chinese have been dealing > > with this kind of problem for centuries. What we call " classics " > > can be understood as the solutions and answers that Chinese > > doctors and scholars have accumulated over the years. > > that is also my point. the value of the 28 pulses is not open and > shut. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2000 Report Share Posted May 20, 2000 James, You've managed to say something very succinctly that I think is very important. It has to do with the status of the classics as artifacts and components within a large data transmission system that we know as traditional Chinese medicine. >The classics are actually the starting point for study and research, > not the accumulation or final arbiter of what can be known. This hits the nail right on the head. And it's what troubled me about Todd's earlier remark about the data about pulse diagnosis contained in the classics not being capable of being accomodated in modern practice. My view is that for modern practice to be most effective it must be firmly rooted in a deep comprehension of the theories and principles of the classics so that the modern practitioner is guided in his or her clinical application. This, of course, is easier said than done. And when you get right down to it implies a major overhaul of the existing educational system. Ken - James Ramholz <OMJournal Saturday, May 20, 2000 8:57 AM Re: Does this match your experience? > I just wanted to make a comment about the training in pulse > diagnosis, which is fairly nonexistent in the schools. Pulses > wouldn't be " very difficult to adapt to modern practice " if it was > actually included in the curriculum. When I asked my students what > training they've gotten, it's usually one or two days at their > school, and a few have taken a weekend workshop. > > Learning to read pulses is akin to learning how to play a musical > instrument. It takes time and training. In music, while different > styles and types of music may be prefered, the song should still > recognizable from any of them. > > That's why I followed the example of the way Leon Hammer teaches (I > don't teach Hammer's system) and offered more extensive training. My > class is 60-hours. The 60 hours cover the basic classical material > from the Nan Jing and Li Shi-zhen, then we apply it to case studies > and clinical practice in class. In the future, a second semester will > get into the more advanced work and, later, the Dong Han material. > > While the Nan Jing and Li Shi-zhen systems seem very different, they > can be integrated very effectively. And, by using various ideas from > the Nan Jing, such as " front and back " and 3 or 5 levels, we can > integrate it into contemporary perspectives (even Western). Nothing > should be left out of your training. Otherwise, it would be like the > 3 blindmen arguing about the elephant. > > The classics are actually the starting point for study and research, > not the accumulation or final arbiter of what can be known. > > > > > , herb-t@s... wrote: > > > > > > > > The pulse is very difficult to adapt at all to modern practice. > > typically, intern supervisors will disagree radically about pulse > > qualities on the same patient in the same moment of time. Students > > are even advised not to take notice of such things, because it puts > the > > chinese profs on the spot. So if no one can agree at the training > > level and the accuracy is questionable, even at the professional > > level, > > what is one to think? > > > > > > Such questions become all the more complicated when we > > > turn to the classics and find that Chinese have been dealing > > > with this kind of problem for centuries. What we call " classics " > > > can be understood as the solutions and answers that Chinese > > > doctors and scholars have accumulated over the years. > > > > that is also my point. the value of the 28 pulses is not open and > > shut. > > > > > > > ------ > Avoid the lines and visit avis.com for quick and easy online > reservations. Enjoy a compact car nationwide for only $29 a day! > Click here for more details. > http://click./1/3011/9/_/542111/_/958838278/ > ------ > > Chronic Diseases Heal - Chinese Herbs Can Help > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2000 Report Share Posted May 20, 2000 <I just wanted to make a comment about the training in pulse diagnosis, which is fairly nonexistent in the schools.> and < And when you get right down to it implies a major overhaul of the existing educational system.> James Ramholz's course sounds excellent and very useful. I had tried the weekend workshop route before I applied to acupuncture school and the lack of usefulness was one major region I enrolled in a real program. I'm glad to report that there are at least some schools where pulse diagnosis is taken seriously. We spent the better part of a semester at Pacific doing little else (primarily Li Shi-zhen), with tongue diagnosis taking up most of the rest of the time and that was in only one of the OM class series. In the required clinic internships, interns and assistants each take pulses (only before treatment) and compare their assessments- not the same as apprenticeship with a master, but far better than a weekend workshop. Still it's difficult to distinguish the shape without having dealt with large numbers of patients- I was told not to put great confidence in that part of the assessment until I'd been practicing ten years. Karen Vaughan CreationsGarden *************************************** Email advice is not a substitute for medical treatment. 'People have illness because they do not have love in their life and are not cherished'.- Sun Si Miao ______________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2000 Report Share Posted May 20, 2000 I agree with Jim's arguments as well. . . .as I told one of my intern assistants yesterday, " for me, it is more important to get a proper pulse diagnosis than to put needles in the patient " . . . .the medicine, for me, begins and ends with proper pulse diagnosis. This is the basis of zhen duan, diagnosis, and there can be no proper treatment without it. And, yes, the classics are the starting point for study and research. . .but we desperately need better translations of many seminal texts, including the Nei Jing. I have been evangelizing for more pulse material in the syllabi at PCOM for some time, and it is starting to happen. Pulse diagnosis will be an integral part of the doctorate program in the coming year. >I just wanted to make a comment about the training in pulse >diagnosis, which is fairly nonexistent in the schools. Pulses >wouldn't be " very difficult to adapt to modern practice " if it was >actually included in the curriculum. When I asked my students what >training they've gotten, it's usually one or two days at their >school, and a few have taken a weekend workshop. > >Learning to read pulses is akin to learning how to play a musical >instrument. It takes time and training. In music, while different >styles and types of music may be prefered, the song should still >recognizable from any of them. > >That's why I followed the example of the way Leon Hammer teaches (I >don't teach Hammer's system) and offered more extensive training. My >class is 60-hours. The 60 hours cover the basic classical material >from the Nan Jing and Li Shi-zhen, then we apply it to case studies >and clinical practice in class. In the future, a second semester will >get into the more advanced work and, later, the Dong Han material. > >While the Nan Jing and Li Shi-zhen systems seem very different, they >can be integrated very effectively. And, by using various ideas from >the Nan Jing, such as " front and back " and 3 or 5 levels, we can >integrate it into contemporary perspectives (even Western). Nothing >should be left out of your training. Otherwise, it would be like the >3 blindmen arguing about the elephant. > >The classics are actually the starting point for study and research, >not the accumulation or final arbiter of what can be known. > > > > > , herb-t@s... wrote: >> >> >> >> The pulse is very difficult to adapt at all to modern practice. >> typically, intern supervisors will disagree radically about pulse >> qualities on the same patient in the same moment of time. Students >> are even advised not to take notice of such things, because it puts >the >> chinese profs on the spot. So if no one can agree at the training >> level and the accuracy is questionable, even at the professional >> level, >> what is one to think? >> > >> > Such questions become all the more complicated when we >> > turn to the classics and find that Chinese have been dealing >> > with this kind of problem for centuries. What we call " classics " >> > can be understood as the solutions and answers that Chinese >> > doctors and scholars have accumulated over the years. >> >> that is also my point. the value of the 28 pulses is not open and >> shut. >> >> > > >------ >Avoid the lines and visit avis.com for quick and easy online >reservations. Enjoy a compact car nationwide for only $29 a day! >Click here for more details. >http://click./1/3011/9/_/542111/_/958838278/ >------ > >Chronic Diseases Heal - Chinese Herbs Can Help Quote Link to comment Share on other sites More sharing options...
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