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7/23/2019 Clean Needle Technique 7th edition
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Clean Needle TechniqueCNT Manual
Best Practices for AcupunctureNeedle Safety
and Related Procedures7th Edition
Published by the Council of Colleges of Acupuncture and Oriental Medicine©2 15
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//
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///
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K<'G')5/)9 "7??7) #+G'<:' 6G')5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> S4
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&('$ @@A !"#$ &'()$*)"# +,' -)./.0)$.'" I D1J :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: KL
C> "*, K<757-7& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SQ
d()+ M()/5(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SP
!"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/- >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> SP
K<';(</)9 ()+ %(/)5(/)/)9 ( "&'() [/'&+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4B
!"#$%& ()*+$,*-$. #/1 01$@"1*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4B
MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4C
#&-7.7& M=(E %'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4A
!"#$%& ()*+$,*-$. #/1 !A*- 01$@"1"%*/- >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4T
N:7&(5/7) 78 L:'+ M.(<;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4T
M5()+(<+ K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4b
O(:/- M5';: 78 5.' "&'() *''+&' ,'-.)/01' 87< #-1;1)-51<' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4b
A> "*, O(:/- K</)-/;&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4S
M'55/)9 L; 5.' "&'() [/'&+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 44
N):;'-5/)9 *''+&' K(-I(9/)9 K</7< 57 L:' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4Q
MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4Q
K(&;(5/)9 5.' K7/)5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4Q
N):'<5/)9 *''+&' 57 "7<<'-5 W';5. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4P
*''+&' Y'?7G(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QB
W'(&/)9 =/5. O&77+ 57 O&77+ "7)5(-5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QB
%()(9/)9 L:'+ *''+&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QB
"71)5/)9 *''+&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QC
T> "*, /) () $88/-' M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QA
,<'(5?')5 K<757-7& /) () $88/-' M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QA
b> "*, 87< d71:' "(&&:`,<(G'& M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Qb
,<(G'& f/5 `,<(G'& f/5 "(<</'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Qb
"&'() N5'?: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Qb
*7)R"&'() N5'?: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QD
,<(G'& f/5 N5'?: *75 /) O(9: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QD
d()+ "&'():'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS
,<(G'& M.(<;: "7)5(/)'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS
K<';(</)9 5.' f/5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS
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,<'(5?')5 K<757-7& /) ( ,<(G'& M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS
D> "*, /) ( "7??1)/5F #-1;1)-51<' "&/)/- 7< *#W# M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QP
,<'(5?')5 K<757-7& /) ( "7??1)/5F "&/)/- 7< *#W# M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QP
S> "*, /) ( K1E&/- d'(&5. M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PC
d()+=(:./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PC
#-1;1)-51<' 601/;?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PA
K7:/5/7)/)9 5.' K(5/')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PA
Y'?7G/)9 *''+&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PA
K75')5/(& "7?;&/-(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PT
4> ,7F7.(</ #-1;1)-51<' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Pb
%7+/8/-(5/7): 57 M5()+(<+ "&'() *''+&' ,'-.)/01' 87< "7)5(-5 *''+&/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Pb
Q> M1??(<F 78 M(8'5F Y'-7??')+(5/7): 87< "&'() *''+&' ,'-.)/01' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PD
Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PQ
&('$ @@@A !"#$ &'()$*)"# +,' 6"3($"2 -BC B++*)" &',)"2.'"# ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: HMH
C> %7J/E1:5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBA
%7J/E1:5/7) $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBA
Z')'<(& %7J/E1:5/7) K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBT
%7J( O':5 K<(-5/-' Z1/+'&/)':>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBb
W/<'-5 %7J/E1:5/7) R ,'-.)/01' 87< *7)RM-(<</)9 %7J/E1:5/7) =/5. %7J( "7)': >>>>>>>>>>>>>>>>>>>>> CBb
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBb
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBD
W/<'-5 %7J/E1:5/7) R ,'-.)/01' 87< M-(<</)9 %7J/E1:5/7) =/5. %7J( "7)': >>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBD
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBD
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBS
N)+/<'-5 %7J/E1:5/7) a ,'-.)/01' =/5. N)5'<;7:'+ %7J/E1:5/7)>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CB4
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CB4
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBQ
N)+/<'-5 %7J/E1:5/7) R ^(<?/)9 *''+&' %7J/E1:5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBQ
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBQ
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBP
N)+/<'-5 %7J( a ,'-.)/01' =/5. %7J( M5/-I >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCB
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCB
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M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCB
%7J( W/:;7:(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCC
A> d'(5 X(?;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA
O':5 K<(-5/-' K<757-7&: 87< d'(5 X(?;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA
T> "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCb
"1;;/)9 $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCb
Z')'<(& Y'-7??')+(5/7): 87< "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCb
M(?;&' O':5 K<(-5/-' K<757-7&: 87< "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCD
[/<' "1;;/)9 %'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCS
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCS
M1-5/7) "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CC4
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CC4
^'5 "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CC4
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCQ
b> ,.'<(;'15/- O&77+ ^/5.+<(=(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP
O&''+/)9 $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP
Z')'<(& Y'-7??')+(5/7): 87< O&''+/)9 ,'-.)/01': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP
M(?;&' O':5 K<(-5/-' K<757-7& 87< O&''+/)9 #-1;1)-51<' K7/)5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAB
b> K&1? O&7::7?`M'G') M5(< *''+&' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA
K&1? O&7::7? $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA
Z')'<(& Y'-7??')+(5/7): 87< K&1? O&7::7? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA
O':5 K<(-5/-' K<757-7&: 87< K&1? O&7::7? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAT
D> Z1( M.( >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAb
Z1( M.( $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAb
M1??(<F 78 Z1( M.( Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAb
Z1( M.( O':5 K<(-5/-' K<757-7&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAD
%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAD
S> #-1;7/)5 N)]'-5/7) ,.'<(;/': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAS
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#-1;7/)5 N)]'-5/7) ,.'<(;F O':5 K<(-5/-' K<757-7&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CA4
M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAQ
M1??(<F 78 M(8'5F Y'-7??')+(5/7): 87< "&'() N)]'-5/7) ,'-.)/01' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAP
Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAP
&('$ @N O @0+")$*,0# -##,)*($"2 =*$8 -)./.0)$.'" (02 6"3($"2 P"(3$8)('" &'()$*)"# :::::::::::::::::::::::: HQH
C> K(5.79'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTC
A> %'-.()/:?: 78 W/:'(:' ,<():?/::/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTC
#1579')71: N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTA
"<7::RN)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTA
T> O&77+E7<)' K(5.79'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTT
d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTT
d';(5/5/: # 2d#c3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTb
d';(5/5/: # M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTb
d';(5/5/: O 2dOc3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTD
,<():?/::/7) 78 dOc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTD
dOc M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTS
N)+/G/+1(&: (5 Y/:I 78 dOc N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTS
6J;7:1<' 57 dOc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CT4
dOc c(--/)(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CT4
,.' dOc N)8'-5/7) K<7-':: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTQ
,<'(5?')5 78 dOc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTP
d';(5/5/: " 2d"c3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTP
#-15' MF?;57?: 78 d';(5/5/: " >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbB
Y/:I [(-57<: 87< d"c N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbB
d"c M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbC
"7):'01')-': 78 d"c N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbC
d';(5/5/: W 2dWc3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbC
dWc M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbA
d';(5/5/: 6 2d6c3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbA
".<7)/- "(<</'<: 78 d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbA
K<'G')5/7) 78 d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbT
,(E&' CU M1??(<F 78 d';(5/5/: ".(<(-5'</:5/-: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbT
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d1?() N??1)7+'8/-/')-F W/:'(:' 2dNc3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbT
dNc ,<():?/::/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Cbb
dNc M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbD
Y/:I 78 ,<():?/::/7) 5.<719. N)G(:/G' K<7-'+1<': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbD
N)+/G/+1(&: (5 Y/:I 78 dNc N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbD
,':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbS
Y';7<5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Cb4
,.' dNc N)8'-5/7) K<7-':: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Cb4
,<'(5?')5 78 dNc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbQ
#++/5/7)(& Y/:I: 57 d'(&5.-(<' ̂ 7<I'<: 2d"^:3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbQ
b> $5.'< d'(&5.-(<' #::7-/(5'+ N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbP
,1E'<-1&7:/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbP
,O M1<G/G(& $15:/+' d7:5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC
#-1;1)-51<' ,O M(8'5F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC
MI/) N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC
M5(;.F&7-7--1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC
%'5./-/&&/)RY':/:5()5 M5(;.F&7-7--1: #1<'1: 2%YM#3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDA
K<'G')5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDA
%YM# M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDT
M5<';57-7--1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDT
%F-7E(-5'</( $5.'< 5.() ,1E'<-1&7:/: 2%$,3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDT
d'<;': M/?;&'J >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDb
N)8&1')\( >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDD
N)8&1')\( M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDD
"W" [1)+(?')5(& 6&'?')5: 57 K<'G')5 N)8&1')\( ,<():?/::/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDS
*7<7G/<1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDS
K<'G')5/7) 78 *7<7G/<1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDS
"&7:5</+/1? +/88/-/&' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CD4
K<'G')5/7) 78 M;<'(+ 78 "&7:5</+/1? +/88/-/&' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDQ
D> M1??(<F 78 K<'G')5/7) 78 W/:'(:' ,<():?/::/7) /) #-1;1)-51<' K<(-5/-'>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP
O(:/- "</5/-(& K</)-/;&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP
K<'G')5/)9 K(5/')5 57 K(5/')5 "<7:: N)8'-5/7): a "</5/-(& Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP
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K<'G')5/)9 K(5/')5 57 K<(-5/5/7)'< "<7:: N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP
K<'G')5/)9 K<(-5/5/7)'< 57 K(5/')5 "<7:: N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP
Y'G/'=>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSB
Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSB
&('$ NA &"'#,00"3 P"(3$8E D3"(03*0"## (02 4(+"$5 &'()$*)"# ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: HKL
C> d()+=(:./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSQ
688'-5/G' d()+=(:./)9 ,'-.)/01' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSP
d()+ dF9/')' ,'-.)/01'U M7(; ()+ ^(5'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSP
d()+ W<F/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4B
d()+ dF9/')' ,'-.)/01' R #&-7.7&RO(:'+ M()/5/\'<: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4B
d()+=(:./)9 R #)5/:';5/- ,7='&'55': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4B
d()+ [&7<( >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C
Y/)9:`V'='&<F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C
d'(&5.-(<' =7<I'<: ()+ #-51(& d()+=(:./)9 K<(-5/-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C
*'-'::/5F 78 d()+=(:./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C
^.(5 /: 5.' </9.5 =(F 57 =(:. F71< .()+:g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4A
Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4T
A> K(5/')5 MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4T
#&-7.7& M=(E %'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4D
$;5/7): 87< MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4D
Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4S
T> Y'-7??')+(5/7): 87< K<(-5/5/7)'< d'(&5. ()+ dF9/')' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4S
h'(<&F K.F:/-(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44
"&75./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44
d()+ "(<' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44
K'<:7)(& d'(&5. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44
,':5/)9 87< ,OH dOcH d"c ()+ dNc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q
,O 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q
dOc 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q
d"c 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q
dNc 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4P
b> K'<:7)(& K<75'-5/G' 601/;?')5 2KK63 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4P
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#<' 9&7G': )''+'+ 87< (-1;1)-51<' )''+&' /):'<5/7)g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQC
#<' 9&7G': )''+'+ 87< (-1;1)-51<' )''+&' <'?7G(&g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQA
D> *''+&':5/-I N)87<?(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQT
Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQT
&('$ N@A D3"(0*0> (02 &($8,>"0 6"2.)$*,0 J")80*R."# *0 P"(3$8)('" (02 -BC &'()$*)" S,)($*,0# ::: HLT
C> W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQP
"&(::/8/-(5/7): 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPB
,F;': 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPB
".&7</)' ()+ ".&7</)' "7?;71)+: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPB
%/-<7E/7-/+(& #-5/G/5F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPC
Z&15(<(&+'.F+' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPC
dF+<79') ;'<7J/+' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA
N7+7;.7<: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA
K.')7& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA
6K# ()+ [W# #;;<7G(& 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA
%7)/57</)9 ()+ X(E'&/)9 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA
A> N)+/-(5/7): 87< M5'</&/\(5/7)H d/9.RX'G'& W/:/)8'-5/7)H ()+ X7=RX'G'& W/:/)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>> CPT
T> "&'()/)9 601/;?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPT
Y'1:' 78 M/)9&'RL:' %'+/-(& W'G/-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPT
K<'R-&'()/)9 78 Y'1:(E&' %'+/-(& 601/;?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPT
N):5<1?')5 "&'()/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPb
!"#$%& ()*+$,*-$. #/1 K*.*-#$7%*-4 ?$)."R,$ H$+*7", MS)*@B$-% >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPb
b> "&'() L:' 78 X1E</-()5:>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPS
D> "&'()/)9 ()+ W/:/)8'-5/)9 6)G/<7)?')5(& M1<8(-': /) d'(&5.-(<' [(-/&/5/': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPS
L:' 78 W/:/)8'-5()5: 87< M1<8(-' "&'()/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CP4
S> O&77+ 7< O7+F [&1/+ M;/&&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CP4
4> X(1)+'</)9 M.''5:H ,7='&: 7< $5.'< X/)'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPQ
Q> M.(<;: ()+ *7)RM.(<;: O/7.(\(<+ 601/;?')5 ()+ W/:;7:(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPQ
P> Y'91&(5'+ ^(:5' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPP
W/:;7:(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABB
"7)5(?/)(5'+ X(1)+<F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABB
M1??(<F 78 Y'-7??')+(5/7): a K(<5 cN >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABC
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Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABA
&('$ N@@A B++*)" &',)"2.'"# +,' 6*#< 6"2.)$*,0 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UMV
C> ['+'<(& M5()+(<+: ()+ Z1/+'&/)': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABD
$Md#U O&77+E7<)' K(5.79'): M5()+(<+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABD
M5()+(<+ K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABS
*MK# >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABS
$Md#U 6J;7:1<' "7)5<7& K&() >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AB4
$Md#U d(\(<+71: "7??1)/-(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACB
$Md#U $5.'< d(\(<+: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACC
$Md#U W/:;7:/)9 78 O/7.(\(<+71: ̂ (:5' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACC
W/:-(<+/)9 9&7G':H -7557) E(&&: ()+ 75.'< ?(5'</(& -7)5(?/)(5'+ =/5. E&77+ >>>>>>>>>>>>>>>>>>>>>>>>>>>> ACT
^.(5 :.71&+ ;(5/')5: +7 =/5. ;<':: 5(-I: 7< 75.'< /?E'++'+ +'G/-': 5.(5 5.'F )''+ 57 <'?7G'(5 .7?'g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACT
A> M(8'5F "7):/+'<(5/7): Y'9(<+/)9 5.' K<(-5/-' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACb
T> Y'-7<+I'';/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACD
".(<5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACD
Z')'<(& ".(<5/)9 "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACD
M5()+(<+ Y'01/<'?')5: 87< #$% -.(<5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AC4
W(/&F #;;7/)5?')5 M-.'+1&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACP
b> K(5/')5 "7)8/+')5/(&/5F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACP
dNK## d'(&5. N)87<?(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACP
Y';7<5/)9 78 "7??1)/-(E&' W/:'(:' ()+ #E1:' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAC
D> N)87<?'+ "7):')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAC
S> d/9.RY/:I K(5/')5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAA
4> $5.'< N?;7<5()5 M(8'5F K<(-5/-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAA
K<'G')5/)9 ,</;: ()+ [(&&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAA
d7= 57 K<'G')5 [(&&: W1' 57 M&/;: ()+ ,</;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAT
Y':;7):' 57 ( O7+/&F [&1/+ M;/&& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAT
[/<:5 #/+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAT
%')5(& d'(&5. N::1':`M1/-/+' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAb
Q> M1??(<F 78 Y'-7??')+(5/7): a K(<5 cNN >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAb
Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAD
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&('$ N@@@ O -//"02*)"# :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UUW
#;;')+/J #U Z&7::(<F`#EE<'G/(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AA4
#;;')+/J OU ^.'<' 57 [/)+ %7<' N)87<?(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT
d'(&5.-(<' #::7-/(5'+ N)8'-5/7):>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT
"W"`M;'-/8/- K(5.79'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT
d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT
dNc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATb
,O >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATb
$5.'< W/:'(:': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATb
d()+=(:./)9 /)87<?(5/7) ()+ +'5(/&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD
M5()+(<+ K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD
$Md# W7-1?')5: ()+ ,<(/)/)9 Y'01/<'?')5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD
$Md# O&77+E7<)' K(5.79') M5()+(<+: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD
6J;7:1<' "7)5<7& K&() 26"K3 M(?;&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD
$Md# W7-1?')5: Y'&(5/)9 57 6"K: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD
d(\(<+71: "7??1)/-(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATS
dNK## >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATS
#;;')+/J "U #-1;1)-51<' K7/)5: 5.(5 Y'01/<' M;'-/(& MI/&& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AT4
Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATP
D3"(0 1""23" J")80*R." W$8 92*$*,0 X-Y ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UVM
@02"; ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UVK
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Preface
,.' ;<78'::/7) 78 (-1;1)-51<' ()+ $</')5(& ?'+/-/)' 2#$%3 /) 5.' L)/5'+ M5(5': -7)5/)1': 57
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References
C> K'<&'5. %>H V(I1E7=:I/ 6>H O1::' Y> ^.(5 /: _E':5 ;<(-5/-'_ /) .'(&5. -(<'g M5(5' 78 5.' (<5 ()+
;'<:;'-5/G': /) /?;<7G/)9 5.' '88'-5/G')':: ()+ '88/-/')-F 78 5.' 61<7;'() .'(&5. -(<'
:F:5'?:: I$",%C 0/,*7&: ABBC V1)iDS2T3UATDRDB>
A> %788'55 KH %77<' Z> ,.' M5()+(<+ 78 "(<'U X'9(& d/:57<F ()+ W'8/)/5/7):U 5.' O(+ ()+ Z77+
*'=:> U$.% V MB$14 H$+ > ABCC ['E<1(<Fi CA2C3U CBPaCCA>
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Part I:
AOM Clinical Procedures, Saf ety, Adverse Events (AEs) and Recommendations to Reduce AEs
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-&/)/-(& '88/-(-F /: ;75')5/(&&F ')+()9'<'+ =.') ( -&/)/-/() /: )75 -79)/\()5 78 5.' ;75')5/(& </:I:
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EF ?'?E'<: 78 5.' ;1E&/-H :5(5' <'91&(57<:H ()+ 75.'< ;<7G/+'<: 57 E' ='&& 5<(/)'+ ()+ 5.'
;<(-5/-' 78 (-1;1)-51<' 57 E' <'&(5/G'&F :(8'> N) 5./: :'-5/7)H -7??7)&F 1:'+ (-1;1)-51<' ()+
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()+ #$%R(::7-/(5'+ -&/)/-(& ;<7-'+1<': =/&& E' 9/G') /) K(<5 NN ()+ K(<5 NNN>
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qX/-'):'+ (-1;1)-51</:5: /) 5.' L>M> (<' ='&&R5<(/)'+> #: )75'+ /) 5.' /)5<7+1-5/7) 57 5./:
?()1(&H 5.'<' (<' ( )1?E'< 78 .'(&5.-(<' ;<(-5/5/7)'<:H .7='G'<H =.7 15/&/\' (-1;1)-51<' =/5.
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,./: 8/<:5 ;(<5 78 5.' ?()1(& /: ( <'G/'= 78 5.' ?'+/-(& &/5'<(51<' +'5(/&/)9 5.' :(8'5F 78 G(</71:
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(;;&/-(5/7)> L:/)9 5.' ;</)-/;&': 78 'G/+')-'R/)87<?'+ ;<(-5/-':H 5.' /)87<?(5/7) ;<':')5'+
.'<' /: 5.' E':5 /)87<?(5/7) (G(/&(E&' (5 5.' 5/?' 78 ;1E&/-(5/7)> ^./&' 5.'<' (<' ( )1?E'< 78
='&& +'G/:'+ ()+ <';7<5'+ :51+/': 78 5.' ?/)/?(& #6: (::7-/(5'+ =/5. (-1;1)-51<' )''+&/)9H
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ReferencesC> Z1/+'&/)': 7) O(:/- ,<(/)/)9 ()+ M(8'5F /) #-1;1)-51<'> ^7<&+ d'(&5.
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1. Acupuncture
Safety/Adverse Events – A Review of the Literature
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Safety Guidelines to Prevent Bruising, Bleeding, and Vascular Injury
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Safety Guidelines for Aggravation of Symptoms
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Preventing Rare but Serious Adverse Events (SAEs) Associated with
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Pneumothorax
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2. Moxibustion
Safety/Adverse Events – A Review of the Literature
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References
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5. Therapeutic Blood Withdrawal
Safety/Adverse Events – A Review of the Literature
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6. Gua Sha
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D4
7. Plum Blossom Needling
Safety/Adverse Events – A Review of the Literature
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8. Press Tacks and Intradermal Needles
Safety/Adverse Events – A Review of the Literature
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References
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9. Ear Seeds
Safety/Adverse Events – A Review of the Literature
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References
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10. Tui Na
Safety/Adverse Events – A Review of the Literature
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References
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:7?(5/- ;(/)s>j.7)9917 j.') V/1> ABCB V()iTB2C3UDDRP>
A> ^(&57)Rd(+&7-IH V> K</?(<F K(<I/):7)_: +/:'(:'U ,.' 1:' 78 ,1/)( ()+ (-1;1)-51<' /) (--7<+
=/5. () 'G7&G/)9 .F;75.':/: 78 /5: -(1:' 8<7? 5.' ;'<:;'-5/G' 78 "./)':' 5<(+/5/7)(&
?'+/-/)'> #?'</-() V71<)(& 78 #-1;1)-51<' CPPQiAS2ART3UCSTRC44
T> K(5'& f"H Z<7:: #H Z<(.(? *H Z7&+:?/5. "dH 6\\7 VH %7</') #H K'&7:7 K%> %(::(9' 87<
?'-.()/-(& )'-I +/:7<+'<:> "7-.<()' W(5(E(:' MF:5 Y'G> ABCA M'; CAiPU"WBBbQ4C> +7/U
CB>CBBA`CbSDCQDQ>"WBBbQ4C>;1Eb>
b> N)+/-(5/7):H "7)5<(/)+/-(5/7): ()+ K7/)5: 87< #55')5/7) /) ,1/)(>
.55;U``5-?+/:-7G'<F>-7?`,1/)(R%(::(9'`/)87`ABBQBPCTyACb>.5?& #--'::'+ W'-'?E'<
ABCA>D> f'&&79H Vd> GC$ =1% /# H".."4$> %7+'<) %'+/-/)' K1E&/:./)9 "7>H O(55&' "<''IH %N>H CQPD>
K>ABC
S> %FI&'E1:5 %H N&'< V> K7&/-F 87< 5.'<(;'15/- ?(::(9' /) () (-(+'?/- .'(&5. -')5'<U ( ?7+'& 87<
:5()+(<+ ;7&/-F +'G'&7;?')5> V #&5'<) "7?;&'?')5 %'+> ABB4 %(FiCT2b3Ub4CRD>
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4> "./ HM.1&()H'5 (&>淑兰,等.急性腰扭伤按摩致腰部血肿一例.颈腰痛杂志,1995;16( 2):90. # -(:'
78 .'?(57?( (5 5.' =(/:5 (::7-/(5'+ =/5. ?(::(9' 87< 5<'(5/)9 (-15' &1?E(< :;<(/)> ,.'
V71<)(& 78 "'<G/-7+F)/( ()+ X1?E7+F)/(Hc7&>CSH)7> AH;>PBH CPPD> q#<5/-&' /) "./)':'s
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78 ;(<(&F:/: (::7-/(5'+ =/5. ?(::(9' (5 -'<G/-(& :;/)'> X/)9)() V71<)(& 78 6?'<9')-F%'+/-/)'Hc7&>SH)7>CH;>SPH ABBC> q#<5/-&' /) "./)':'s
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:.71&+'<> "./)':' V71<)(& 78 "7)G(&':-')5 %'+/-/)'H c7&>CBH *7> CH ;>TH ABBC> q#<5/-&' /)
"./)':'s
CB> l/7)9H Z1()F1>熊冠宇.手法治疗颈椎病致脑干梗塞l例.河南中医,2003;23(1 0):7. # -(:' 78
E<(/) :5'? /)8(<-5/7) (::7-/(5'+ =/5. ?()1(& 5.'<(;F 87< -'<G/-(& :;7)+F&7:/:> p d')()
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S4
11. Other Acupuncture-Related Tools
Manaka/Japanese Acupuncture Tools
A Review of the Literature
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(::7-/(5'+ =/5. '/5.'< %()(I( ;1?;/)9 -.7<+: 7< %()(I( .(??'< 5<'(5?')5:>
Preventing Adverse Events
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Shonishin Pediatric Japanese Acupuncture Tools A Review of the Literature
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Part II: Best Practices for Acupuncture - CNT
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4Q
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4P
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QB
Needle Removal
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4. CNT for House Calls/Travel Setting
Travel Kit /Travel Kit Carrier
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Non-Clean Items
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QS
Hand Cleanser
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Q4
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?(5'</(&H E</)9/)9 /5 /)57 -7)5(-5 =/5. 5.' ;<(-5/5/7)'<k: 8/)9'<: ()+ /)-<'(:/)9 5.' </:I 78
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:(?'>
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QP
5. CNT in a Community Acupuncture Clinic or NADA Setting,.' "&'() *''+&' ;<757-7& /: '::')5/(&&F 5.' :(?' 87< 'G'<F (-1;1)-51<' ;(5/')5 /) ()F :'55/)9>
,.' -</5/-(& /5'?: <'?(/) 5.' :(?'U (&=(F: ':5(E&/:. ( -&'() 8/'&+H (&=(F: =(:. .()+: E'87<'
'G'<F (-1;1)-51<' 5<'(5?')5H (&=(F: 1:' :/)9&'R1:' +/:;7:(E&' :5'</&' 8/&/87<? )''+&':H 87&&7=
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E' -.()9'+ 87< '(-. )'= ;(5/')5> #<?<':5: 7< 75.'< :1<8(-': 5.(5 (<' 'J;7:'+ 57 E(<' :I/)
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Treatment Protocol in a Community Clinic or NADA Setting
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PB
S> 6):1<' 5.' :I/) (5 5.' (-1;1)-51<' ;7/)5: 57 E' 1:'+ /: -&'()> N8 4Bt (&-7.7& :=(E: (<'
1:'+H (&&7= 5.' (&-7.7& 57 +<F> q:5<7)9&F <'-7??')+'+s
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+<7;;'+ /)57 5.' 51E'H .()+&' 8/<:5H 57 ?/)/?/\' 5.' </:I 78 -7)5(?/)(5/)9 5.' ;7/)5 78
5.' )''+&'> q:5<7)9&F <'-7??')+'+sQ> N):'<5 5.' )''+&': =/5.715 571-./)9 5.' :.(85 78 5.' )''+&' 5.(5 =/&& E' /):'<5'+ /)57 5.'
;(5/')5k: :I/)> q-</5/-(&s N8 ( 91/+' 51E' /: 57 E' <'1:'+H /5 :.71&+ E' ;&(-'+ 7) 5.' -&'()
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PC
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References
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CBB
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CBC
Part III: Best Practices for Related AOM Office Procedures
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CBA
1. Moxibustion
Moxibustion Overview
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E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>
-> O' ( <'-';5(-&' 87< E1<)5 ?7J(H 1)&':: ( :1/5(E&' (:.5<(F 7< 75.'< )7)R
8&(??(E&' <'-';5(-&' /: ;<'8'<<'+>
A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>
T> %(I' :1<' )7 -&75./)9 /: -&7:' 57 5.' (<'( E'/)9 5<'(5'+ =/5. ?7J/E1:5/7)>
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CB4
b> K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 ?7J/E1:5/7) (;;&/-(5/7) a +7 )75 &77I
(=(F 8<7? 5.' ;(5/')5 7< ?7J(H =</5' /) 5.' -.(<5H 7< 5(&I 57 ()F7)' E':/+': 5.' ;(5/')5
+1</)9 ?7J/E1:5/7) (;;&/-(5/7)>
D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:
;<'G')5: 5.' ;<(-5/5/7)'<k: 8/)9'<: 8<7? E'/)9 E1<)'+ ()+ <'+1-': 5.' </:I 78 +<7;;/)9E1<)/)9 ?7J( 7)57 5.' ;(5/')5 7< 5<'(5?')5 :1<8(-'>
S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E'
8&1:.'+ +7=) 5.' :/)I> W7 )75 ;15 ?7J( (:. +/<'-5&F /)57 ( 5<(:. -() (: 5./: ?(F /9)/5' (
5<(:. 8/<'>
W: *'G'< (;;&F +/<'-5 ?7J( 57 5.' 8(-' 7< =/5./) 5.' .(/<&/)'>
Indirect Moxibustion – Technique with Interposed Moxibustion
,.' /9)/5'+ ?7J( -7)' +7': )75 -7)5(-5 5.' :I/) +/<'-5&FH E15 /: /):1&(5'+ 8<7? 5.' :I/) EF (
&(F'< 78 9/)9'<H :(&5H 9(<&/-H 7< (-7)/5' -(I'> W';')+/)9 7) 5.' 5'-.)/01' 1:'+H 5./: I/)+ 78 ?7J(
?(F /)+1-' E&/:5'</)9H E15 /5 /: ?7:5 8<'01')5&F 1:'+ 87< )7)R:-(<</)9 ?7J/E1:5/7)>
Method
C> # :/)9&' ?7J( -7)' /: ;<';(<'+ ;</7< 57 1:'>
A> # 5.7<719. ;(5/')5 ./:57<F /: ;'<87<?'+ 57 /+')5/8F ()F -7)+/5/7): 5.(5 ?/9.5 &/?/5 (
;(5/')5k: <':;7):' 57 ;(/) 7< 5.' (E/&/5F 57 :'):' .'(5 q-</5/-(&s 7< ?(F /)-<'(:' (
<'(-5/7) 57 5.' ?7J( :?7I'> q<'-7??')+'+s
T> K<7;'< G')5/&(5/7) /: (::1<'+ 5.<719. 1:' 78 =/)+7=: 7< (/< 8/&5'<: 7< 75.'< (/< 8/&5'</)9
;<7-'::> q-</5/-(&s
b>
#&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>601/;?')5U ?7J( -7)':H .'?7:5(5`87<-';:`5=''\'<:H .'<E(& /):1&(5/7) 2(-7)/5' -(I'H
9(<&/-H ()+ 9/)9'<3H -1; 78 =(5'< 2/8 +':/<'+3H (:.5<(F 2/8 +':/<'+3H &1E</-()5 7< :I/) &75/7)H
&/9.5'<H /)-'):' :5/-IH ()+ 75.'< '01/;?')5 (: )''+'+> q<'-7??')+'+s
D> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s
S> ,.' (<'( 57 =./-. ?7J( =/&& E' (;;&/'+ /: ;<';(<'+ =/5. :I/) &75/7) 7< &1E</-()5H /8
+':/<'+ E(:'+ 7) 5.' 5F;' 78 ?7J( ;<(-5/-'>
4> ,.' .'<E(& /):1&(5/7) /: 5.') (;;&/'+ 57 5.' (<'( 57 E' .'(5'+>
Q> ,.' -7)' 78 ?7J(H 1)&/5H /: (;;&/'+ 57 5.' .'<E(& /):1&(57<>
P>
N8 +':/<'+H ( .'?7:5(5 7< 5=''\'<: ?(F E' (;;&/'+ 57 5.' ?7J( ()+ 5.' /)-'):' 27< 75.'<?(5'</(&3 /: 5.') 1:'+ 57 &/9.5 5.' ?7J(> q<'-7??')+'+s K<(-5/5/7)'<: ?(F (&:7 -.77:'
57 1:' 5.'/< 8/)9'<: 87< ?7J( (;;&/-(5/7) ()+ =/5.+<(=(& E(:'+ 7) ;'<:7)(& ;<'8'<')-'
()+ 5<(/)/)9>
CB> # ?(5'</(& :1-. (: () /)-'):' :5/-I /: &/9.5'+H 1:/)9 5.' &/9.5'<H (=(F 8<7? 5.' ;(5/')5>
$5.'< ?(5'</(&: -() E' 1:'+ (: &7)9 (: () 7;') 8&(?' /: I';5 :7?' +/:5()-' 8<7? 5.'
;(5/')5k: :I/)> q<'-7??')+'+s
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CBQ
CC> ̂ .') (E715 A`T 78 5.' ?7J( /: E1<)5 7< 5.' ;(5/')5 8''&: ( E1<)/)9 +/:-7?87<5H <'?7G'
5.' -7)' ()+ /):1&(57< ()+ ;&(-' 5.' ?7J( /) 5.' -1; 78 =(5'< 7< (:.5<(F>
q<'-7??')+'+s
Safety Considerations
C>
#&=(F: .(G' (--':: 57 =(5'< 57U
(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>
E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>
-> O' ( <'-';5(-&' 87< E1<)5 ?7J(H 1)&':: ( :1/5(E&' (:.5<(F 7< 75.'< )7)R
8&(??(E&' <'-';5(-&' /: ;<'8'<<'+>
A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>
T> %(I' :1<' )7 -&75./)9 /: -&7:' 57 5.' (<'( E'/)9 5<'(5'+ =/5. ?7J/E1:5/7)>
b> K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 ?7J/E1:5/7) (;;&/-(5/7) a +7 )75 &77I
(=(F 8<7? 5.' ;(5/')5 7< ?7J(H =</5' /) 5.' -.(<5H 7< 5(&I 57 ()F7)' E':/+': 5.' ;(5/')5
+1</)9 ?7J/E1:5/7) (;;&/-(5/7)>
D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:
;<'G')5: 5.' ;<(-5/5/7)'<k: 8/)9'<: 8<7? E'/)9 E1<)'+ ()+ <'+1-': 5.' </:I 78 +<7;;/)9
E1<)/)9 ?7J( 7)57 5.' ;(5/')5 7< 5<'(5?')5 :1<8(-'>
S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E'
8&1:.'+ +7=) 5.' :/)I> W7 )75 ;15 ?7J( (:. +/<'-5&F /)57 ( 5<(:. -() (: 5./: ?(F /9)/5' (
5<(:. 8/<'>
4> *'G'< (;;&F /)5'<;7:'+ ?7J( 57 5.' 8(-' 7< =/5./) 5.' .(/<&/)'>
Indirect Moxibustion - Warming Needle Moxibustion,./: ?'5.7+ 1:': E75. ( )''+&' ()+ ?7J(> #85'< 5.' (-1;1)-51<' ;7/)5 /: )''+&'+ ()+
:5/?1&(5'+ (: +':/<'+ 7< )''+'+ 87< 5.' (<</G(& 78 0/H ( :?(&& :'-5/7) 78 ( ?7J( :5/-I 2(E715 A -?
&7)93 7< ( ?7J( -7)' /: ;&(-'+ 7) 5.' .()+&' 78 5.' )''+&'> ,.' ?7J( :5/-I /: 5.') /9)/5'+ 8<7?
/5: E7557? ()+ (&&7='+ 57 E1<) 715>
,.' ?'5.7+ E'&7= 1:': )7 (++/5/7)(& ?(5'</(& 57 :'-1<' 5.' ?7J( 7) 5.' )''+&'> N):5'(+H (
;<75'-5/G' -7G'< 78 -(<+E7(<+ /: ;&(-'+ 7) 5.' :I/) 57 (G7/+ E1<)/)9 (:.': 8<7? 8(&&/)9 7) 5.'
;(5/')5> $5.'< ?'5.7+: ()+ +'G/-': .(G' E'') 15/&/\'+ :(8'&F 57 ;<'G')5 5.' ?7J( 8<7? 8(&&/)9
7) 5.' ;(5/')5> ,.' :;'-/8/- ?'5.7+ 7< +'G/-' 57 E' 1:'+ -() E' -.7:') E(:'+ 7) :(8'5F
'G/+')-' ()+ ;<(-5/5/7)'< ;<'8'<')-':>
Method
C> %7J( :5/-I: 7< -7)': (<' ;<';(<'+ ;</7< 57 &/9.5/)9 ()F ?7J(>
A> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>
601/;?')5U ?7J( :5/-I: 7< &77:' ?7J( 57 ?(I' -7)':H 5=''\'<:`87<-';:`.'?7:5(5H -1;
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CBP
78 =(5'< 2/8 +':/<'+3H (:.5<(F 2/8 +':/<'+3H ;<75'-5/G' :I/) -7G'<H &/9.5'<H ()+ /)-'):' :5/-I>
q<'-7??')+'+s
T> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s
b> # -&'() )''+&' 5<(F /: ;<';(<'+ (: +/:-1::'+ /) 5.' "*, :'-5/7) 78 5./: ?()1(&> q-</5/-(&s
D>
,.' (-1;1)-51<' /: ;'<87<?'+ 87&&7=/)9 "*, 91/+'&/)':> q-</5/-(&sS> N):'<5 ?'5(&R7)&F )''+&': 57 5.' +';5. <'01/<'+ 57 <'5(/) 5.' )''+&' 1;</9.5 :'-1<'&F>
W7 )75 1:' ;&(:5/- 5/;;'+ )''+&': (: 5.' ;&(:5/- ?(F ?'&5 +1</)9 5.' ?7J( 5.'<(;F>
q<'-7??')+'+s
4> # +/:- 78 /):1&(57< -(<+E7(<+ 7< 75.'< ?(5'</(& /: ;&(-'+ 7) 5.' ;(5/')5k: :I/) (<71)+ 5.'
E(:' 78 5.' )''+&'> #&5'<)(5'&FH ( +'G/-' 7< /):1&(57< ?(5'</(& /: (55(-.'+ 57 5.' )''+&'
E'&7= =.'<' 5.' ?7J( =/&& :/5> O75. ?'5.7+: ;<'G')5 (:. 8<7? 8(&&/)9 7) 5.' ;(5/')5k:
:I/)> q:5<7)9&F <'-7??')+'+s
Q> # :?(&& :5/-I 7< -7)' 78 ?7J( /: ;&(-'+ 7) 5.' .()+&' 78 5.' )''+&'>
P> ,.' /)-'):' /: &/9.5'+H 1:/)9 5.' &/9.5'<H (=(F 8<7? 5.' ;(5/')5> q<'-7??')+'+s
CB> ,.' /)-'):' /: 1:'+ 57 &/9.5 5.' ?7J(H =./-. .(: E'') ;&(-'+ 7) 5.' .()+&' 78 5.'
)''+&'> q<'-7??')+'+s
CC> ̂ .') (E715 A`T 78 5.' ?7J( /: E1<)5 7< 5.' ;(5/')5 8''&: ( =(<? :'):(5/7) (<71)+ 5.'
)''+&'H <'?7G' 5.' -7)' ()+ ;&(-' 5.' ?7J( /) 5.' -1; 78 =(5'< 7< (:.5<(F>
q<'-7??')+'+s
CA> M.71&+ 5.' ;(5/')5 /)+/-(5' 5.(5 5.'<' /: () 1)-7?87<5(E&' (?71)5 78 .'(5H 1:' 5.'
5=''\'<: 7< .'?7:5(5 57 /??'+/(5'&F <'?7G' 5.' )''+&' ()+ ?7J(> ,.' .75 )''+&'
?1:5 E' <'?7G'+ =/5. () /):5<1?')5H :/)-' /5 =/&& E' 577 .75 57 ?()/;1&(5' :(8'&F EF
.()+> q<'-7??')+'+s
Safety Considerations
C> #&=(F: .(G' (--':: 57 =(5'< 57U
(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>
E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>
-> O' ( <'-';5(-&' 87< E1<)5 ?7J(H 1)&':: ( :1/5(E&' (:.5<(F 7< 75.'< )7)R8&(??(E&'
<'-';5(-&' /: ;<'8'<<'+>
A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>
T> %(I' :1<' )7 -&75./)9 /: -&7:' 57 5.' (<'( E'/)9 5<'(5'+ =/5. ?7J/E1:5/7)>
b>
K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 ?7J/E1:5/7) (;;&/-(5/7) a +7 )75 &77I(=(F 8<7? 5.' ;(5/')5 7< ?7J(H =</5' /) 5.' -.(<5H 7< 5(&I 57 ()F7)' E':/+': 5.' ;(5/')5
+1</)9 ?7J/E1:5/7) (;;&/-(5/7)>
D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:
;<'G')5: 5.' ;<(-5/5/7)'<k: 8/)9'<: 8<7? E'/)9 E1<)'+ ()+ <'+1-': 5.' </:I 78 +<7;;/)9
E1<)/)9 ?7J( 7)57 5.' ;(5/')5 7< 5<'(5?')5 :1<8(-'>
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CCB
S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E'
8&1:.'+ +7=) 5.' :/)I> W7 )75 ;15 ?7J( (:. +/<'-5&F /)57 ( 5<(:. -() (: 5./: ?(F /9)/5' (
5<(:. 8/<'>
4> *'G'< (;;&F =(<?/)9 )''+&' ?7J( 57 5.' 8(-'>
Indirect Moxa – Technique with Moxa Stick
%7J( :5/-I: ?(F E' 1:'+ '/5.'< 2C3 EF .7&+/)9 5.' ?7J( ART -? 7G'< 5.' :/5' 57 E' 5<'(5'+ 57
E</)9 ?/&+ =(<?5. 57 5.' (<'(`;7/)5 87< 1; 57 CD ?/)15':H 7< 1)5/& 5.' :I/) E'-7?': :&/9.5&F <'+
7< =(<? 57 5.' ;<(-5/5/7)'<k: 571-.i 7< 2A3 5.' /9)/5'+ ?7J( :5/-I /: ?7G'+ 1; ()+ +7=) 7G'<
5.' ;7/)5 7< )'(< 7< (<71)+ () (-1;1)-51<' )''+&'>
O'-(1:' ?7J( :5/-I: -() E' G'<F +/88/-1&5 57 E' &/5 ;<7;'<&FH 87< ;<(-5/5/7)'< :(8'5FH /5 /:
<'-7??')+'+ 5.(5 ( -()+&'H 7< 8/<';&(-' 8&(?' 57<-. E' 1:'+> N) 5.' ?'5.7+ E'&7=H ( -()+&' /:
1:'+> $5.'< ?'5.7+: 5.(5 I''; 5.' 8&(?' (=(F 8<7? 5.' ;(5/')5 ()+ 5.' ;<(-5/5/7)'<k: 8/)9'<:
?(F E' 15/&/\'+ E(:'+ 7) ;<(-5/5/7)'< ;<'8'<')-'>
Method
C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>
601/;?')5U ?7J( :5/-IH ?7J( 'J5/)91/:.'<H -1; 78 =(5'< 2/8 +':/<'+3H &/9.5'<H ()+ -()+&'>
q<'-7??')+'+s
A> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s
T> X/9.5 5.' -()+&' 1:/)9 5.' &/9.5'<> ,.') &/9.5 5.' ?7J( :5/-I 1:/)9 5.' -()+&'>
q<'-7??')+'+s
b> N??'+/(5'&F 'J5/)91/:. 5.' -()+&' 7)-' 5.' ?7J( /: &/5> q<'-7??')+'+s
D>
#;;&F ?7J( 1:/)9 7)' 78 5.' ?'5.7+: (E7G'>
S> 6G'<F 8'= ?/)15':H 5(; ()F (:. 8<7? 5.' ?7J( :5/-I /)57 5.' ?7J( 'J5/)91/:.'< 57
;<'G')5 8(&&/)9 (:. 8<7? 8(&&/)9 7) 5.' ;(5/')5 7< 5.' 5(E&'> q:5<7)9&F <'-7??')+'+s
4> ^.') 5.' ;(5/')5 8''&: =(<?5.H <'?7G' 5.' :5/-I ()+ (;;&F 57 5.' )'J5 ;7/)5 57 E'
=(<?'+H (: )''+'+> q<'-7??')+'+s
Q> #85'< 5.' <'01/:/5' ;7/)5: .(G' E'') =(<?'+ (: /)+/-(5'+ 87< 5.' 5<'(5?')5 +':/<'+H
;&(-' 5.' ?7J( :5/-I /) 5.' 'J5/)91/:.'<H &/5 ')+ +7=)=(<+> q-</5/-(&s
P> L:' 5.' -1; 78 =(5'<H /8 )'-'::(<FH 57 'J5/)91/:. (:. 5.(5 8(&&: 715:/+' 78 5.' ?7J(
'J5/)91/:.'< 5<(F> q<'-7??')+'+s
Safety Considerations
C> #&=(F: .(G' =(5'< 7) .()+ 57U
(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>
E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>
A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>
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7/23/2019 Clean Needle Technique 7th edition
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CCA
2. Heat Lamps
Best Practice Protocols for Heat Lamps
d'(5 &(?;: (<' +':/9)'+ 87< 1:' /) (;;&/-(5/7): :;'-/8/-(&&F <'01/</)9 ( :.7<5R=(G' /)8<(<'+
<(+/(5/7) :71<-'> N)8<(<'+ <(+/(5/7) 8<7? 5./: &(?; -(1:': :1<8(-': 57 E' .'(5'+> [7< ?7:5 785.' -7??7)&F 1:'+ -7??'<-/(& .'(5 &(?;: 2:1-. (: ,WK &(?;:3H &(?;: :.71&+ )'G'< E' ;&(-'+
-&7:'< 5.() CA /)-.': 57 ()F ;'<:7) 7< :1<8(-'> M7?' .'(5/)9 &(?;: (<' +':/9)'+ 87< ?1-.
&7='< 5'?;'<(51<': ()+ ?(F E' E<719.5 -&7:'< 57 5.' ;(5/')5k: :I/) :1<8(-' /8 5.(5 -() E'
(--7?;&/:.'+ :(8'&F ()+ (--7<+/)9 57 5.' ?()18(-51<'<k: ?()1(&:>
Method
[7< 1:' =.') .'(5/)9 /: )''+'+ 7G'< ( 9')'<(& (<'( 87< 5.'<(;'15/- =(<?/)9>
C> ".'-I &(?; 87< ()F +'8'-5:> q-</5/-(&s
A>
".'-I 5.' (<'( 57 E' 5<'(5'+ 87< :I/) &':/7):> q:5<7)9&F <'-7??')+'+sT> %(I' :1<' (&& -&75./)9 ()+ -7?E1:5/E&' ?(5'</(&: (<' ?7G'+ :188/-/')5&F 715 78 5.' (<'(
57 E' .'(5'+> q:5<7)9&F <'-7??')+'+s
b> K&19 &(?; /)57 5.' =(&& :7-I'5>
D> K7:/5/7) &(?; .'(+ (5 &'(:5 CA /)-.': 8<7? 5.' (<'( 57 E' .'(5'+> q:5<7)9&F
<'-7??')+'+s
S> ,1<) 7) 5.' .'(5 &(?; 5.') :'5 5/?' 87< )7 ?7<' 5.() CBRCD ?/)15':> q<'-7??')+'+s
4> O'-(1:' 5.' .'(5 78 5.' &(?; ?(F -(1:' 5.' .'(+ 78 5.' 1)/5 57 +<7; 57=(<+ 5.'
;(5/')5H )'G'< &'(G' 5.' /??'+/(5' (<'( 78 ( ;(5/')5 E'/)9 5<'(5'+ =/5. ( .'(5 &(?;>
q:5<7)9&F <'-7??')+'+sQ> ".'-I 5.' (<'( E'/)9 .'(5'+ (5 &'(:5 7)-' 'G'<F D ?/)15': 57 E' :1<' 5.(5 5.' :I/) +7':
)75 E'-7?' 577 .75 7< 5.(5 5.' &(?; (<? ;7:/5/7) .(: )75 -.()9'+> q:5<7)9&F
<'-7??')+'+s
P> L);&19 5.' &(?; 7)-' 5.' .'(5/)9 ;'</7+ .(: ')+'+> q<'-7??')+'+s
Safety Considerations
• "</5/-(&U d'(5 5.'<(;/': ?1:5 E' -&7:'&F ?7)/57<'+ EF ;<(-5/5/7)'<:>
• "</5/-(&U d'(5 &(?;: :.71&+ )75 E' 1:'+ 7) /)8()5:H -./&+<')H /)-(;(-/5(5'+H :&'';/)9H 7<
1)-7):-/71: ;'<:7):>
• "</5/-(&U ^.') .'(5 &(?;: (<' 1:'+ 7) ;(5/')5: =.7 .(G' ( <'+1-'+ <':;7):' 57 .'(5H
5.' 1:' 78 .'(5 ?1:5 E' ?7)/57<'+ (5 (&& 5/?':>
• "</5/-(&U K<'G')5 =(5'<H ?7/:51<'H &/01/+: 7< ?'5(& 7E]'-5: 8<7? -7?/)9 /) -7)5(-5 =/5.
5.' &(?;> W7 )75 1:' ( .'(5 &(?; /) ='5 7< ?7/:5 ')G/<7)?')5:>
• "</5/-(&U W7 )75 1:' /8 ()F ;(<5 78 5.' &(?; /: -<(-I'+> W7 )75 (&&7= ()F ;(<5 78 5.' &(?;
57 571-. (--'::7<F '01/;?')5>
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CCT
• M5<7)9&F Y'-7??')+'+U d'(5 &(?;: :.71&+ )75 E' 1:'+ =/5.715 ( <':;7):/E&'
(55')+()5 ;<':')5 +1</)9 5.' ')5/<' +1<(5/7) 78 1:'>
• M5<7)9&F Y'-7??')+'+U W7 )75 1:' 7G'<R:'):/5/G' :I/) 7< ;'<:7): .(G/)9 ;77< E&77+
-/<-1&(5/7)> M188/-/')5 5'?;'<(51<': (<' 9')'<(5'+ 5.(5 ?(F -(1:' E1<):>
•
M5<7)9&F Y'-7??')+'+U ,(I' ( -(<'81& ;(5/')5 ./:57<F 57 /+')5/8F +/(E'5':H)'1<7;(5./':H 7< 75.'< -7)+/5/7): 5.(5 ?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) 7< 5.'
(E/&/5F 57 :'):' .'(5>
• M5<7)9&F Y'-7??')+'+U ,.' ;<(-5/5/7)'< :.71&+ ?7)/57< 5.' ;(5/')5k: :I/) 5'?;'<(51<'
()+ 5.' (?71)5 78 .'(5 9')'<(5'+ EF ( .'(5 &(?; ()+ )75 <'&F :7&'&F 7) ;(5/')5
8''+E(-I (E715 .'(5 :'):(5/7):>
• M5<7)9&F Y'-7??')+'+U W7 )75 1:' 5./: .'(5 :71<-' /) -&7:' ;<7J/?/5F 57 -7?E1:5/E&'
?(5'</(&: 2&/55'<H ;(;'<H '5->3 7< 57 ?(5'</(&: (+G'<:'&F (88'-5'+ EF .'(5 7< +<F/)9>
• Y'-7??')+'+U ^.') ( ;(5/')5k: /)87<?(5/7) /: 1)-&'(<H <'01':5 () 7;/)/7) 8<7? (
;.F:/-/() E'87<' 1:/)9 ( .'(5 &(?; 7) 5.' &/?E: 78 ( ;(5/')5 =/5. +/(E'5/- 7< 75.'<)'1<7;(5./':>
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CCb
3.Cupping
Cupping Overview
"1;;/)9 2E( 91() 8(+3 /: ( 5.'<(;'15/- ;<7-'+1<' 1:'+ EF #$% ()+ 75.'< .'(&5.-(<'
;<(-5/5/7)'<: (<71)+ 5.' =7<&+> "1;;/)9H 7)' 78 5.' 7&+':5 ?'5.7+: 78 5<(+/5/7)(& "./)':'
?'+/-/)'H /: (--7?;&/:.'+ EF .(G/)9 ( -1; (;;&/'+ 57 5.' :I/)i 5.' ;<'::1<' /) 5.' -1; /:
<'+1-'+ EF 1:/)9 ( -.()9' /) .'(5 7< EF :1-5/7)/)9 715 (/<H :7 5.(5 5.' :I/) ()+ :1;'<8/-/(&
?1:-&' &(F'< /: +<(=) /)57 ()+ .'&+ /) 5.' -1;> "1;;/)9 1:': ( ;(<5/(& G(-11? 57 /)5')5/7)(&&F
-<'(5' 5.'<(;'15/- ;'5'-./(' ()+ '--.F?7:/: /) 5.' +'<?/:> ,.'<' (<' ( )1?E'< 78 -1;;/)9
:5F&':H /)-&1+/)9 :1-5/7) -1;;/)9H 8/<' -1;;/)9H '?;5F -1;;/)9H :&/+/)9 7< 9&/+/)9 -1;;/)9> O':5
;<(-5/-' 91/+'&/)': (<' ;<7G/+'+ 87< 5.<'' 78 5.':' :5F&':U 8/<' -1;;/)9H :1-5/7) -1;;/)9H ()+ ='5
-1;;/)9 7< -1;;/)9 (85'< 5.' 1:' 78 ( &()-'5 87< E&77+ =/5.+<(=(&>
General Recommendations for Cupping
• "</5/-(&U [7&&7= M5()+(<+ K<'-(15/7):>
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+ >
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*% (5*/->
• "</5/-(&U "1;;/)9 :.71&+ )75 E' (;;&/'+ bQ .71<: E'87<' 7< Ab .71<: (85'< -.'?75.'<(;F
5<'(5?')5>
• "</5/-(&U "1; 7G'< -&'(< :I/) 7)&F> W7 )75 -1; 7G'< () (-5/G' :I/) &':/7)H ?7&':H :='&&/)9H
5<(1?(H /)8&(??(5/7)H /)8'-5/7)H 7< E1<): 2/)-&1+/)9 :1)E1<)3>
• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ./:57<FH /)-&1+/)9 E&''+/)9 +/:7<+'<: ()+
?'+/-(5/7) ./:57<FH E'87<' (;;&F/)9 -1;:>
• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ./:57<F 57 /+')5/8F +/(E'5':H )'1<7;(5./': 7<
75.'< -7)+/5/7): 5.(5 ?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) =.') ;&())/)9 57 15/&/\'
8/<' -1;;/)9>
• "</5/-(&U M-<'') ;(5/')5: 87< ./:57<F 78 <'(-5/G' :I/) &':/7): :1-. (: I'&7/+ :-(<</)9 7<
fw'E)'< ;.')7?')7)>
• "</5/-(&U #::':: -(<'81&&F 5.' 1:' 78 8/<' -1;;/)9 7) ;(5/')5: =.7 .(G' ( +'-<'(:'+
<':;7):' 57 ;(/) 2'>9>H 5.7:' =/5. +/(E'5': 7< )'1<7;(5./':3>
• "</5/-(&U K<(-5/5/7)'<: ?1:5 =(:. .()+: E'87<' :5(<5/)9 5.' ;<7-'+1<' ()+ (9(/) (85'<
<'?7G/)9 9&7G': 2/8 1:'+3>
• "</5/-(&U K'<:7)(& ;<75'-5/G' '01/;?')5 2KK63 R ='(< 9&7G': ()+ 'F' ;<75'-5/7) (5 (&&
5/?': =.') E&77+ 7< $KN% ?(F E' ;<':')5 2='5 -1;;/)9H -1;;/)9 (85'< )''+&/)93>
• "</5/-(&U 6(-. (<'( 57 E' ='5 -1;;'+ ?1:5 E' -&'()'+ /??'+/(5'&F E'87<' -1;;/)9 EF 5.'
;<(-5/5/7)'<>
• "</5/-(&U X()-'5: 1:'+ 87< ='5 -1;;/)9 :.71&+ E' :5'</&'H 1:'+ 7)&F 7)-'H 5.') +/:-(<+'+
/) ( ;<7;'< :.(<;: -7)5(/)'<>
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CCD
• "</5/-(&U N8 E&77+ 7< 75.'< $KN% (<' ;<':')5H -7&&'-5 =/5. -7557) :=(EH 9(1\'H ;(;'<
57='&H 7< -&75. ()+ +/:;7:' /) E/7.(\(<+ 5<(:.>
• "</5/-(&U ^.') E&77+ 7< 75.'< $KN% (<' ;<':')5H (&&7= 5.' G(-11? 57 E' -7?;<7?/:'+
:&7=&FH ()+ 5.') <'?7G' 5.' -1;>
•
"</5/-(&U N8 &1E</-()5: (<' 1:'+ 87< 9&/+/)9 -1;;/)9 7< ?7G/)9 -1;;/)9H +'-()5 ( ;7<5/7) 87<1:'> W7 )75 +/; E(-I /)57 &1E</-()5 -7)5(/)'< 7< 571-. 5.' :;715 78 ( ;1?; -7)5(/)'<
=./&' -1;;/)9>
• "</5/-(&U L:' (;;<7;</(5' KK6 =./&' -&'()/)9 ()+ +/:/)8'-5/)9 -1;:>
• "</5/-(&U "&'() (&& -1;: 78 (&& &1E</-()5: ()+ E/7&79/-(& ?(5'</(& 1:/)9 :7(; ()+ =(5'<
E'87<' +/:/)8'-5/)9>
• "</5/-(&U W/:/)8'-5 (&& -1;: 1:/)9 () (;;<7;</(5' [W#R-&'(<'+ /)5'<?'+/(5'R 57 ./9.R&'G'&
+/:/)8'-5/)9 :7&15/7) /) (--7<+()-' =/5. &(E'& /):5<1-5/7):>
• M5<7)9&F Y'-7??')+'+U L:' -(15/7) /8 -1;;/)9 ;(5/')5: -1<<')5&F 5(I/)9 ()5/R-7(91&()5
?'+/-(5/7):>
•
M5<7)9&F Y'-7??')+'+U "1;;/)9 7G'< )''+&': ?(F -(1:' )''+&': 57 5<(G'& E'F7)+ (
:(8' +';5.> 6/5.'< /):'<5 5.' )''+&' 7E&/01'&FH 7< (G7/+ 5.' 5.'<(;F /) (<'(: =/5.
1)+'<&F/)9 7<9():>
• M5<7)9&F Y'-7??')+'+U K&(-' E1<)/)9 ?(5'</(& /)57 5.' +'';':5 ;(<5 78 -1;H ()+ )'G'<
<'5(/) 5.' E1<)/)9 ?(5'</(& /):/+' 5.' -1;: =.') 5.' -1;: (<' ;&(-'+ 7)57 5.' :I/)>
• M5<7)9&F Y'-7??')+'+U $E:'<G' -(<'81& ()+ &/?/5 <'5')5/7) 5/?' 57 5.' ;.F:/-(&
57&'<()-' 78 5.' ;(5/')5>
• M5<7)9&F Y'-7??')+'+U W/:/)8'-5 (&& -1;: 1:/)9 ( ./9.R&'G'& +/:/)8'-5/)9 :7&15/7)
87&&7=/)9 ;(-I(9' +/<'-5/7): 87< :'?/R-</5/-(& +'G/-':>
•
M5<7)9&F Y'-7??')+'+U 6J;&(/) 5.'<(;'15/- /)5')5/7) 78 -1;;/)9 ()+ ;<':')5 ( 5/?'&/)'
78 <':7&15/7)> "1; -./&+<') 7)&F /) 5.' ;<':')-' 78 ( ;(<')5 7< (::/9)'+ 91(<+/()>
• Y'-7??')+'+U L:' +/:;7:(E&' -1;: 87< ='5 -1;;/)9 ()+ +/:;7:' 78 1:'+ ='5 -1;: /)
5.' E/7.(\(<+ 5<(:.>
• Y'-7??')+'+U # .()+715 'J;&(/)/)9 -1;;/)9 /) -&/)/-(& ;<(-5/-'H /)-&1+/)9 :I/) -.()9':
()+ ( 5/?'&/)' 87< 5.'/< <':7&15/7)H ?(F ;<75'-5 5.' ;(5/')5 8<7? 5.' :5<':: 78
?/:/)5'<;<'5(5/7)>
Sample Best Practice Protocols for Cupping
#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 -1;;/)9 :(8'5F 2K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F<'-7??')+(5/7): (E7G'H ()+ 1:/)9 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5.
-1;;/)9 5.'<(;/':H 5.' 87&&7=/)9 E':5 ;<(-5/-' 91/+'&/)': .(G' E'') +'G'&7;'+> #: :5(5'+ (5 5.'
:5(<5 78 5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<: 57 ;(5/')5:H
;<(-5/5/7)'<: ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (: )''+'+ 57 I'';
1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78 ;<(-5/-' (: &7)9 (:
:(8'5F <'?(/): 5.' ;</7</5F>
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CCS
Fire Cupping Method
!"#$ &'()*+,'* #-.(/.*$ 0"* ,$* (1 2- (&*- 1/23* -*2' 2 &20#*-04 !"#$ 3256 #1 0"* 0*)"-#7,* #$
!"# %"!& '(""#)*+, "--.'/"!.**+ -.0'& 102!/!3 ()+ E&/:5'</)9 78 5.' :I/) 28/<:5 7< :'-7)+ +'9<''
E1<)3> N) (++/5/7)H 5.' -1;;/)9 ?(F &'(G' <'+ 7< E<1/:'R&/I' -/<-1&(< ?(<I: =.'<' 5.' -1;: (<'
(;;&/'+> ,.' ;(5/')5 :.71&+ E' '+1-(5'+ 5.(5 5.':' ?(<I: (<' -7??7);&(-' =/5. 5./:5'-.)/01'> ,.' ;(5/')5 :.71&+ (&:7 E' /)87<?'+ 5.(5 5.'F :.71&+ I''; 5.' -1;;'+ (<'(
;<75'-5'+ 8<7? =/)+ 7< -7&+ +<(85:> N5 /: :5<7)9&F <'-7??')+'+ 5.(5 ;(5/')5: E' (:I'+ 87<
-7):')5 E'87<' (;;&F/)9 -1;;/)9 5'-.)/01':>
C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>
601/;?')5U -1;;/)9 ](<H .'?7:5(5H &/9.5'<H -7557) E(&&H (&-7.7&H ()+ E1<) -<'(?>
q<'-7??')+'+s
A> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s
T> N8 5.' (<'( 57 =./-. -1;;/)9 =/&& E' (;;&/'+ )''+: 57 E' -&'()'+H -&'()/)9 -() E'
(--7?;&/:.'+ =/5. (&-7.7&H :7(; ()+ =(5'<H 7< ()75.'< -&'():/)9 5'-.)/01' q-</5/-(&s
b> ,.' 8&(?' (;;(<(51: /: ;<';(<'+ EF -&(?;/)9 ( -7557) E(&& /) 5.' .'?7:5(5 ()+ 5.')
:&/9.5&F ?7/:5')/)9 5.' -7557) =/5. (&-7.7&> #&5'<)(5'&FH () (&-7.7& :=(E ?(F E' 1:'+>
D> ,.' ](< /: .'&+ =/5. 5.' ?715. 8(-/)9 ;'<;')+/-1&(<&F 57 5.' :I/) :1<8(-' /) 5.' )7)R
+7?/)()5 .()+> q:5<7)9&F <'-7??')+'+s
S> ,.' 8&(?' (;;(<(51: /: &/5 ()+ 5.') /) 7)' :/)9&' ?75/7)U
(> ,.' 8&(?' /: /)5<7+1-'+ +''; /)57 5.' -1; 01/-I&F ()+ ;1&&'+ (=(F (5 5.' :(?'
5/?' 5.(5 5.' -1; /: 5.') (;;&/'+ 57 5.' :I/) :1<8(-' q-</5/-(&s
E> ,.' .'?7:5(5 /: <'?7G'+ 7E&/01'&F (=(F 8<7? 5.' ;(5/')5k: :I/) :1<8(-' /) 7<+'<
57 '):1<' :(8'5F> q:5<7)9&F <'-7??')+'+s
-> ,.' 8&(?' /: 'J5/)91/:.'+> q-</5/-(&s
+> $)-' 5.' 8&(?' .(: E'') 'J5/)91/:.'+ ()+ 5.' 8&(?' (;;(<(51: <'?7G'+ 57 5.'
'01/;?')5 :1<8(-'H 5.' ;<(-5/5/7)'< =/&& +'5'<?/)' 5.' &'G'& 78 :1-5/7) /)+1-'+
()+ =/&& <'5(/) 5.' -1; 87< ARCB ?/)15': 7< ?7<' 7< <';'(5 5.' (E7G' ;<7-'+1<'
57 -<'(5' ( :5<7)9'< G(-11?>
4> ,.' -1; /: <'?7G'+ =.') 5.' 5.'<(;F /: +7)' EF 9')5&F ;<F/)9 5.' ](< '+9' 1; 8<7? 5.'
:I/) 7< +';<'::/)9 5.' :I/) )'J5 57 5.' </? 78 5.' -1; 57 +'8'(5 5.' G(-11?> ,.' -1; /:
5.') ;15 (:/+' ()+ ;<7-'::'+ 87< -&'()/)9 ()+ +/:/)8'-5/)9> q:5<7)9&F <'-7??')+'+s
Safety Considerations
• ! #$%& '#()& $* +,$#$-&. (/. *0 (## 1201&! #!$%&'()*+, &, )+-)%&($- $.,$/0$!$ )+ (0),
!"#$"% !$'( )* +,%%,-*./ 0#1%$.0#2 '*((0#2 $3 *4$03!*#( ,# " -,56 '$5+"1* (7"( 0' #,(
!"#$$#%"& (&#)* %+, (-, -(* ,.& ,)&#,$&(, ,#%"&/ 01)2,21#"3
• !"# %&'( )*+,# -.)/ 0# (#*/ ,1#+' &2 &0)/'.,/3&4)5 q:5<7)9&F <'-7??')+'+s
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CC4
• d(G' (--':: 57 =(5'< 57 ;15 715 5.' 8&(?' /8 )'-'::(<F 7< 57 -77& 5.' :I/) /8 ( :?(&& E1<)
+7': 7--1<> q<'-7??')+'+s
• K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 5.' -1; (;;&/-(5/7)> q:5<7)9&F
<'-7??')+'+s
•
!"#$ " &'($ $)*'+,-'./$( 0+ /"+1 '+ " (!!" $% &'$(' )!* +,- *.$%/ 0$,-R!"#$%&'( *+,,&'(-!"#$%&&#'(#()
• !" $%&'% ($ )%'*'"( +,-" -"./%01 2!"#$ &!" '() *+ ",#! #-. /"+*'" -0"
!"# %!&' ()*' +,!+
!"#$# &' () *$)+#( )$ ,$-,+#. -$#-! !"#$%$"&'(
Suction Cupping
"1;;/)9 ?(F &'(G' <'+ 7< E<1/:'R&/I' -/<-1&(< ?(<I: =.'<' 5.' -1;: (<' (;;&/'+> ,.' ;(5/')5
:.71&+ E' '+1-(5'+ 5.(5 5.':' ?(<I: (<' -7??7);&(-' =/5. 5./: 5'-.)/01'> ,.' ;(5/')5 :.71&+
(&:7 E' /)87<?'+ 5.(5 .' 7< :.' :.71&+ I''; 5.' -1;;'+ (<'( ;<75'-5'+ 8<7? =/)+ 7< -7&+
+<(85:> N5 /: :5<7)9&F <'-7??')+'+ 5.(5 ;(5/')5: E' (:I'+ 87< -7):')5 E'87<' (;;&F/)9 -1;;/)9
5'-.)/01':>
#: 5./: ?'5.7+ 1:': )7 8&(?'H E1<): (<' )75 () (+G'<:' 'G')5 (::7-/(5'+ =/5. 5./: ?'5.7+ 78
-1;;/)9>
Method
C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>
601/;?')5U -1;;/)9 ](<:H ;1?; 'J5<(-57<H &1E</-()5> q<'-7??')+'+s
A> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s
T>
N8 5.' (<'( 57 =./-. -1;;/)9 =/&& E' (;;&/'+ )''+: 57 E' -&'()'+H 1:' (&-7.7&H :7(; ()+=(5'<H 7< ()75.'< -&'():/)9 5'-.)/01'> q:5<7)9&F <'-7??')+'+s
b> # :?(&& (?71)5 78 &75/7) 7< &1E</-()5 /: (;;&/'+ 57 5.' :I/)> q<'-7??')+'+s
D> K&(-' 5.' -1; 7) 5.' :I/)H (55(-. 5.' ;1?; 'J5<(-57<H ()+ <'?7G' ')719. (/< 57 E</)9
:7?' :I/) /)57 5.' -1;>
S> ,.' -1; /: <'?7G'+ =.') 5.' 5.'<(;F /: +7)' EF <'&'(:/)9 5.' :1-5/7) G(&G' 57 +'8'(5
5.' G(-11?> ,.' -1; /: 5.') ;15 (:/+' ()+ ;<7-'::'+ 87< -&'()/)9 ()+ +/:/)8'-5/)9>
q<'-7??')+'+s
Wet Cupping
,./: ?'5.7+ /)G7&G': E75. E&77+R&'55/)9 ()+ -1;;/)9> O':5 ;<(-5/-': 87< E75. ;(<5: 78 5./:
5<'(5?')5 (<' /)-7<;7<(5'+ E'&7=>
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CCQ
Method
C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>
601/;?')5U -1;;/)9 ](<:H &1E</-()5H ()+ ( -&'() 8/'&+ =/5. &()-'5:H -7557) E(&&:H (&-7.7&
:=(E:H :5'</&' 9(1\'H :.(<;: -7)5(/)'<H ()+ :I/) -&'():'<> q<'-7??')+'+s
A>
,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&sT> K<(-5/5/7)'<: ?1:5 1:' 9&7G': ()+ :.71&+ (&:7 15/&/\' 'F' ;<75'-5/7) 57 ;<'G')5 'J;7:1<'
57 E&77+> q-</5/-(&s
b> ,.' (<'( 57 =./-. -1;;/)9 =/&& E' (;;&/'+ /: -&'()'+ =/5. (&-7.7& 27< ?(F E' 5.7<719.&F
-&'()'+ =/5. (;;<7;</(5' ?(5'</(&: :1-. (: :7(; ()+ =(5'<3> q-</5/-(&s
D> ,.' :I/) (5 5.' :/5' :.71&+ E' ;1)-51<'+ 1:/)9 :5'</&' &()-'5:H =/5. ( )'= &()-'5 E'/)9
1:'+ 87< '(-. ;1)-51<'> q-</5/-(&s W/:-(<+ 5.' &()-'5: +/<'-5&F /)57 5.' :.(<;: -7)5(/)'<
(85'< 1:'> q-</5/-(&s
S> #;;&F 5.' -1;: 2;1?; 7< 8&(?' -1;;/)9 (: +':-</E'+ (E7G'3 ()+ <'5(/) 87< 5.' +':/<'+
&')95. 78 5.'<(;F>4> N8 5.' ;<(-5/5/7)'< .(: <'?7G'+ '/5.'< 9&7G': 7< 9799&':H ;15 5.' ;'<:7)(& ;<75'-5/G'
'01/;?')5 2KK63 E(-I 7) 87< -1; <'?7G(&> q-</5/-(&s
Q> #&&7= 5.' G(-11? 57 E' -7?;<7?/:'+ :&7=&F 5.') <'?7G' 5.' -1;H 5(I/)9 -(<' 57
;<'G')5 E7+F 8&1/+ 8<7? :;<'(+/)9 7< :;&(:./)9> q-</5/-(&s
P> N??'+/(5'&F /:7&(5' 5.' -1;:>
CB> M57; ()F -7)5/)1'+ E&''+/)9 5.<719. 1:' 78 (;;<7;</(5' ;<'::1<' 1:/)9 :5'</&' 9(1\'>
q-</5/-(&s
CC> "&'() 1; ()F E&''+/)9 5.(5 .(: 7--1<<'+> "&'() 5.' :/5' 78 5.' ;1)-51<': =/5. ()
(;;<7;</(5' :I/) -&'():'<> q:5<7)9&F <'-7??')+'+s
CA> W/:-(<+ 'J5<(G(:(5'+ E&77+ /) 5.' E/7.(\(<+ 5<(:.> q-</5/-(&s
CT> N??'+/(5'&F =(:. -1;: =/5. :7(; ()+ =(5'<>
Cb> Y'?7G' 9799&':H 97=) ()+ 9&7G':> W/:;7:' 78 KK6 (: /)+/-(5'+ EF 5.' -&/)/-k: $Md#
:5()+(<+>
CD> ̂ (:. .()+: =/5. :7(; ()+ =(5'<> q-</5/-(&s
CS> Y'?7G' -1;: 57 ;<7-'::/)9 (<'( 87< /):5<1?')5 +'-7)5(?/)(5/7)>
C4> "&'() 5.' -1;: 78 ()F E/7&79/-(& ?(5'</(& =/5. :7(; ()+ =(5'< ()+ &1E</-()5 ,d6*
:5'</&/\' 5.' -1;:> q-</5/-(&s $<H +/:-(<+ -7)5(?/)(5'+ -1;: /) 5.' E/7.(\(<+ 5<(:.>
q<'-7??')+'+s
CQ> M5'</&/\' =/5. ( (157-&(G' 7< EF 87&&7=/)9 &(E'& /):5<1-5/7) 87< ./9.R&'G'& +/:/)8'-5/7)
:7&15/7) 287< 'J(?;&'H /??'<:' 87< S .71<: /) 4>Tt .F+<79') ;'<7J/+' :7&15/7)3>q-</5/-(&s
CP> "&'() '01/;?')5 :1<8(-' ()+ 5(E&' =/5. () (;;<7;</(5' +/:/)8'-5()5 :7&15/7)> q-</5/-(&s
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CCP
4. Therapeutic Blood Withdrawal
Bleeding Overview
N) FC*-$.$ =7)@)-7%)1$ "-+ H/D*R).%*/-5 2C3 5.' 1:' 78 5.' 5.<''R'+9'+ )''+&' 2&()-'3 /: :(/+
57 .(G' E'') ./:57</-(&&F 1:'+ 87< ./9. 8'G'<H ?')5(& +/:7<+'<:H :7<' 5.<7(5H ()+ &7-(& -7)9':5/7)7< :='&&/)9> %7+'<) ;<(-5/5/7)'<: ?(F 1:' E&''+/)9 5'-.)/01': 57 -&'(< .'(5 :F)+<7?':H
:5<7)9&F +/:;'<:' ;7/)5:H ()+ :5<7)9&F :5/?1&(5' :;'-/8/- ;7/)5:> #: 57 5'-.)/01'H 5.' ;7/)5 57 E'
E&'+ /: ;</-I'+ :1;'<8/-/(&&FH ]1:5 B>BDRB>C -1) 2/)-.':3 +'';H =./-. :.71&+ E' &/9.5 ()+
:1;'<8/-/(& ()+ 5.' (?71)5 78 E&''+/)9 57 E' z+'5'<?/)'+ EF 5.' ;(5.7&79/-(& -7)+/5/7)>z N)
9')'<(&H (-1;1)-51</:5: :.71&+ 1:' -(15/7) /8 '?;&7F/)9 E&''+/)9 5.'<(;F 87< ;'<:7): =.7 .(G'
='(I)':: 78 5.'/< F/) 7< F()9 0/H ( E&''+/)9 +/:7<+'<H ( ='(I -7):5/515/7)H 7< =.7 5(I'
()5/-7(91&()5 ?'+/-(5/7)>
General Recommendations for Bleeding Techniques
• "</5/-(&U K'<:7)(& ;<75'-5/G' '01/;?')5 2KK63 R ='(< 9&7G': (5 (&& 5/?': (: E&77+ ()+
$KN% =/&& E' ;<':')5>
• "</5/-(&U X()-/)9 +'G/-': ?1:5 E' &/?/5'+ /) 1:' 57 ( :/)9&' ;(5/')5>
• "</5/-(&U X()-'5: :.71&+ E' 1:'+ 7)&F 7)-'H ()+ 5.') +/:-(<+'+ /) ( ;<7;'< :.(<;:
-7)5(/)'<>
• "</5/-(&U X()-'5: :.71&+ E' 1:'+ 7)&F 7)-' ()+ -())75 E' <'/):'<5'+ /)57 ()75.'< :/5'
7) 5.' :(?' 7< ( +/88'<')5 ;(5/')5>
• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ./:57<FH /)-&1+/)9 E&''+/)9 +/:7<+'<: ()+
?'+/-(5/7) ./:57<FH E'87<' 1:/)9 E&''+/)9 5'-.)/01':>
• "</5/-(&U W7 )75 E&''+ /) () (<'( 78 () (-5/G' :I/) &':/7)>
• Y'-7??')+'+U L5/&/\' 'F' ;<75'-5/7)H :1-. (: 9799&':H =.') ;'<87<?/)9 E&''+/)9
5'-.)/01':>
• Y'-7??')+'+U L5/&/\' :/)9&'R1:' &()-'5: ')9/)''<'+ 57 <'5<(-5 (85'< 1:' 57
:/9)/8/-()5&F <'+1-' 5.' </:I 78 )''+&':5/-I /)]1</':>
Sample Best Practice Protocol for Bleeding Acupuncture Points
#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 E&''+/)9 :(8'5F 2/) K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F
<'-7??')+(5/7): (E7G'H ()+ 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5. E&''+/)9
;<(-5/-':H 5.' 87&&7=/)9 E':5 ;<(-5/-' 91/+'&/)': .(G' E'') +'G'&7;'+> #: :5(5'+ (5 5.' :5(<5 78
5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<: 57 ;(5/')5:H
;<(-5/5/7)'<: ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (: )''+'+ 57 I'';
1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78 ;<(-5/-' (: &7)9 (:
:(8'5F <'?(/): 5.' ;</7</5F>
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CAB
Method
C> M'&'-5 ( -&'()H +<FH 8&(5 :1<8(-' 57 :'<G' (: 5.' :'55/)9 87< 5.' -&'() 8/'&+> 2*75'U ,.'
:'&'-5'+ &7-(5/7) "#**$, E' 5.' 5<'(5?')5 5(E&'}3q:5<7)9&F <'-7??')+'+s
A> ^(:. .()+: 87< (5 &'(:5 CBRCD :'-7)+: 1)+'< <1))/)9 =(5'<H &(5.'</)9 ='&& =/5. :7(;>
$<H /8 :7(; ()+ =(5'< (<' 1)(G(/&(E&'H -&'() .()+: =/5. () (&-7.7&RE(:'+ .()+ :()/5/\'<>q-</5/-(&s
T> K&(-' ( -&'() ;(;'< 57='&H -&'() 5(E&' ;(;'< 7< 75.'< E(<</'< 5.(5 =/&& :'<G' (: ( -&'()
8/'&+ 7) 5.' =7<I :1<8(-' /) ( =(F 5.(5 +7': )75 -7?;<7?/:' 5.' -&'()&/)':: 78 5.'
:1<8(-' 5.(5 =/&& :'<G' (: 5.' -&'() 8/'&+> q-</5/-(&s
b> M'5 715 5.' ?(5'</(&: )''+'+ 87< ( 5<'(5?')5> X()-'5: :.71&+ E' ;&(-'+ 7) 5.' -')5'< 78
5.' -&'() 8/'&+ 8/<:5> q<'-7??')+'+s
D> "&'() /5'?: :1-. (: -7557) E(&&: ()+ 1)7;')'+ (&-7.7& :=(E: ?(F '/5.'< E' ;&(-'+ 7)
5.' -&'() 8/'&+ 7< I';5 /) ](<: 7< -7)5(/)'<: )'(< 5.' -&'() 8/'&+ :7 (: 57 E' (5 .()+ 87<
5.' ;<(-5/5/7)'<> q<'-7??')+'+sS> K15 7) 9&7G': q-</5/-(&s ()+ 9799&': 7< 75.'< 'F' ;<75'-5/7) (: /)+/-(5'+ EF 5.' :(8'5F
-7??/55'' 7< 788/-'< (5 F71< -&/)/-> q<'-7??')+'+s
4> 6):1<' 5.(5 5.' ;(5/')5k: :I/) /: -&'() E'87<' /):'<5/)9 ( &()-'5> MI/) -() E' -&'()'+ =/5.
4Bt /:7;<7;F& (&-7.7&H :7(; ()+ =(5'<H 7< ()75.'< ?'5.7+> q-</5/-(&s N8 1:/)9 () (&-7.7&
:=(EH (&&7= 5.' (&-7.7& 57 +<F> q-</5/-(&s
Q> K1&& 5.' :I/) 5(15 )'(< 5.' (<'( 57 E' &()-'+> q<'-7??')+'+s
P> K<':: 5.' &()-'5 01/-I&F /)57 5.' ;7/)5> M7?' ;<(-5/5/7)'<: ;7:/5/7) 5.' &()-'5 E'G'& :/+'
+7=) 7G'< ()+ ]1:5 &(5'<(& 57 5.' /)5')+'+ ;7/)5H 5.') <7&& 5.' &()-'5 7G'< ()+ /)57 5.'
;7/)5 /) 7<+'< 57 (G7/+ 5.' +/:-7?87<5 78 ( :1++') +''; )''+&':5/-I> L:' ( <'5<(-5(E&'
:/)9&'R1:' &()-'5 /8 5.' ?'5.7+ E'/)9 1:'+ (&&7=: 87< 5.' 1:' 78 :1-.> q<'-7??')+'+s
M1-. +'G/-': 5')+ 57 ;<7+1-' ( +'';'< )''+&':5/-I ()+ ?(F -(1:' ?7<' ;(5/')5
+/:-7?87<5 E15 ?(F &/?/5 )''+&':5/-I </:I> d7='G'<H <'5<(-5(E&' +'G/-': ?1:5 E' 1:'+ 7)
( :/)9&' ;(5/')5 ()+ +/:-(<+'+>
CB> W/:;7:' 78 5.' &()-'5 /??'+/(5'&F /)57 () (;;<7;</(5' :.(<;: -7)5(/)'<> q-</5/-(&s
CC> n%/&Ip 7< n:01''\'p ')719. E&77+ 8<7? 5.' &()-'+ ;7/)5 (: /)+/-(5'+ 87< 5.' <':1&5 F71
'J;'-5>
CA> L:' ( :5'</&' -7557) E(&& 7< 9(1\' 57 <'?7G' E&77+ 8<7? 5.' &()-'+ (<'(>
q<'-7??')+'+s
CT> W/:;7:' 78 5.' -7557) E(&& /) 5.' E/7.(\(<+ 5<(:.> q:5<7)9&F <'-7??')+'+s
Cb> Y''J(?/)' )''+&'+ :/5': ( :'-7)+ 5/?' 87< :/9): 78 E&''+/)9 7< .'?(57?(H ()+ (;;&F
;<'::1<' =/5. ( :5'</&' -7557) E(&& 7< 9(1\' /8 )'-'::(<F> q<'-7??')+'+s
CD> "&'() 5.' :/5' 78 5.' &()-'+ :I/) ()+ -7G'< =/5. ( E()+(9' (: )'-'::(<F /8 /5 /: :5/&&
E&''+/)9> q:5<7)9&F <'-7??')+'+s
CS> Y'?7G' 9&7G': ()+ 9799&':> W/:;7:' 78 KK6 (: /)+/-(5'+ EF 5.' -&/)/-k: $Md# :5()+(<+>
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CAC
C4> ̂ (:. .()+: /??'+/(5'&F (85'< -7?;&'5/)9 5.' ;<7-'+1<' ()+ <'?7G/)9 9&7G':> q-</5/-(&s
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CAA
4. Plum Blossom/Seven Star Needle
Plum Blossom Overview
K&1? E&7::7?`:'G') :5(< )''+&': 27< -15()'71: (-1;1)-51<'3 /: +':-</E'+ /) =7)@)-7%)1$T =
F/B@1$C$-.*2$ G$D% 2A3 (: E'/)9 1:'81& 57 5<'(5 5.' -15()'71: -.())'&: ()+ /)5'<)(& +/:'(:':(::7-/(5'+ =/5. 5.' ?'</+/() 7G'< =./-. 5.' :I/) =/&& E' 5(;;'+> M'G') :5(< )''+&/)9 /: 1:'+ /)
#$% ;<(-5/-': 87< 5.' 5<'(5?')5 78 ( G(</'5F 78 ;(/) :F)+<7?':>
General Recommendations for Plum Blossom
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+:
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/-:
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 !A*- 01$@"1"%*/->
• "</5/-(&U KK6 /: <'01/<'+ a ='(< 9&7G': (5 (&& 5/?': (: E&77+ ()+ $KN% =/&& E' ;<':')5>
• "</5/-(&U ,.' (<'( 57 E' 5<'(5'+ ?1:5 E' -&'() ()+ 8<'' 78 ()F :I/) &':/7): 7< 5<(1?(5/-
/)]1<F>
• "</5/-(&U ,.' (<'( 78 ;(5/')5k: :I/) 57 E' 5<'(5'+ ?1:5 E' -&'() ;</7< 57 5<'(5?')5>
• "</5/-(&U ,.' .'(+ 78 5.' ;&1? E&7::7? +'G/-' ?1:5 E' :5'</&'> W7 )75 571-. 5.' 5/;: 78
5.' )''+&':>
• "</5/-(&U L:' 7)&F :/)9&'R1:' :5'</&' ;&1? E&7::7? )''+&':>
• "</5/-(&U L:'+ ;&1? E&7::7? )''+&': ?1:5 E' +/:-(<+'+ /)57 ( ;<7;'< :.(<;: -7)5(/)'<
/??'+/(5'&F (85'< 1:'>
• M5<7)9&F Y'-7??')+'+U #G7/+ E</)9/)9 5.' .()+ .7&+/)9 5.' .(??'< 1; 577 ./9. 7<
5(;;/)9 577 87<-'81&&F :7 (: 57 ;<'G')5 ;1)-51</)9 5.' :I/)>• M5<7)9&F Y'-7??')+'+U #G7/+ 8&/)9/)9 5.' .(??'< (<71)+ :7 (: 57 ;<'G')5 5.' :;<'(+
78 E&77+ 7< $KN%>
• Y'-7??')+'+U K<(-5/5/7)'<: :.71&+ ='(< 9&7G': ()+ 'F' ;<75'-5/7) =./&' 1:/)9 5.'
;&1? E&7::7? +'G/-'>
Best Practice Protocols for Plum Blossom
#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 ;&1? E&7::7? :(8'5F 2K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F
<'-7??')+(5/7): (E7G'H ()+ 1:/)9 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5.
:'G') :5(< )''+&/)9 ;<(-5/-':H 5.' 87&&7=/)9 E':5 ;<(-5/-' 91/+'&/)': .(G' E'') +'G'&7;'+> #:
:5(5'+ (5 5.' :5(<5 78 5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<:
57 ;(5/')5:H ;<(-5/5/7)'<:H ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (:
)''+'+ 57 I''; 1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78
;<(-5/-' (: &7)9 (: :(8'5F <'?(/): 5.' ;</7</5F>
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CAT
Method
C> M'&'-5 ( -&'()H +<FH 8&(5 :1<8(-' 57 :'<G' (: 5.' :'55/)9 87< 5.' -&'() 8/'&+> 2*75'U ,.'
:'&'-5'+ &7-(5/7) "#**$, E' 5.' 5<'(5?')5 5(E&'}3q:5<7)9&F <'-7??')+'+s
A> ^(:. .()+: 87< (5 &'(:5 CBRCD :'-7)+: 1)+'< <1))/)9 =(5'<H &(5.'</)9 ='&& =/5. :7(;>
$<H /8 :7(; ()+ =(5'< (<' 1)(G(/&(E&'H -&'() .()+: =/5. () (&-7.7&RE(:'+ .()+ :()/5/\'<>q-</5/-(&s
T> K&(-' ( -&'() ;(;'< 57='&H -&'() 5(E&' ;(;'< 7< 75.'< E(<</'< 5.(5 =/&& :'<G' (: ( -&'()
8/'&+ 7) 5.' =7<I :1<8(-' /) ( =(F 5.(5 +7': )75 -7?;<7?/:' 5.' -&'()&/)':: 78 5.'
:1<8(-' 5.(5 =/&& :'<G' (: 5.' -&'() 8/'&+> q<'-7??')+'+s
b> M'5 715 5.' ?(5'</(&: )''+'+ 87< ( 5<'(5?')5> M'G') :5(< .(??'<: :.71&+ E' ;&(-'+ 7)
5.' -')5'< 78 5.' -&'() 8/'&+ 8/<:5> q<'-7??')+'+s
D> "&'() /5'?: :1-. (: -7557) E(&&: ()+ 1)7;')'+ (&-7.7& :=(E: ?(F '/5.'< E' ;&(-'+ 7)
5.' -&'() 8/'&+ 7< I';5 /) ](<: 7< -7)5(/)'<: )'(< 5.' -&'() 8/'&+ :7 (: 57 E' (5 .()+ 87<
5.' ;<(-5/5/7)'<> q<'-7??')+'+sS> K15 7) 9&7G': q-</5/-(&s ()+ 9799&': 7< 75.'< 'F' ;<75'-5/7)> q<'-7??')+'+s
4> 6):1<' 5.(5 5.' ;(5/')5k: :I/) /: -&'() E'87<' 15/&/\/)9 5.' ;&1? E&7::7? )''+&'> q-</5/-(&s
MI/) -() E' -&'()'+ =/5. 4Bt /:7;<7;F& (&-7.7&H :7(; ()+ =(5'<H 7< ()75.'< ?'5.7+> N8
1:/)9 () (&-7.7& :=(EH (&&7= 5.' (&-7.7& 57 +<F> q-</5/-(&s
Q> ,.' :'G') :5(< .(??'< /: .'&+ CRA /)-.': (E7G' 5.' :1<8(-' 78 5.' :I/) ()+ 5(;;'+
<(;/+&F (&7)9 5.' (<'( 57 E' :5/?1&(5'+> #G7/+ E</)9/)9 5.' .()+ .7&+/)9 5.' .(??'< 1;
577 ./9. 7< 5(;;/)9 577 87<-'81&&F :7 (: 57 ;<'G')5 ;1)-51</)9 5.' :I/)> #G7/+ 8&/)9/)9 5.'
.(??'< (<71)+ :7 (: 57 ;<'G')5 :;<'(+ 78 E&77+ 7< $KN%> q<'-7??')+'+s
P> ^.') 5.' :I/) E'-7?': <'+H 7< ;<7;'< <'(-5/7) .(: E'') 7E:'<G'+H :57; 15/&/\/)9 5.'
;&1? E&7::7? +'G/-'> q<'-7??')+'+s
CB> W/:;7:' 78 5.' ;&1? E&7::7? .(??'< /??'+/(5'&F /)57 () (;;<7;</(5' :.(<;:
-7)5(/)'<> q-</5/-(&s
CC> "&'() 5.' :/5' 78 5.' 5<'(5?')5 ()+ -7G'< =/5. ( E()+(9' (: )'-'::(<F 2/8 E&''+/)93>
q<'-7??')+'+s
CA> Y'?7G' 9&7G': ()+ 9799&':> W/:;7:' 78 1:'+ KK6 (: /)+/-(5'+ EF 5.' -&/)/-k: $Md#
+7-1?')5>
CT> ̂ (:. .()+: /??'+/(5'&F (85'< -7?;&'5/)9 5.' ;<7-'+1<' ()+ <'?7G/)9 9&7G':> q-</5/-(&s
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CAb
5. Gua Sha
Gua Sha Overview
Z1( :.( /: 5.' ;<7-':: 78 -&7:'&FR5/?'+ 1)/+/<'-5/7)(& ;<'::R:5<7I/)9 78 5.' E7+F :1<8(-' =/5. (
:?775.R'+9'+ /):5<1?')5 57 /)5')5/7)(&&F <(/:' 5<():/57<F 5.'<(;'15/- ;'5'-./(' ()+'--.F?7:/: <';<':')5/)9 'J5<(G(:(5'+ E&77+ /) 5.' :1E-15/:> Z1( :.( /: )75 (::7-/(5'+ =/5.
:/9)/8/-()5 (+G'<:' 'G')5: 'J-';5 ?/:/)5'<;<'5(5/7) 78 5.'<(;'15/- ;'5'-./(' (: /&&)'::H /)]1<FH
7< (E1:' EF 75.'< ;<(-5/5/7)'<:> M51+F =/5. ( 01(&/8/'+ 91( :.( /):5<1-57< /: <'-7??')+'+ 57
&'(<) ;<'-/:'&F .7= ()+ =.'<' 57 91( :.( ()+ .7= 57 1:' 91( :.( /) ( -&/)/-(& ;<(-5/-'> 2M'' K(<5
N 87< 5.' &/5'<(51<' <'G/'=>3
Summary of Gua Sha Recommendations
• "</5/-(&U [7&&7= M5()+(<+ K<'-(15/7):>
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+:
• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/-:
• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ;(5/')5 ./:57<FH /)-&1+/)9 E&''+/)9 +/:7<+'<:
()+ ?'+/-(5/7) ./:57<FH E'87<' 15/&/\/)9 91( :.( /) 7<+'< 57 ;&() 87< ()F 'J-'::/G'
;'5'-./(' ;<7+1-5/7)>
• "</5/-(&U Z1( :.( :.71&+ )75 E' (;;&/'+ bQ .71<: E'87<' 7< Ab .71<: (85'< -.'?75.'<(;F
5<'(5?')5>
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CAS
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CAQ
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CAP
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Summary of Safety Recommendations for Clean Injection Technique
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References
C> ".')9 l/))7)9 2-./'8 '+/57<3> FC*-$.$ =7)@)-7%)1$ "-+ H/D*R).%*/->[7<'/9) X()91(9':
K<'::H O'/]/)9i CPQ4
A> $_"7))7< V ()+ O'):IF W 25<():&(57<:3> =7)@)-7%)1$T = F/B@1$C$-.*2$ ,'J5> 6(:5&()+ K<'::H
M'(55&'H ^#> CPQC>T> Y15(&( ^#H ^'E'< WVH ()*+$,*-$ #/1 K*.*-#$7%*/- "-+ !%$1*,*W"%*/- *- I$",%C7"1$ <"7*,*%*$.5
XYYZ> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) d'(&5.-(<' N)8'-5/7) "7)5<7& K<(-5/-':
#+G/:7<F "7??/55'' 2dN"K#"3>
.55;U``===>-+->97G`./-;(-`;+8`91/+'&/)':`W/:/)8'-5/7)y*7GyABBQ>;+8 Y'G/'='+
W'-'?E'< APH ABBP> #--'::'+ V()1(<F CQH ABCD>
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CTB
b> */'&:') #H f&/9&'< OH f7&& OM> =++$-+)BU M(8'5F ;<757-7&: 87< Z1( :.( 2;<'::R:5<7I/)93 ()+
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.55;U``===>-+->97G`/)]'-5/7):(8'5F`"W":Y7&'>.5?& #--'::'+ V()1(<F ABCT>
4> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) $)' ()+ $)&F "(?;(/9)>
.55;U``===>7)'()+7)&F-(?;(/9)>7<9`:(8'y/)]'-5/7)y;<(-5/-':> #--'::'+ V()1(<F ABCT>
Q> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)> M(8' N)]'-5/7) K<(-5/-' 57 K<'G')5 ,<():?/::/7)
78 N)8'-5/7): 57 K(5/')5:>
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CTC
Part IV – Infections Associated with Acupuncture and
Related Healthcare Practices
1. PathogensN5 /: '::')5/(& 5.(5 ;<(-5/5/7)'<: 1)+'<:5()+ 5.' ?'-.()/:?: 78 +/:'(:' 5<():?/::/7) ()+ I)7=
5.' -.(<(-5'</:5/-: 78 /)8'-5/71: +/:'(:':H ;(<5/-1&(<&F E&77+E7<)' ;(5.79'): :1-. (: .';(5/5/:
()+ dNcH :I/) /)8'-5/7): 8<7? !%"@C&,/7/77). ()+ !%1$@%/7/77). ()+ 75.'< -7??7) .'(&5.-(<'
(::7-/(5'+ /)8'-5/7): 2d#N3> ,.' I)7=&'+9' 78 ?'-.()/:?: ()+ -.(<(-5'</:5/-: 1)+'<:-7<': 5.'
)''+ 57 1:' "&'() *''+&' ,'-.)/01' 87< 5.' ;<75'-5/7) 78 ;(5/')5:H ;<(-5/5/7)'<:H ()+ :5(88> N5 /:
/?;'<(5/G' 87< () (-1;1)-51</:5 57 -7):/+'< 5.' :(8'5F 78 ;(5/')5:H -&/)/-/():H ()+ 75.'<
?'?E'<: 78 5.' -&/)/- :5(88> #+.'<')-' 57 "&'() *''+&' ,'-.)/01' =/&& <'+1-' 5.' </:I 78 5.'
:;<'(+ 78 E&77+E7<)' ()+ :1<8(-' ;(5.79'):>
Y'(+'<: 78 5./: ?()1(& :.71&+ )75' 5.(5 5.'<' (<' .1)+<'+: 78 ;(5.79'): 5.(5 (<' )75(++<'::'+ .'<'/)> #-1;1)-51<' ;<(-5/5/7)'<: ?1:5 I''; (E<'(:5 78 +'G'&7;?')5: /) .'(&5.-(<'
(::7-/(5'+ /)8'-5/7): ()+ :5(5' ()+ )(5/7)(& :5()+(<+: 57 -7)5<7& :1-. /)8'-5/7): /) -&/)/-(&
:'55/)9:>
2. Mechanisms of Disease Transmission
# 81)+(?')5(& <7&' 78 5.' /??1)' :F:5'? /: 57 +/88'<')5/(5' :'&8 8<7? )7)R:'&8> ,./:
+/88'<')5/(5/7) (&&7=: 5.' /??1)' :F:5'? 57 (55(-I 87<'/9) 7< ;(5.79')/- G/<1:': ()+ E(-5'</(
=./&' ;<75'-5/)9 5.' E7+Fk: 7=) -7):5/51')5:> [(/&1<' 78 5./: (E/&/5F 57 +/88'<')5/(5' :'&8 8<7?
)7)R:'&8 ?(F <':1&5 /) G(</71: /)8'-5/7): ()+ (157/??1)' +/:7<+'<:> ,.' ;<':')-' 78 G/<1:': 7<E(-5'</( (-5/G(5': /??1)' 8(-57<: 57 <':;7)+ 57 ;(5.79')/- 7<9()/:?:> ,.' /??1)' :F:5'?
-7):/:5: 78 .1?7<(& ()+ -'&&1&(< -7?;7)')5:> d1?7<(& -7?;7)')5: -7):/:5 78 5.' -7):5/515/G'
-7?;&'?')5 ;<75'/) :F:5'? ()+ /??1)79&7E/):> ,.':' ;<75'/): (<' 871)+ /) 5.' &/01/+ 8<(-5/7)
78 5.' E&77+H (: ='&& (: /) 75.'< 5/::1':> "'&&1&(< -7?;7)')5: /)-&1+' )'15<7;./&:H
?(-<7;.(9':`?7)7-F5':H (: ='&& (: O -'&&: ()+ , -'&&:> ,.' /??1)' <':;7):'H /)-&1+/)9 5.'
<':;7):' 57 /)8'-5/7)H <':1&5: 8<7? 5.' -7?;&'J /)5'<(-5/7) E'5='') 5.' .1?7<(& ()+ -'&&1&(<
-7?;7)')5: 78 5.' /??1)' :F:5'?>
,.' E7+F /: -7):5()5&F 'J;7:'+ 57 /)8'-5/71: (9')5:H :7?' 78 =./-. (<' )7<?(&&F 871)+ /) 7< 7)
:;'-/8/- (<'(: 78 5.' E7+FH ':;'-/(&&F 7) 5.' :I/)H /) 5.' ?715.H <':;/<(57<F ;(::(9'=(F:H
1</)(<F 5<(-5H -7&7)H ()+ ?1-71: ?'?E<()': 78 5.' 'F':> %()F 78 5.':' 7<9()/:?: 5.(5 (<'
)7<?(&&F ;<':')5 (<' -(;(E&' 78 -(1:/)9 +/:'(:' /8 5.'F 9(/) (--':: 57 75.'< 5/::1': 7< /8 5.'
/??1)' :F:5'? /: /)'88'-5/G' /) -7)5<7&&/)9 5.' /)8'-5/71: (9')5> N) (++/5/7)H ( ;'<:7) /:
/)5'<?/55')5&F 'J;7:'+ 57 G/<1&')5 E(-5'</( ()+ G/<1:': 8<7? 715:/+' 5.' E7+F 5.(5 -() -(1:'
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CTA
:;'-/8/- +/:'(:':H :1-. (: ;)'1?7)/(H :5<';57-7--(& ()+ :5(;.F&7-7--(& /)8'-5/7):> ,.':'
/)8'-5/71: (9')5: ?(F E' G'<F /)G(:/G' ()+ 7G'<-7?' 5.' )(51<(& E(<</'<: 57 /)8'-5/7)>
*(51<(& E(<</'<: /)-&1+' /)5(-5 :I/) ()+ ?1-71: ?'?E<()': 78 5.' )7:'H 5.<7(5H 1<'5.<(H ()+
<'-51?> *(51<(& E(<</'<: (&:7 /)-&1+' :57?(-. (-/+ 29(:5</- (-/+ ;<7G/+': )7):;'-/8/- /??1)/5F
57 /)9':5'+ E(-5'</(& ;(5.79'):3 ()+ ( .'(&5.F <':;/<(57<F ?1-7:(H =./-. -() 'J;'& /).(&'+
;(5.79'):> $5.'< 8(-57<: /) 5.' /??1)' <':;7):' 5.(5 ;<75'-5 5.' E7+F 8<7? /)G(:/7) ()+
/)8'-5/7) (<' 5.' (-5/G/5F 78 5.' ';/5.'&/(& :I/) &(F'< ()+ ?1-1: ?'?E<()':H ()+ 5.' -&'():/)9
'88'-5: 78 5'(<:H 1</)'H ()+ G(9/)(& :'-<'5/7):>
%/-<7E': -() ')5'< 5.' E7+F 5.<719. ( E<'(I /) 5.' :I/)H :1-. (: ( -15 7< =71)+H 7< 5.<719. ()
7</8/-' 2?715.H )7:'H 1<'5.<(H '5->3> #)F /)8'-5/71: (9')5 -() -(1:' /)8'-5/7) /8 /5 9(/): (--':: 57
5/::1': ()+ :;(-': /) 5.' E7+F =.'<' /5 /: (&&7='+ 57 ;<7&/8'<(5' ()+ /)/5/(5' () /??1)'
<':;7):'> ,.'<' (<' ?()F ;75')5/(& :71<-': 78 /)8'-5/71: +/:'(:': /) () (-1;1)-51<' ;<(-5/-'
:'55/)9> ,.':' /)-&1+' -7)5(?/)()5: 7) 5.' :I/) 78 ;<(-5/5/7)'<:k ()+ ;(5/')5:k .()+:H E&77+H:(&/G(H :='(5H )(:(& ()+ 75.'< E7+/&F :'-<'5/7):H +1:5H -&75./)9H ()+ .(/<> N)8'-5/7): (::7-/(5'+
=/5. (-1;1)-51<' ?(F E' -&(::/8/'+ /)57 5=7 5F;': (--7<+/)9 57 5.' :71<-' 78 5.' +/:'(:' (9')5
a (1579')71: ()+ -<7::R/)8'-5/7):>
Autogenous Infections
#1579')71: 28<7? 5.' X(5/) n(157p a :'&8 ()+ n9')71:p a 9')'<(5'+3 /)8'-5/7): (<' -<'(5'+
=.') ;(5.79'): (&<'(+F ;<':')5 /) ( ;'<:7) (<' ?7G'+ /)57 5.' E7+F 7< 57 ()75.'< &7-(5/7)
=/5./) 5.' E7+F =.'<' 5.'F (<' ;(5.79'):> #) 'J(?;&' 78 5./: /: /?;'5/97 =.'<' )7<?(& :I/)
E(-5'</( ')5'< /)57 :1E-15()'71: (<'(: 5.<719. ( E<'(I /) 5.' :I/) ()+ :'5 1; ( ;1:51&'> ^./&'
5.'<' (<' )7 :;'-/8/- :51+/': /+')5/8F/)9 =.') (-1;1)-51<' ?(F -(1:' () (1579')71: /)8'-5/7)H
5.' /)-/+')-' 78 &7-(&/\'+ :I/) /)8'-5/7): (: -7):'01')-' 78 (-1;1)-51<' /: &7= E15 ;'<:/:5')5
()+ /?;&/': ( ;7::/E&' (1579')71: :71<-'> 2CHA3
$)' 78 5.' +()9'<: 78 <'1:/)9 ( )''+&' +1</)9 5<'(5?')5 /: 5.' 5<():8'< 78 () /)8'-5/71: (9')5
8<7? 7)' &7-(5/7) 57 ()75.'<> $<9()/:?: 5.(5 ?(F 'J/:5 /) &(<9' 01()5/5/': /) 7)' (<'( -() &'(+
57 ;75')5/(&&F &/8' 5.<'(5')/)9 /)8'-5/7): /) 75.'< &7-(5/7):> M.7C$1*7C*" 7/,* 2M: 7/,* 3H ( -7??7)
/)5':5/)(& 7<9()/:?H ?(F -(1:' :'</71: /)8'-5/7): /) 5.' 1</)(<F E&(++'<H ( <'9/7) =.'<' 5.'
7<9()/:? /: )75 )7<?(&&F 871)+> N)5':5/)(& 7<9()/:?: :1-. (: M: 7/,* -() -(1:' &/8'R5.<'(5')/)9
;'</57)/5/: 87&&7=/)9 /)]1<F 57 5.' E7='&> #: ()75.'< 'J(?;&'H 5.' -7??7) :I/) 7<9()/:?!%"@C&,/7/77). $@*+$1B*+*. -() -(1:' :'</71: /)8'-5/7): =.') 5./: 75.'<=/:' -7??7)
E(-5'</1? E'9/): ;<7&/8'<(5/)9 /) 7;') =71)+:>
Cross-Infections
,.':' /)8'-5/7): (<' -(1:'+ EF ;(5.79'): (-01/<'+ 8<7? ()75.'< ;'<:7) 7< EF 5.'
')G/<7)?')5> ,.'F ?(F E' (-01/<'+ +/<'-5&F 2'>9>H 8<7? -7)5(-5 E'5='') ;(5/')5 ()+
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CTT
;<(-5/5/7)'<3H 7< EF 5<():8'< 2'>9>H -(<</'+ 8<7? 7)' ;(5/')5 57 ()75.'< 7) 5.' 1)=(:.'+ .()+:
78 5.' ;<(-5/5/7)'< 7< -7)5(?/)(5'+ /?;&'?')5:3> "<7::R/)8'-5/7): ?(F E' (-01/<'+ EF 5.'
;<(-5/5/7)'< ()+ 788/-' ;'<:7))'& (: ='&& (: EF ;(5/')5:> M7?' 78 5.' ?7:5 :'</71: 7<9()/:?:
5.(5 (<' (::7-/(5'+ =/5. -<7::R/)8'-5/7): /)-&1+' 5.' .';(5/5/: O G/<1:H dNcH ()+ ?'5./-/&&/)R
<':/:5()5 :5(;. (1<'1: 2%YM#3> ,1E'<-1&7:/: /: (&:7 ( :/9)/8/-()5 ;1E&/- .'(&5. -7)-'<) /) 5.'L)/5'+ M5(5':H /)-&1+/)9 :5<(/): 78 H&7/R"7%$1*)B %)R$17),/.*. <':/:5()5 57 ()5/51E'<-1&(<
()5/E/75/-:>
L)+'< )7<?(& -/<-1?:5()-': )(51<(& E(<</'<: ;<'G')5 5.' /)8'-5/71: (9')5 7< G/<1: 8<7? 9(/)/)9
(--':: 57 ( )'= .7:5 ()+ -(1:/)9 () /)8'-5/7)> O15 =.') 5.' )(51<(& +'8'):': (<' ='(I')'+H 7<
5.' /)8'-5/71: (9')5 .(: ( &(<9' ')719. 01()5/5FH 7< E/7&7(+H 57 7G'<=.'&? 5.' E7+Fk: +'8'):':H
5.' 7<9()/:? 7< G/<1: /) 01':5/7) -() -(1:' +/:'(:'> #: ( ;<(-5/5/7)'<H 5.' (-1;1)-51</:5 ?1:5
(&=(F: E' (&'<5 57 5.' ;75')5/(& 87< 5<():8'<</)9 +/:'(:'R-(1:/)9 (9')5: 57 ;(5/')5:>
#) /)8'-5/71: (9')5 -() 5<(G'& 8<7? 7)' .7:5 57 ()75.'< /) ( G(</'5F 78 =(F:H /)-&1+/)9 E'/)9-(<</'+ 7) +1:5 7< +<7;&'5: 78 ?7/:51<' /) 5.' (/<H E'/)9 5<():8'<<'+ /) E7+F 8&1/+:H ()+ EF
?'-.()/-(& 5<():8'< 8<7? 7)' :1<8(-' 57 ()75.'<> ,.' +'):/5F 78 () /)8'-5/71: (9')5 /: 7)' 78
5.' 8(-57<: /) </:I 78 -<7:: /)8'-5/7)> ^./&' ( &7= E/7&7(+ ?(F E' -7)5<7&&'+ EF 5.' E7+Fk:
;<7;'<&F 81)-5/7)/)9H ( ./9. E/7&7(+ ?(F 7G'<=.'&? 5.' /??1)' :F:5'?H ?7<' '(:/&F <':1&5/)9
/) () /)8'-5/7)> [7< 'J(?;&'H 5.' .';(5/5/: O G/<1: /: ( ./9.R+'):/5F G/<1:H 7)' 78 5.' 8(-57<: 5.(5
8(-/&/5(5' 5.' 5<():8'< 78 5./: 7<9()/:? 8<7? ;'<:7) 57 ;'<:7)>
3. Bloodborne Pathogens
Hepatitis# <'G/'= 78 5.' &/5'<(51<' :199':5: 5.(5 .';(5/5/: ?(F E' ( -7?;&/-(5/7) 78 (-1;1)-51<'> ^./&'
<';7<5: 78 .';(5/5/: <'&(5'+ 57 (-1;1)-51<' /) 5.' L>M> (<' &/?/5'+ 57 <';7<5: ;</7< 57 CPQQH 5.'<'
(<' ( )1?E'< 78 <'5<7:;'-5/G' :51+/': ()+ <';7<5: 78 .';(5/5/: <'&(5'+ 57 (-1;1)-51<' /) 75.'<
;(<5: 78 5.' =7<&+> 2THbHD3
,.'<' (<' -1<<')5&F 8/G' <'-79)/\'+ 5F;': 78 .';(5/5/: G/<1:': =./-. (<' &(E'&'+ (&;.(E'5/-(&&F
(:U #H OH "H WH ()+ 6> d';(5/5/: # ()+ 6 (<' 5<():?/55'+ ?(/)&F 5.<719. 8'-(& -7)5(?/)(5'+ 877+
()+ =(5'<> ,.' 75.'<: (<' 5<():?/55'+ EF E&77+ 7< :'J1(& -7)5(-5> d';(5/5/: /: :1-. ( -7)-'<) /)
.'(&5.-(<' :'55/)9: 5.' $--1;(5/7)(& M(8'5F ()+ d'(&5. #+?/)/:5<(5/7) 2$Md#3 .(: (+7;5'+:;'-/8/- &()91(9' <'9(<+/)9 5.' 5<():?/::/7) 78 .';(5/5/: ()+ <'-7??')+(5/7): 87< 5<(/)/)9 ()+
G(--/)(5/7) 78 (5R</:I :5(88 ?'?E'<:> ,.' "W" :5<7)9&F <'-7??')+: 5.(5 (&& .'(&5.-(<' =7<I'<:
E' G(--/)(5'+ 87< 5.' .';(5/5/: O G/<1: 2dOc3> ^.') () '?;&7F'' /: ./<'+ 87< ( ;7:/5/7) =.'<'
5.'<' /: ( </:I 78 /)8'-5/7) =/5. dOcH $Md# <'01/<': 5.(5 5.' '?;&7F'< ?1:5 788'< G(--/)(5/7) 57
5.(5 .'(&5.-(<' =7<I'< (5 )7 -.(<9'> N8 5.' '?;&7F'' <'81:': 57 E' G(--/)(5'+ 87< dOcH 5./:
'?;&7F'' :.71&+ E' <'01/<'+ 57 -7?;&'5' ()+ :/9) ( +7-1?')5 :5(5/)9 5.(5 .' 7< :.'
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CTb
1)+'<:5()+: 5.' </:I: 78 )75 E'/)9 G(--/)(5'+ ()+ /: <'81:/)9 5.' G(--/)(5/7) /) :;/5' 78 5.' </:I
78 dOc /)8'-5/7)> 2M'' M'-5/7) S 87< () 7G'<G/'= 78 $Md# <'91&(5/7):>3
Hepatitis A (HAV)
d';(5/5/: # 2d#c3H 87<?'<&F -(&&'+ /)8'-5/71: .';(5/5/: 7< :.7<5R/)-1E(5/7) .';(5/5/:H /: (
-7??7) /)8'-5/7) /) -7)+/5/7): 78 ;77< :()/5(5/7) ()+ 7G'<-<7=+/)9> #&5.719. 5<():?/::/7) /:
?(/)&F 5.<719. 8'-(& -7)5(?/)(5'+ 877+ ()+ =(5'<H -7)5(?/)(5'+ E&77+ 7) .()+: -() ;7:' (
;75')5/(& .(\(<+ /) (-1;1)-51<' ;<(-5/-'> #++/5/7)(&&FH /) 5.7:' -&/)/-: 5.(5 ;<';(<' ?'+/-/)(&
5'(: 7< 75.'< 877+: 87< ;(5/')5:H () (=(<')':: 78 5.' 5<():?/::/7) <715': ()+ ;<'G')5/7)
;<(-5/-': /: -</5/-(&> N) /):5/515/7)(& 7< /)-(<-'<(5'+ :'55/)9: d#c ?(F :;<'(+ 8<7? ;'<:7) 57
;'<:7) 5.<719. :'J1(& -7)5(-5> Z77+ ;'<:7)(& .F9/')' ()+ ;<7;'< :()/5(5/7) -() .'&; ;<'G')5
5.' 5<():?/::/7) 78 d#c> ,.' /)-1E(5/7) ;'</7+ 78 d#c /: CD 57 DB +(F:H =/5. () (G'<(9'
/)-1E(5/7) ;'</7+ 78 AQ +(F:> 2S3
L)&/I' .';(5/5/: O 2dOc3 7< " 2d"c3H d#c /)8'-5/7) <':1&5: /) 5.' (E<1;5 7):'5 78 :F?;57?:>MF?;57?: /)-&1+' (E+7?/)(& +/:-7?87<5H &7:: 78 (;;'5/5'H 8(5/91'H )(1:'(H +(<I 1</)'H ()+
](1)+/-'> MF?;57?: 1:1(&&F &(:5 &':: 5.() A ?7)5.:> #&5.719. 5.'<' /: )7 -.<7)/- /)8'-5/7)H
(;;<7J/?(5'&F CDt 78 ;'7;&' /)8'-5'+ =/5. d#c .(G' ( ;<7&7)9'+ 7< <'&(;:/)9 -71<:' 78 /&&)'::
&(:5/)9 (: &7)9 (: SRP ?7)5.:> N)+/G/+1(&: =.7 .(G' .(+ d#c -())75 E' <'R/)8'-5'+>
N) 5.' L)/5'+ M5(5':H .';(5/5/: # .(: 7--1<<'+ /) &(<9' )(5/7)=/+' ';/+'?/-: (;;<7J/?(5'&F
'G'<F CB F'(<:H =/5. 5.' &(:5 /)-<'(:' /) -(:': /) CPQP> 243 ,.' d#c /)8'-5/7) <(5' .(: +'-&/)'+
:5'(+/&F :/)-' 5.' &(:5 ;'(I /) CPPDH =.') 5.'<' ='<' TDSHBBB -(:':> d/:57</-(&&FH -./&+<') A
5.<719. CQ F'(<: 78 (9' .(G' .(+ 5.' ./9.':5 <(5': 78 .';(5/5/: # 2CD 57 AB -(:': ;'< CBBHBBB /)
5.' '(<&F 57 ?/+RCPPB:3> M/)-' ABBAH <(5': (?7)9 -./&+<') .(G' +'-&/)'+ ()+ 5.' /)-/+')-' 78
.';(5/5/: # /: )7= :/?/&(< /) (&& (9' 9<71;:> 243 "<'+/5 87< 5.' -.()9': /: 9/G') 57 5.' /::1()-' 78
<715/)' -./&+.77+ G(--/)(5/7): 87< d#c :/)-' CPPP> [7<51)(5'&FH ?7:5 -(:': 78 d#c (<'
<'&(5/G'&F ?/&+H -7?;&/-(5/7): (<' 1)-7??7)H ()+ -.<7)/- -(<</'< :5(5': (<' )75 I)7=)> ,.'<' /:
( G(--/)(5/7) 87< d#c> ,.' "W" +7': )75 <715/)'&F <'-7??')+ d#c G(--/)(5/7) 87< .'(&5.-(<'
=7<I'<: :/)-' 5.'F (<' )75 (5 /)-<'(:'+ </:I> 2Q3 Y715/)' /)8'-5/7) -7)5<7& ;<'-(15/7):H
;(<5/-1&(<&F .()+=(:./)9H =/&& ;<'G')5 5<():?/::/7)>
Hepatitis A Survival in the Environment
,.' d';(5/5/: # G/<1: /: 'J5<'?'&F .'(<5F> d#c -() &/G' 715:/+' 5.' E7+F 87< ?7)5.:H +';')+/)97) 5.' ')G/<7)?')5(& -7)+/5/7):> ,.' G/<1: /: I/&&'+ EF .'(5/)9 57 ‚CQD +'9<'': [ 2‚QD +'9<'':
"3 87< 7)' ?/)15'> d7='G'<H 5.' G/<1: -() :5/&& E' :;<'(+ 8<7? -77I'+ 877+ /8 /5 /: -7)5(?/)(5'+
(85'< -77I/)9> #+'01(5' -.&7</)(5/7) 78 =(5'<H (: <'-7??')+'+ /) 5.' L)/5'+ M5(5':H I/&&: d#c
5.(5 ')5'<: 5.' =(5'< :1;;&F> M'' .55;U``===>-+->97G`.';(5/5/:`.(G`.(G8(0>.5?>
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CTD
Hepatitis B (HBV)
d';(5/5/: O /: -(1:'+ EF 5.' .';(5/5/: O G/<1: 2dOc3H ( +71E&'R:5<()+'+ W*#R-7)5(/)/)9 G/<1:>
O'5='') CPPB ()+ ABBD 5.' /)-/+')-' 78 (-15' .';(5/5/: O +'-&/)'+ 4Pt> #?7)9 ;'<:7): (9'+
S F'(<: 7< 7&+'<H B>A4t .(+ -.<7)/- dOc /)8'-5/7) 2-7<<':;7)+/)9 57 (;;<7J/?(5'&F 4BbHBBB
;'<:7): )(5/7)=/+'>
2PHCB3
N) (+1&5:H 7)97/)9 dOc 5<():?/::/7) 7--1<: ;</?(</&F (?7)9 1)G(--/)(5'+ ;'<:7): =/5.
E'.(G/7<(& </:I: 87< dOc 5<():?/::/7) 2'>9>H .'5'<7:'J1(&: =/5. ?1&5/;&' :'J ;(<5)'<:H /)]'-5/7)R
+<19 1:'<: qNWL:sH ()+ ?') =.7 .(G' :'J =/5. ?') q%M%s3 ()+ (?7)9 .71:'.7&+ -7)5(-5: ()+
:'J ;(<5)'<: 78 ;'<:7): =/5. -.<7)/- dOc /)8'-5/7)> 2CC3
#) ':5/?(5'+ QBBHBBBRC>b ?/&&/7) ;'<:7): /) 5.' L)/5'+ M5(5': .(G' -.<7)/- dOc /)8'-5/7)> 2CA3
d';(5/5/: O G/<1: 2dOcH n:'<1? .';(5/5/:p 7< n&7)9R/)-1E(5/7) .';(5/5/:p3 /: 7)' 78 5.'
E&77+E7<)' ;(5.79'): ;<':')5/)9 ( :/9)/8/-()5 </:I 78 /)8'-5/7) /) 5.' (-1;1)-51<' -&/)/-
')G/<7)?')5> dOc /: 5.' :'-7)+ :1ER5F;' 78 .';(5/5/: 87< =./-. ( G(--/)' 'J/:5:> dOc -() -(1:'
&/8'&7)9 /)8'-5/7)H -/<<.7:/: 78 5.' &/G'<H &/G'< -()-'<H &/G'< 8(/&1<'H ()+ +'(5.> #&5.719. -.<7)/-
/)8'-5/7) /: ?7<' &/I'&F 57 +'G'&7; /) ;'<:7): /)8'-5'+ (: /)8()5: 7< F71)9 -./&+<')H <(5': 78 )'=
/)8'-5/7): ()+ (-15' +/:'(:' (<' ./9.':5 /) (+1&5:> K'<:7): =/5. -.<7)/- +/:'(:' 5.') :'<G' (: (
<':'<G7/< 87< -7)5/)1'+ dOc 5<():?/::/7)> 2CT3 d'(&5.-(<' ;'<:7))'& =.7 .(G' <'-'/G'+ dOc
G(--/)' ()+ +'G'&7;'+ /??1)/5F 57 5.' G/<1: (<' (5 G/<51(&&F )7 </:I 87< dOc /)8'-5/7)> 2Cb3
Transmission of HBV
dOc /: :;<'(+ 5.<719. -7)5(-5 =/5. -7)5(?/)(5'+ E&77+ ()+ E7+F 8&1/+:> N)8'-5'+ /)+/G/+1(&:
()+ 5.7:' -(</)9 87< 5.'?H :.(</)9 &/G/)9 :;(-'H 7< ;(<5/-/;(5/)9 /) ./9. </:I E'.(G/7<:
21);<75'-5'+ :'J =/5. ?1&5/;&' ;(<5)'<: ()+ +<19 1:'3 :.71&+ 87&&7= -(<'81& /)8'-5/7)
;<'G')5/7) ;<7-'+1<':> ,.' /)8'-5'+ ;'<:7) :.71&+ )75 :.(<' ()F /5'?: 5.(5 ?(F E'
-7)5(?/)(5'+ =/5. E&77+H /)-&1+/)9 <(\7<: ()+ 5775.E<1:.':> 2O75. <(\7<: ()+ 5775.E<1:.':
(<' <'91&(<&F -7)5(?/)(5'+ =/5. ?/-<7:-7;/- (?71)5: 78 E&77+ ()+ )''+ 57 E' 5<'(5'+ (:
-7)5(?/)(5'+>3 O(<</'< ;<'-(15/7): :1-. (: 9&7G': 87< .()+&/)9 =(:5'H 7< -7)+7?: ()+ +')5(&
+(?: =.') /)G7&G'+ /) :'J1(& (-5/G/5/':H :.71&+ E' 15/&/\'+>
[7< 5.7:' =.7 .(G' ( ;'<:7)(& ./:57<F 78 -.<7)/-H (-5/G' +/:'(:'H /&&/-/5 +<19: ()+ (&-7.7& :.71&+
E' (G7/+'+ 57 <'+1-' 5.' </:I 78 &7)9R5'<? -7?;&/-(5/7): 78 dOcH :1-. (: &/G'< -/<<.7:/:> Z77+-&'()/)9 78 5.' ;(5/')5k: ')G/<7)?')5 ()+ ;'<:7)(& -(<' /5'?: /: /?;7<5()5> ,.':'
;<'-(15/7)(<F ?'(:1<': :.71&+ E' 87&&7='+ 1)5/& 5.' ;'<:7) 5':5: )'9(5/G' 87< (-5/G' dOc
/)8'-5/7)>
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CTS
HBV Survival in the Environment
dOc -() :1<G/G' 715:/+' 5.' E7+F (5 &'(:5 4 +(F: ()+ :5/&& E' -(;(E&' 78 -(1:/)9 /)8'-5/7)>
.55;U``===>-+->97G`.';(5/5/:`.EG`.EG8(0>.5?>
Individuals at Risk of HBV InfectionN5 /: ':5/?(5'+ 5.(5 5.'<' (<' () ':5/?(5'+ QBBHBBBRC>b ?/&&/7) ;'7;&' /) 5.' L)/5'+ M5(5': =.7
.(G' -.<7)/- dOc /)8'-5/7)> 2CT3 ,.' )1?E'< 78 )'= /)8'-5/7): .(: +'-&/)'+ F'(<&F :/)-' 5.'
CPQB:> Y715/)' G(--/)(5/7) /: 5.' ;</?(<F <'(:7) 87< 5./: +'-&/)'> 2CT3
N)+/G/+1(&: (5 </:I 87< dOc /)8'-5/7) 5.<719. 7--1;(5/7)(& 'J;7:1<': (<' 5.7:' =.7 (<' )75
/??1)' 57 dOc ()+ =.7 -7?' /)57 8<'01')5 -7)5(-5 =/5. E&77+ ()+ E&77+ ;<7+1-5:>
d'(&5.-(<' =7<I'<: :1-. (: (-1;1)-51</:5:H ;.F:/-/():H +')5/:5:H )1<:':H E&77+ E()I =7<I'<:H
;(<(?'+/-(& ;'<:7))'&H ()+ &(E7<(57<F :5(88 .(G' ( :/9)/8/-()5 </:I 78 7--1;(5/7)(& 'J;7:1<' ()+
(<' (5 </:I 78 dOc /)8'-5/7) /8 )75 G(--/)(5'+> $5.'<: =.7 (<' (5 </:I /)-&1+' 5.7:' =.7 -7?' /)
-7)5(-5 =/5. E&77+ 7< E7+/&F 8&1/+: 8<7? () /)+/G/+1(& =/5. ( ./9. </:I 78 /)8'-5/7)> ,.' </:I 78
dOc /)8'-5/7) /) 5.' =7<I;&(-' /: ;</?(</&F <'&(5'+ 57 5.' +'9<'' 78 -7)5(-5 =/5. E&77+ /) 5.'
=7<I;&(-' ()+ 57 5.' dOc :5(51: 78 5.' :71<-' ;'<:7)>
^./&' dOc -() E' 5<'(5'+H 5.' </:I 78 -.<7)/- .';(5/5/: /: :/9)/8/-()5H ()+ ;<'G')5/7) <'?(/):
5.' ?7:5 /?;7<5()5 =(F 57 <'+1-' 5.' ;75')5/(& 87< ( )'9(5/G' 715-7?'> N) 5.' =7<I;&(-'H 5.'
</:I 78 -7)5<(-5/)9 .';(5/5/: O /: (::7-/(5'+ =/5. -7)5(-5 =/5. /)8'-5'+ E7+F 8&1/+: :1-. (: E&77+>
,.' </:I 78 ( .'(&5.-(<' =7<I'< +'G'&7;/)9 .';(5/5/: 87&&7=/)9 'J;7:1<' 57 dOc /: AAtRTCt> ,.'
</:I 78 +'G'&7;/)9 :'<7&79/- 'G/+')-' 78 /)8'-5/7) /: T4tRSAt> 2CD3
$)' 78 5.' ?7:5 -7??7) ?7+': 78 dOc 5<():?/::/7) /) 5.' .'(&5.-(<' :'55/)9 /: 5.'
1)/)5')5/7)(& /)]1<F 78 ( .'(&5.-(<' =7<I'< 8<7? ( )''+&':5/-I 7< -15 EF ( -7)5(?/)(5'+
/):5<1?')5> ,.' <(5' 78 dOc 5<():?/::/7) 57 :1:-';5/E&' .'(&5.-(<' =7<I'<: <()9': 8<7? St 57
TBt (85'< ( :/)9&' )''+&':5/-I 'J;7:1<' 57 () dOcR/)8'-5'+ ;(5/')5H E15 /: G/<51(&&F \'<7 /8 5.(5
.'(&5.-(<' =7<I'< .(: E'') /??1)/\'+ (9(/):5 dOc> 2CD3 d';(5/5/: O :1<8(-' ()5/9') 2dO:#93
;7:/5/G' /)+/G/+1(&: =.7 (<' d';(5/5/: O n'p ()5/9') 2dO'#Z3 ;7:/5/G' .(G' ?7<' G/<1: /) 5.'/<
E&77+ ()+ (<' ?7<' &/I'&F 57 5<():?/5 +/:'(:'> ,.' ;<':')-' 78 dO'#9 :199':5: 5.(5 dOc /: /) ()
(-15' :5(9' ()+ :.71&+ E' -7):/+'<'+ ./9.&F /)8'-5/71:> ,.' )1?E'<: 78 7--1;(5/7)(&&F :;<'(+
dOc .(G' +'-&/)'+ :/)-' 5.' CPQB: 8<7? 7G'< CBHBBB ())1(&&F 57 E'&7= bBB /) ABBC> Y';7<5: 78
/)8'-5/7): /) ABBS ='<' /)8<'01')5> N) CPPAH 5.' "W" E'9() ( -7?;<'.'):/G' :5<(5'9F 57
'&/?/)(5' dOc 5<():?/::/7) /) 5.' L)/5'+ M5(5':H /)-&1+/)9 5.<719. G(--/)(5/7)> N) ABBD /5 =(:
)75'+ /) 87&&7=R1; :1<G'/&&()-' 5.(5 4Dt 78 .'(&5.-(<' =7<I'<: .(G' E'') G(--/)(5'+> 2CD3
$5.'< 9<71;: (5 </:I /)-&1+' 5.7:' =.7 &/G' /) -<7=+'+ 7< 1):()/5(<F -7)+/5/7): 2/)-&1+/)9
;</:7)'<: ()+ -'<5(/) /??/9<()5 ;7;1&(5/7):3H .(G' ?1&5/;&' :'J1(& -7)5(-5:H ?') =.7 .(G'
.7?7:'J1(& -7)5(-5H &/G' /) 5.' :(?' .71:' =/5. :7?'7)' =.7 .(: -.<7)/- dOcH .(G' :'J =/5.
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CT4
:7?'7)' /)8'-5'+ =/5. dOcH .(G' .'?7;./&/(H (<' ( ;(5/')5 7< =7<I /) ( .7?' 87< 5.'
+'G'&7;?')5(&&F +/:(E&'+H 5<(G'& 57 (<'(: =.'<' .';(5/5/: O /: ')+'?/-H (<' /)]'-5/7) +<19 1:'<:H
7< .(G' :'G'<(& 78 5.':' </:I 8(-57<:> 2CT3
Exposure to HBV
dOc /: 5<():?/55'+ 5.<719. ;'<-15()'71: 7< ;(<')5'<(& -7)5(-5 =/5. /)8'-5'+ E&77+H E7+F
8&1/+:H ()+ EF :'J1(& /)5'<-71<:'> dOc /: 7)&F :;<'(+ =.') E&77+H :'?') 7< 75.'< E7+/&F 8&1/+:
2$KN%3 ')5'< 5.' E7+F 78 ()75.'< ;'<:7) 5.<719. () 7</8/-'H ( E<'(I /) 5.' :I/) 7< 5.<719.
?1-1: ?'?E<()':> dOc ?(F (&:7 E' 5<():?/55'+ ;'</)(5(&&F> dOc /: )75 :;<'(+ 5.<719. :.(</)9
'(5/)9 15'):/&:H -(:1(& -7)5(-5H 7< E<'(:58''+/)9> N5 /: )75 :;<'(+ EF -7)5(?/)(5'+ =(5'< 7<
877+> dOc /: (E&' 57 <'?(/) 7) ()F :1<8(-' /5 -7?': /)57 -7)5(-5 =/5. 87< (E715 ( =''IH '>9>H
5(E&'R57;:H <(\7< E&(+':H E&77+ :5(/):H =/5.715 &7:/)9 /)8'-5/G/5F> dOc +7': )75 -<7:: 5.' :I/) 7<
5.' ?1-71: ?'?E<()' E(<</'<> M7?' E<'(I /) 5./: E(<</'<H =./-. -() E' ?/)/?(& ()+
/):/9)/8/-()5H /: <'01/<'+ 87< 5<():?/::/7)> 2CAH CS3
d'(&5.-(<' =7<I'<: =.7 (<' )75 /??1)' (<' (5 ( ./9.'< </:I 87< dOc 5.() 5.' 9')'<(& ;1E&/-
+1' 57 5.'/< ;75')5/(& 87< 8<'01')5 7--1;(5/7)(& 'J;7:1<' 57 ()+ E&77+ ;<7+1-5:H (: ='&& (:
75.'< E7+F 8&1/+:>
d';(5/5/: O ?1:5 E' <'-79)/\'+ (: () 7--1;(5/7)(& .(\(<+ 87< (-1;1)-51</:5:H (: /5 /: 87< 75.'<
.'(&5.-(<' ;<78'::/7)(&: =.7:' ;<7-'+1<': -7??7)&F /)-&1+' 5.' ;')'5<(5/7) 78 5.' :I/) 7<
-(1:' 'J;7:1<' 57 E&77+ ()+ 75.'< E7+F 8&1/+:> N)G(:/G' ;<7-'+1<':H =.'<' 5.'<' /:
-7):/+'<(E&' </:I 78 'J;7:1<' 57 -7)5(?/)(5'+ E&77+ ()+ E7+F 8&1/+:H ;7:' 5.' 9<'(5':5 </:I 78
7--1;(5/7)(& /)8'-5/7) 8<7? dOc> ,.' "W" :5<7)9&F <'-7??')+: 5.(5 (&& ;'<:7))'& =7<I/)9 /)
:1-. (<'(: :.71&+ :-<1;1&71:&F 87&&7= M5()+(<+ K<'-(15/7):> W/:;7:(E&' '01/;?')5 ()+
;<75'-5/G' -&75./)9 :.71&+ E' 1:'+ =.') (;;<7;</(5'H ()+ (;;<7;</(5' +/:/)8'-5/7) ;<757-7&:
'?;&7F'+>
N) 5.' 'G')5 78 'J;7:1<'H .';(5/5/: O /??1)' 9&7E1&/) ()+ .';(5/5/: O G(--/)' .(G' E'') :.7=)
57 E' '88'-5/G' <':;7):':> [7< 5.' .'(&5.-(<' =7<I'<H ?1&5/;&' +7:': 78 .';(5/5/: O /??1)'
9&7E1&/) 7< .';(5/5/: O G(--/)' (&7)' /: 4BtR4Dt '88'-5/G' /) ;<'G')5/)9 :'01'&(' 78 dOc
'J;7:1<'> 2CD3
HBV Vaccination# G(--/)' (9(/):5 .';(5/5/: O =(: +'G'&7;'+ /) CPQC> #)F .'(&5.F (+1&5 =/5. () /)5(-5 /??1)'
:F:5'? =/&& &/I'&F <':;7)+ 57 7)' :'</': 78 5.' G(--/)'> #5 5./: 5/?' /5 /: -&'(< 5.(5 /??1)/5F
-&'(<&F &(:5: ='&& 7G'< 5=')5F F'(<:H E15 :/)-' 5.' G(--/)' .(: 7)&F E'') /) 'J/:5')-' :/)-' CPQCH
)7 7)' F'5 I)7=: 'J(-5&F .7= &7)9 /??1)/5F =/&& &(:5> ,.'<' /: )7 5':5/)9 <'-7??')+'+ E'87<'
G(--/)(5/7)i E15 CRA ?7)5.: 87&&7=/)9 -7?;&'5/7) 78 5.' :'</':H ( 5/5'< /: <'-7??')+'+ 57
(::':: 5.' <':;7):'> N8 5.'<' /: ( <':;7):'H )7 81<5.'< E77:5'<: 7< :'</': (<' <'-7??')+'+> N8
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CTQ
5.'<' /: )7 <':;7):'H 5.') ( :'-7)+ :'</': ?(F E' 9/G') ()+ =/&& 1:1(&&F E' :1--'::81&> ,.'<'
(<' ( &7= )1?E'< 78 )7)R<':;7)+'<: 'G') (85'< 5.' :'-7)+ :'</':i )7 81<5.'< G(--/)' /:
<'-7??')+'+ 87< 5.'?> 2C43
c(--/)(5/7) /: <'-7??')+'+ 87< ;'<:7))'& ;'<87<?/)9 /)G(:/G' ;<7-'+1<':H -&'()/)9
-7)5(?/)(5'+ '01/;?')5H 7< ;'<87<?/)9 +15/': /) () (<'( =.'<' 5.'<' /: ( </:I 78 'J;7:1<'> ,.'
"W" <'-7??')+: 5.(5 (&& .'(&5.-(<' =7<I'<: E' G(--/)(5'+ (9(/):5 dOc> $Md# <'01/<': (&&
'?;&7F'<: 57 788'< dOc G(--/)(5/7) 57 ;'<:7))'& ;'<87<?/)9 /)G(:/G' ;<7-'+1<': 7< -&'()/)9
-7)5(?/)(5'+ '01/;?')5> 2Cb3 N) $-57E'< CPP4H 5.' #+G/:7<F "7??/55'' 7) N??1)/\(5/7)
K<(-5/-': 'J;()+'+ /5: .';(5/5/: O G(--/)(5/7) <'-7??')+(5/7): 57 /)-&1+' (&& -./&+<') (9'+ BR
CQ F'(<:>
The HBV Infection Process
,.' /)-1E(5/7) ;'</7+ 87< dOc /: DB 57 CQB +(F:> 2CQ3 W1</)9 5./: ;'</7+H 5.' /)8'-5/71: G/<1:
(;;'(<: /) 5.' E&77+H ()+ /5 ?(F (;;'(< /) 5.' 8'-': ()+ :'?')> W1</)9 5./: ;'</7+ 5.' /)8'-5/7)?(F E' :;<'(+ 57 75.'< ;'7;&' 'G') 5.719. )7 :F?;57?: (<' ;<':')5> dOc '(<&F :F?;57?:
785') E'9/) =/5. ?/&+ 8&1R&/I' :/9): ()+ :F?;57?: :1-. (: ( 8'G'< 2/) SBt 78 -(:':3H 9')'<(&
?(&(/:'H 7< 5.' /):/+/71: 7):'5 78 ()7<'J/( ()+ (E+7?/)(& ;(/)> $5.'< :F?;57?: ?(F /)-&1+'
-./&&:H )(1:'(H ]7/)5 ;(/):H <(:.H ()+ +/(<<.'(> ,F;/-(&&F 5.':' :F?;57?: &(:5 8<7? 5=7 57 :/J
=''I:> ,.':' :F?;57?: (<' 8<'01')5&F 87&&7='+ EF ( ;'</7+ 78 'J5<'?' 8(5/91' ()+ +';<'::/7)
5.(5 -() 'J5')+ 87< :'G'<(& ?7)5.:>
K<(-5/5/7)'<: :.71&+ E' (=(<' 5.(5 :7?' /)+/G/+1(&: /)8'-5'+ =/5. 5.' G/<1: +'G'&7; ?/&+
:F?;57?: 7< (<' (:F?;57?(5/-> #;;<7J/?(5'&F TBt 78 5.7:' /)8'-5'+ .(G' )7 :/9): 7<
:F?;57?:> 2C43 "./&+<') =/5. dOc (<' 785') (:F?;57?(5/-> d7='G'<H (:F?;57?(5/- ;(5/')5:
(<' (: /)8'-5/71: (: 5.7:' =.7 (<' :F?;57?(5/-> $)&F ( E&77+ 5':5 =/&& 5'&& =.'5.'< () /)+/G/+1(&
/: /)8'-5'+ =/5. dOc>
[1&&F 4Bt 78 ;'7;&' =.7 .(G' <'-7G'<'+ 8<7? 5.' :F?;57?(5/- :5(9' 78 5.' +/:'(:' (<' :5/&&
/)8'-5/71: 87< 5.<'' ?7)5.: 7< ?7<' (85'< :F?;57?: .(G' :1E:/+'+> #?7)9 /)8()5: =.7 (-01/<'
dOc /)8'-5/7) 8<7? 5.'/< ?75.'<: (5 E/<5.H 1; 57 PBt E'-7?' -.<7)/-(&&F /)8'-5'+> ,.' 7&+'<
F71 (<' =.') /)8'-5'+H 5.' &7='< 5.' <(5' 78 -.<7)/- /)8'-5/7)H =/5. TBtaDBt 78 -./&+<')
/)8'-5'+ (5 (9' CaD F'(<: E'-7?/)9 -.<7)/-(&&F /)8'-5'+H ()+ (?7)9 (+1&5: (;;<7J/?(5'&F Dt 78
(&& (-15' dOc /)8'-5/7): ;<79<':: 57 -.<7)/- /)8'-5/7)> 2CQ3
N8 ( ;<(-5/5/7)'< E'-7?': /)8'-5'+ =/5. dOcH .' 7< :.' ?(F 1)I)7=/)9&F 5<():?/5 dOc 57
;(5/')5: 7< 788/-' :5(88 5.<719. 5<():?/::/7) 78 E&77+ 8<7? -15: 7< 7;') :7<':> K<78'::/7)(&&F
()+ &'9(&&F 5.' <(?/8/-(5/7): 78 5./: 87<? 78 5<():?/::/7) (<' ')7<?71:> d/9. :5()+(<+: 78
.F9/')' ()+ "&'() *''+&' ,'-.)/01' =/&& 9<'(5&F <'+1-' 5.' </:I 78 dOc /)8'-5/7) 87<
;<(-5/5/7)'<:H (: ='&& (: ;(5/')5:> # ;<(-5/5/7)'< =/5. (-15' dOc :.71&+ )75 ;<(-5/-' +1</)9 5.'
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CTP
/)8'-5/71: ;'</7+> N8 ( ;<7G/+'< /: 871)+ 57 E' /)8'-5'+H .' 7< :.' :.71&+ -7):1&5 =/5. ( ;.F:/-/()
E'87<' 97/)9 E(-I 57 =7<I> 2Cb3
Treatment of HBV
^./&' dOc -() E' 5<'(5'+H 5.' </:I 78 -.<7)/- .';(5/5/: /: :/9)/8/-()5H ()+ ;<'G')5/7) <'?(/):
5.' ?7:5 /?;7<5()5 =(F 57 <'+1-' 5.' ;75')5/(& 87< ( )'9(5/G' 715-7?'> N) 5.' =7<I;&(-'H 5.'
</:I 78 -7)5<(-5/)9 .';(5/5/: O /: (::7-/(5'+ =/5. -7)5(-5 =/5. /)8'-5'+ E7+F 8&1/+: :1-. (: E&77+>
,.' </:I 78 ( .'(&5.-(<' =7<I'< +'G'&7;/)9 .';(5/5/: 87&&7=/)9 'J;7:1<' 57 dOc /: AAtRTCt> ,.'
</:I 78 +'G'&7;/)9 :'<7&79/- 'G/+')-' 78 /)8'-5/7) /: T4tRSAt> ,./: </:I /: :/9)/8/-()5&F ./9.'<
5.() 5.' (;;<7J/?(5'&F B>Tt -/5'+ 87< dNc> 2CD3
N) 5.' 'G')5 78 'J;7:1<'H .';(5/5/: O /??1)' 9&7E1&/) ()+ .';(5/5/: O G(--/)' .(G' E'') :.7=)
57 E' '88'-5/G' <':;7):':> [7< 5.' .'(&5.-(<' =7<I'<H ?1&5/;&' +7:': 78 .';(5/5/: O /??1)'
9&7E1&/) 7< .';(5/5/: O G(--/)' (&7)' /: 4BtR4Dt '88'-5/G'> 2CbRCP3
"7?E/)/)9 5.':' 5=7 5<'(5?')5: /)-<'(:': '88/-(-F> ,.' dOc G(--/)' /: :(8' ()+ '88'-5/G'>
Hepatitis C (HCV)
d';(5/5/: " G/<1: 2d"c3 /)8'-5/7) /: 5.' ?7:5 -7??7) -.<7)/- E&77+E7<)' G/<(& /)8'-5/7) /) 5.'
L)/5'+ M5(5':> [/<:5 /+')5/8/'+ /) CPQQH d"c /: 5.' -(1:(5/G' (9')5 87< =.(5 =(: 87<?'<&F I)7=)
(: )7)R# )7)RO .';(5/5/:H ()+ /: ':5/?(5'+ 57 .(G' /)8'-5'+ (: ?()F (: AbAHBBB #?'</-():
())1(&&F +1</)9 5.' CPQB:> %()F 78 5.7:' /)8'-5'+ (<' )75 (=(<' 78 5.'/< /)8'-5/7)H <':1&5/)9 /)
-.<7)/- &/G'< +/:'(:' 5.(5 ?(F )75 E'-7?' (;;(<')5 87< CBRAB F'(<:>
d"c /: ( G/<1: -7)5(/)/)9 ( :/)9&' :5<()+ 78 Y*# 5.(5 /: ?7:5 '88'-5/G'&F 5<():?/55'+ EF;'<-15()'71: -7)5(-5 5.<719. /)]'-5/7) +<19 1:' 7< 'J;7:1<' 57 /)8'-5'+ E&77+ 7< E&77+
;<7+1-5:>
,7+(FH ?7:5 ;'7;&' E'-7?' /)8'-5'+ =/5. 5.' .';(5/5/: " G/<1: EF :.(</)9 )''+&': 7< 75.'<
'01/;?')5 57 /)]'-5 +<19:> O'87<' CPPAH =.') =/+':;<'(+ :-<'')/)9 78 5.' E&77+ :1;;&F E'9()
/) 5.' L)/5'+ M5(5':H d';(5/5/: " =(: (&:7 -7??7)&F :;<'(+ 5.<719. E&77+ 5<():81:/7): ()+
7<9() 5<():;&()5:> 2AB3
^./&' d"c ?(F E' 5<():?/55'+ 5.<719. :'J1(& -7)5(-5H -7)5<(-5/)9 ( d"c /)8'-5/7) 5.<719. 5./:
<715' /: -7):/+'<(E&F &':: '88/-/')5> ,.' </:I 78 5<():?/::/7) 8<7? :'J1(& -7)5(-5 /: E'&/'G'+ 57 E'G'<F &7=> ,.' </:I /)-<'(:': 87< 5.7:' =.7 .(G' ?1&5/;&' :'J ;(<5)'<:H .(G' ( :'J1(&&F
5<():?/55'+ +/:'(:'H ')9(9' /) n<719. :'JpH 7< (<' /)8'-5'+ =/5. dNc> 2AC3
N) ABBPH 5.'<' ='<' () ':5/?(5'+ CSHBBB )'= .';(5/5/: " G/<1: /)8'-5/7): /) 5.' L)/5'+ M5(5':>
d7='G'<H 5.' 788/-/(& )1?E'< 78 <';7<5'+ .';(5/5/: " -(:': /: ?1-. &7='<> %()F ;'7;&' =.7 (<'
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CbB
/)8'-5'+ )'G'< .(G' :F?;57?: ()+ 5.'<'87<' )'G'< -7?' 57 5.' (55')5/7) 78 ?'+/-(& 7< ;1E&/-
.'(&5. 788/-/(&:> 2AC3
K'(I <(5': 78 d"c 7--1<<'+ /) 5.' CPQB:H ()+ .(G' +'-&/)'+ +1' 57 ( <'+1-5/7) /) /)8'-5/7):
<':1&5/)9 8<7? /)]'-5/7) +<19 1:'> ^./&' )'= /)8'-5/7): (<' +'-&/)/)9H (;;<7J/?(5'&F T>P ?/&&/7)
/)+/G/+1(&: /) 5.' L)/5'+ M5(5': (<' -.<7)/-(&&F /)8'-5'+ =/5. d"c (: 78 ABCB> 2AB3
,.' </:I 78 :'<7-7)G'<:/7) (85'< ;'<-15()'71: 7--1;(5/7)(& 'J;7:1<' /: (;;<7J/?(5'&F C>Qt /8
5.' :71<-' E&77+ /: :'<7;7:/5/G' 87< d"c> ,./: /: -7):/+'<(E&F ./9.'< 5.() 5.' </:I 78
;'<-15()'71: 7--1;(5/7)(& 'J;7:1<' +1' 57 dNc :'<7;7:/5/G' E&77+ ()+ &7='< 5.() 5.' </:I 78
:'<7-7)G'<:/7) (85'< ;'<-15()'71: 7--1;(5/7)(& 'J;7:1<' 57 dOc :'<7;7:/5/G' 8&1/+:> 2CD3
Acute Symptoms of Hepatitis C
,.7:' =.7 ?()/8':5 :F?;57?: 78 (-15' .';(5/5/: " =/&& 'J;'</')-' :F?;57?: :/?/&(< 57 5.'
75.'< -(:': 78 (-15' .';(5/5/:H /)-&1+/)9 8&1R&/I' :F?;57?:H ]7/)5 (-.':H ](1)+/-' ()+`7< ?/&+
:I/) <(:.> $5.'< :F?;57?: /)-&1+' ( &7:: 78 (;;'5/5'H (E+7?/)(& ;(/)H +(<I'<R5.()R)7<?(& 1</)'
-7&7< ()+ &/9.5 7< 9<'F -7&7<'+ :577&:> K<(-5/5/7)'<: :.71&+ E' (=(<' 5.(5 &':: 5.() TBt 78 5.7:'
/)8'-5'+ =/5. .';(5/5/: " ?()/8':5 (-15' +/:'(:' :F?;57?:>
Risk Factors for HCV Infection
N)+/G/+1(&: =.7 /)]'-5 +<19:H 'G') /8 5.'F +/+ :7 7)&F 7) 7)' 7--(:/7) ?()F F'(<: ;<'G/71:&FH
.(G' 5.' ./9.':5 </:I 78 d"c /)8'-5/7)> N)+/G/+1(&: =/5. ( ./:57<F 78 /)]'-5/7) +<19 1:' <';<':')5
SBt 78 5.7:' /)8'-5'+> d"c /: <(;/+&F (-01/<'+ 87&&7=/)9 /)]'-5/7) +<19 1:' 5.<719. :.(</)9
)''+&': ()+ 75.'< '01/;?')5> #: ?()F (: QBt 78 /)]'-5/7) +<19 1:'<: (<' 871)+ 57 E' /)8'-5'+
=/5. d"c ()+ (<' 785') -7R/)8'-5'+ =/5. dNc 2TBRDBt3> 2AA3 $5.'< </:I: 78 d"c /)8'-5/7) /)-&1+'5<():81:/7): ()+ 5<():;&()5: E'87<' 5.' :-<'')/)9 5.(5 /: -1<<')5&F /) ;&(-' 2E'87<' CPPA3 ()+H
57 ( &'::'< +'9<''H :'J1(& -7)5(-5 2CDt3> ,.'<' /: ( </:I 78 7--1;(5/7)(& 'J;7:1<' 87< d"cH
;(<5/-1&(<&F =.'<' 5.'<' /: 'J;7:1<' 57 &(<9' (?71)5: 78 E&77+H :1-. (: .'?7+/(&F:/: ()+
:1<9'</':> d"c /: :;<'(+ 8<7? ?75.'< 57 E(EF> #E715 CBt 78 5.7:' /)8'-5'+ .(G' )7
<'-79)/\(E&' :71<-' 78 /)8'-5/7)> ^./&' /5 /: ;7::/E&' 87< d"c 57 E' 5<():?/55'+ 8<7?
;'<-15()'71: 'J;7:1<' 57 E&77+H 'J;7:1<': :1-. (: (-1;1)-51<'H 5(5577/)9H 7< E7+F ;/'<-/)9
.(G' )75 E'') :.7=) 57 ;&(-' ;'7;&' (5 /)-<'(:'+ </:I 87< d"c /)8'-5/7)> d"c /: ?7:5 '88/-/')5&F
5<():?/55'+ EF 'J;7:1<': 5.(5 /)G7&G' +/<'-5 ;(::(9' 78 E&77+ 5.<719. 5.' :I/)H ;(<5/-1&(<&F
=/5. .7&&7=RE7<' )''+&':>
^./&' 5.' </:I 78 7--1;(5/7)(& 'J;7:1<' &'(+/)9 57 d"c :'<7-7)G'<:/7) ?(F E' &/?/5'+ 57
)''+&': =/5. ( &1?')H /5 /: /?;7<5()5 57 :5(5' 5.(5 (: =/5. dNc ()+ dOcH 'J;7:1<' 87&&7=/)9 (
)''+&':5/-I /)G7&G/)9 () (-1;1)-51<' )''+&' ?1:5 E' 5<'(5'+ (: ( ;7::/E&' :71<-' 78 /)8'-5/7)>
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CbC
d"c .(: E'') (::7-/(5'+ =/5. (-1;1)-51<' /) :7?' <'5<7:;'-5/G' :51+/': 78 (-1;1)-51<' #6:>
2DH AT3
HCV Survival in the Environment
,.' .';(5/5/: " G/<1: 2d"c3 -() <'?(/) G/(E&' 715:/+' 5.' E7+F 87< bRD +(F:> 2Ab3
Consequences of HCV Infection
#E715 CDRADt 78 5.7:' /)8'-5'+ -&'(< 5.'/< d"c /)8'-5/7) =/5.715 81<5.'< ;<7E&'?:> ,.'
<'?(/)+'< 24DRQDt3 =/&& +'G'&7; -.<7)/- /)8'-5/7) ()+ (;;<7J/?(5'&F SBR4Bt =/&& 97 7) 57
+'G'&7; -.<7)/- .';(5/5/:> 2# -.<7)/- /)8'-5/7) /: 5.' -.<7)/- ;<':')-' 78 5.' (9')5H d"cH ()+
5.' ;(5/')5k: /??1)' <':;7):'> ".<7)/- .';(5/5/: /: -.<7)/- /)8&(??(5/7) 78 5.' &/G'< 5.(5 ?(F
E' -(1:'+ EF -.<7)/- /)8'-5/7)> ^./&' 5.'F 785') 97 579'5.'<H 5.'F (<' +'8/)'+ +/88'<')5&F ()+
(: :1-. (: )75 /)5'<-.()9'(E&'>3 "/<<.7:/: 78 5.' &/G'< 7--1<: /) (5 &'(:5 ABt 78 ;(5/')5: 7G'< (
CBRAB F'(< ;'</7+ ()+ .';(57-'&&1&(< -(<-/)7?( 2&/G'< -()-'<3 7--1<: /) CRDt 78 -(:':> d"cR
(::7-/(5'+ -.<7)/- &/G'< +/:'(:' /: 5.' ?7:5 8<'01')5 /)+/-(5/7) 87< &/G'< 5<():;&()5(5/7) (?7)9(+1&5:> 2AD3 W<19 5<'(5?')5 /: () /?;7<5()5 (+]1)-5 57 -(<' 87< ?()F ;'<:7): =/5. d"c> ,.'<' /:
)7 G(--/)' 87< 5./: +/:'(:'> K'7;&' /)8'-5'+ =/5. d"c :.71&+ E' G(--/)(5'+ 87< d#c ()+ dOc 57
;<'G')5 81<5.'< -7?;&/-(5/7): 78 5.'/< +/:'(:'>
,.' /)-1E(5/7) ;'</7+ 78 d"c /: ABRPB +(F:H =/5. ?7:5 -(:': 7--1<</)9 D 57 CB =''I: (85'<
'J;7:1<'> 2AD3 ,.' ;'</7+ 78 -7??1)/-(E/&/5F 'J5')+: 8<7? 7)' =''I (85'< 'J;7:1<' 5.<719.
5.' -.<7)/- :5(9'> ,.' 7):'5 /: /):/+/71: ()+ (--7?;()/'+ EF ()7<'J/(H )(1:'(H G7?/5/)9H ()+
](1)+/-'> ,.' -71<:' /: :/?/&(< 57 dOc E15 ?7<' ;<7&7)9'+>
,.'<(;F 87< .';(5/5/: " /: ( <(;/+&F -.()9/)9 (<'( 78 E/7?'+/-(& -&/)/-(& ;<(-5/-'> ,<'(5?')5+'-/:/7): (<' E(:'+ 7) &/G'< ')\F?' &'G'&:H 9')75F;' 78 5.' /)8'-5/)9 G/<1:H ()+ -7)+/5/7) 78 5.'
&/G'<H /)-&1+/)9 5.' 'J5')5 78 :-(<</)9> L:1(&&F 5<'(5?')5 ?(F 'J5')+ 8<7? Ab =''I: 57 A F'(<:
()+ 8<'01')5&F /)-&1+': /)5'<8'<7) ()+ </E(G/</) 2AS3H (&5.719. )'='< ()5/RG/<(& 5.'<(;/':
15/&/\/)9 :1-. +<19: (: ;<75'(:' /)./E/57<: ()+ ;7&F?'<(:' /)./E/57<: (<' E'-7?/)9 (G(/&(E&'>
Hepatitis D (HDV)
dWcH :7?'5/?': I)7=) (: +'&5( .';(5/5/:H /: ( +'8'-5/G' G/<1: 5.(5 <'01/<': -7)-1<<')5 dOc
/)8'-5/7) 87< +'G'&7;?')5 78 +/:'(:'> N) 5.' L>M>H ?7:5 -(:': 78 .';(5/5/: W 7--1< /) /)]'-5/7)
+<19 1:'<: ()+ .'?7;./&/(-:> ,<():?/::/7) 78 .';(5/5/: W /: 5.<719. ;'<-15()'71: 7< ?1-7:(&-7)5(-5 =/5. /)8'-5/71: E&77+> ,.'<' /: )7 G(--/)' 87< dWci .7='G'<H :/)-' 5.' dWc G/<1:
<'01/<': 5.' ;<':')-' 78 dOcH G(--/)(5/7) (9(/):5 dOc /: '88'-5/G' (9(/):5 dWc <'&(5'+ +/:'(:'>
,.' 715-7?' 78 :/?1&5()'71: dOc ()+ dWc /: )7 +/88'<')5 8<7? 5.' 715-7?' 78 dOc (&7)'>
d7='G'<H =.') -.<7)/- dOc /)8'-5/7) /: (--7?;()/'+ EF dWcH /5 ?(F &'(+ 57 :'G'<'H
81&?/)(5/)9 .';(5/5/: 7< 5<():87<? ( ?/&+ 7< (:F?;57?(5/- -.<7)/- dOc /)57 ( ?7<' :'G'<'
+/:'(:' ;<7-'::H 7< ( +/:'(:' ;<7-':: 5.(5 ?(F E' (--'&'<(5'+ +1' 57 /)-<'(:'+ :-(<</)9 78 5.'
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CbA
&/G'<> K<'G')5/7) 78 d';(5/5/: W /) ;'<:7): =.7 (<' )75 (&<'(+F dOcR/)8'-5'+ -() E'
(--7?;&/:.'+ 5.<719. d';(5/5/: O G(--/)(5/7)> 2A43
HDV Survival in the Environment
dWc /: 871)+ =/5. dOc> dOc -() E' -(;(E&' 78 -(1:/)9 /)8'-5/7) 87< ( =''I> %7:5 'J;'<5:
E'&/'G' 5.(5 dWc +7': )75 &(:5 (: &7)9 E15 /5 /: E':5 57 5(I' 5.' :(?' ;<'-(15/7): (: =/5. dOc>
Hepatitis E (HEV)
d';(5/5/: 6H &/I' .';(5/5/: #H /: :;<'(+ EF 8'-(&R7<(& 5<():?/::/7) 2AQ3> %7:5 715E<'(I: (<' 871)+
/) +'G'&7;/)9 -71)5</':H =.'<' +</)I/)9 =(5'< /: -7)5(?/)(5'+ EF 8'-': 8<7? /)8'-5'+ ()/?(&:
()+ .1?():> d6c /: <(<'&F :'') /) 5.' L>M>H =/5. 5.' 'J-';5/7) 78 5<(G'&'<: 57 +'G'&7;/)9
-71)5</':H ;(<5/-1&(<&F M715. #:/( ()+ *7<5. #8</-(> N)8'-5/7) 8<7? ;'<:7) 57 ;'<:7) /: &'::
8<'01')5 5.() =/5. .';(5/5/: #> ,.' /)-1E(5/7) ;'</7+ /: CD 57 SB +(F:H =/5. () (G'<(9' 78 bB
+(F:> ,.' 5/?' ;'</7+ /: CD 57 SB +(F:H =/5. () (G'<(9' 78 bB +(F:> ,.' 5/?' ;'</7+ 78
-7??1)/-(E/&/5F /: 1)I)7=)> ,.' +/:'(:' /: -.(<(-5'</\'+ EF :1++') 7):'5 78 8'G'<H ?(&(/:'H)(1:'(H ()+ ()7<'J/(> ,.' +/:'(:' G(</': /) :'G'</5F 8<7? ( ?/&+ /&&)':: &(:5/)9 4 57 Cb +(F: 57 (
:'G'<'&F +/:(E&/)9 +/:'(:' &(:5/)9 :'G'<(& ?7)5.:> V(1)+/-' ?(F E' ;<':')5> K<'9)()5 =7?')
.(G' ( ?7<5(&/5F <(5' 78 ABt> ,.'<' /: )7 'G/+')-' 78 ( -.<7)/- /)8'-5/7) /) &7)9R5'<? 87&&7=R1;
78 ;(5/')5: =/5. d6c> ,.'<' /: )7 G(--/)' 87< d6c>
Chronic Carriers of Hepatitis
".<7)/- -(<</'<: (<' /)+/G/+1(&: =.7 -7)5/)1' 57 :.'+ .';(5/5/: G/<1: 5.<719. E7+/&F 8&1/+: ()+
'J-<'5/7): &7)9 (85'< /)8'-5/7)> ,.'F (<' -&(::/8/'+ /)57 5=7 -(5'97</':U ".<7)/- K'<:/:5')5 ()+
".<7)/- #-5/G'> # -.<7)/- ;'<:/:5')5 -(<</'< /: (:F?;57?(5/- 7< .(: ?/)/?(& :F?;57?: E15 -()-7)5/)1' 57 /)8'-5 75.'<:> # -.<7)/- (-5/G' -(<</'< .(: ;<79<'::/G' :F?;57?(5/- +/:'(:' 5.(5
-7)5/)1': 57 +(?(9' 5.' &/G'<> MF?;57?: /)-&1+' ?(&(/:'H ='/9.5 &7::H &7:: 78 (;;'5/5'H ()+
785') ](1)+/-'> K(5/')5: =/5. .';(5/5/: # ()+ 6 )'G'< +'G'&7; -.<7)/- :5(5':> d';(5/5/: O
E'-7?': -.<7)/- /) D 57 CBt 78 /)8'-5/7): 25./: <(5' G(</': +';')+/)9 7) 5.' (9' 78 5.' ;(5/')53H
d"c /) 4DRQDt 78 /)8'-5/7):> ,7 9'5 ( 977+ .';(5/5/: ./:57<F (: ;(<5 78 5.' ;(5/')5 /)5(I'H (:I
(E715 -7)5(-5 =/5. E&77+ ;<7+1-5: :1-. (: 5<():81:/7):H +/(&F:/:H ()+ /)]'-5/7) +<19 1:'>
K(5/')5: =.7 .(G' <'-'/G'+ 5<():81:/7): 7< +/(&F:/: E'87<' CPPB 7< =.7 .(G' ( ./:57<F 78
/)]'-5/7) +<19 1:' ;<':')5 () /)-<'(:'+ </:I> #&:7H ?()F ;(5/')5: /) ( ;1E&/- .'(&5.-(<' :'55/)9H
:1-. (: -.'?/-(& +';')+')-FH dNcH ()+ ,O -&/)/-:H ?(F .(G' ( ./:57<F 78 :7?' 87<? 78 .';(5/5/:HE15 ?(F )75 I)7= =.(5 5F;' ()+ ?(F )75 I)7= =.'5.'< 5.'F (<' -.<7)/- -(<</'<:> ,.' 1:' 78
"&'() *''+&' ,'-.)/01' ()+ M5()+(<+ K<'-(15/7): /: 5.' 7)&F '88'-5/G' =(F 57 ;<'G')5
5<():?/::/7) 78 G/<(& .';(5/5/: +/:'(:':>
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CbT
Prevention of Hepatitis
$)' 78 5.' ?7:5 -7?;'&&/)9 <'(:7): 87< 5.' +'G'&7;?')5 78 5.' "&'() *''+&' ,'-.)/01'
;<757-7& /) CPQb =(: 57 ;<7G/+' 91/+'&/)': 57 ;<'G')5 5.' 5<():?/::/7) 78 .';(5/5/: =/5./)
(-1;1)-51<' -&/)/- :'55/)9:> M/)-' 5.(5 5/?'H 5.' /)-/+')-' 78 .';(5/5/: O 5.<719. (-1;1)-51<'
.(: +<(?(5/-(&&F +'-<'(:'+> 2AHT3 "7)5/)1/)9 :5</-5 (+.'<')-' 57 "&'() *''+&' ,'-.)/01' /:'::')5/(& /) 7<+'< 57 ;<'G')5 5<():?/::/7) 78 dOc 7< ( <'&(5'+ G/<1: 57 ;(5/')5:H ;<(-5/5/7)'<:
()+ :5(88>
,.' &(-I 78 ()F 'G/+')-' 78 5<():?/::/7) 78 G/<(& +/:'(:' 8<7? (-1;1)-51<' )''+&': /) 5.' L>M>
:/)-' CPPB -() E' +/<'-5&F (::7-/(5'+ =/5. 5.' /)5<7+1-5/7) 78 "*, -71<:' ()+ 5.' 1:' 78 :/)9&'R
1:' +/:;7:(E&' :5'</&' )''+&':>
Table 1: Summary of Hepatitis Characteristics
2M'' .55;U``===>-+->97G`.';(5/5/:`<':71<-':`;<78'::/7)(&:`;+8:`(E-5(E&'>;+8 3 87< +'5(/&:
(E715 d';(5/5/: #H O ()+ "3
P"/($*$*# @0).[($*,0 J'(0#?*##*,0 B0#"$ N())*0" D8',0*)
- H\I\M 2(5# X")(3I,'(3 -['./$ ]"# 1,
! V\IHKM 2(5# !3,,2[,'0" @0#*2*,.# ]"# ^"/"02# ,0
(>" >',./
F\IHM_ *0
(2.3$#`
8*>8"' *0)8*32'"0G
D HVIHLM 2(5# !3,,2[,'0" @0#*2*,.# 1, W\IL\_
^ a0<0,=0 &"').$(0",.# ,'
?.),#(3 ),0$()$
=*$8 *0+")$*,.#
[3,,2
@0#*2*,.# 1, a0<0,=0
9 H\IKM 2(5# X")(3I,'(3 -['./$ 1, 1,
Human Immunodeficiency Disease (HIV)
,.' .1?() /??1)7+'8/-/')-F G/<1: 2dNc3 /: () Y*#R-7)5(/)/)9 G/<1: 5.(5 /) .1?(): &'(+: 57 (
-7):5'&&(5/7) 78 ;<7E&'?: 'J5')+/)9 8<7? +'-&/)/)9 /??1)' 81)-5/7) 5.(5 &'(+: 57 () ')+R:5(9'
:F)+<7?' /) 1)5<'(5'+ ;(5/')5:H -(&&'+ 5.' (-01/<'+ /??1)' +'8/-/')-F :F)+<7?' 2#NWM3> ,.':'
?'+/-(& ;<7E&'?: ?(F E' 'J(-'<E(5'+ EF -7R/)8'-5/7) =/5. 75.'< +/:'(:'R-(1:/)9 (9')5: :1-.
(: 5.' .'<;': G/<1:':> dNc -7)5/)1': 57 E' ( 9<7=/)9 ?'+/-(& -.(&&')9' =7<&+=/+'> %(5.'<: ()+
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Cbb
X7)-(< /)+/-(5' 5.(5 7G'< 5.' AD F'(< ;'</7+ 8<7? ABBS 57 ABTBH E'5='') QP ?/&&/7) ()+ CC4
?/&&/7) ;'7;&' =/&& +/' 78 dNc`#NWM> 2AP3
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=7<I'<: 2d"^:3 .(G' ':5/?(5'+ 5.(5 5.' (G'<(9' </:I 87< dNc 5<():?/::/7) (85'< ( ;'<-15()'71:
'J;7:1<' /: (;;<7J/?(5'&F B>TtH 5.' </:I 78 dOc 5<():?/::/7) /: S 57 TBtH ()+ 5.' </:I 78 d"c
5<():?/::/7) /: (;;<7J/?(5'&F C>Qt> 2TT3 ,.' ?7:5 -7??7) ?7+' 78 5<():?/::/7) /:
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"W"H /)-&1+' 5.' 1:' 78 E(<</'<: (: 9&7G':H ?(:I:H 97=):H 9799&':H ()+ ;<'G')5/7) 5'-.)/01':
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HIV Survival in the Environment
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<';<7+1-' 715:/+' 78 5.' E7+F> $15:/+' 78 5.' E7+FH 5.' G/<1: +/': =/5./) ?/)15': =/5.715 5.'
5'?;'<(51<' )'-'::(<F 87< /5: :1<G/G(&> .55;U``===>-+->97G`./G`E(:/-:`5<():?/::/7)>.5?&
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+<7;;'+ 57 (E715 bBHBBB '(-. F'(<> #5 5.' ')+ 78 ABBPH () ':5/?(5'+ CHCbQHABB ;'<:7): (9'+
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;'<:7): =.7:' /)8'-5/7): .(+ )75 E'') +/(9)7:'+> 2TD3 ,.' )1?E'< 78 #NWM -(:': E'9() 57 8(&&
+<(?(5/-(&&F /) CPPS =/5. 5.' (+G')5 78 ;<75'(:' /)./E/57<:>
N5 /: /?;7<5()5 57 )75' 5.(5 5.' ;7;1&(5/7) +/:5</E15/7) 78 dNc .(: -.()9'+> N)/5/(&&F dNc =(:
871)+ ;</?(</&F (?7)9 ?') =.7 .(+ :'J =/5. ?')H /)]'-5/7) +<19 1:'<:H :'J =7<I'<:H ()+
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:1--'::81& ;<757-7&: 87< ;'</)(5(& -(:':H )'=E7<): (<' (-01/</)9 dNc 8<7? 5.'/< ?75.'<: ?1-.
&':: 8<'01')5&F> 6887<5: 57 5':5 (&& 'J;'-5()5 ?75.'<: ()+ :5(<5 5.7:' 871)+ dNc ;7:/5/G' 7)
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/: /) ( ;<78'::/7) =/5. ( </:I 78 E&77+ 'J;7:1<' 2:1-. (: .'(&5.-(<' =7<I'<:3 /: /) +()9'< 78
-7)5<(-5/)9 dNc>
dNc :'<7-7)G'<:/7) /) .'(&5.-(<' =7<I'<: /: <(<'H E15 M5()+(<+ K<'-(15/7): ?1:5 E'
?(/)5(/)'+> $8 5.7:' .'(&5.-(<' ;'<:7))'& 87< =.7? -(:' /)G':5/9(5/7): ='<' -7?;&'5'+ 8<7?CPQCRABCBH D4 .(+ +7-1?')5'+ :'<7-7)G'<:/7) 57 dNc 87&&7=/)9 7--1;(5/7)(& 'J;7:1<':> ,.'
<715': 78 /)8'-5/7) /)-&1+'+ bQ 5.(5 ='<' +1' 57 ;1)-51<' 7< -15 /)]1</':> [7<5FR)/)' .'(&5.-(<'
;'<:7))'& ='<' 'J;7:'+ 57 dNcR/)8'-5'+ E&77+i 5.<'' 57 -7)-')5<(5'+ G/<1: /) ( &(E7<(57<Fi 7)'
57 G/:/E&F E&77+F 8&1/+i ()+ 871< 57 () 1):;'-/8/'+ 8&1/+> 2TS3
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,.' "W" /: (&:7 (=(<' 78 CbT 75.'< -(:': 78 dNc /)8'-5/7) 7< ( +/(9)7:/: 78 #NWM (?7)9
.'(&5.-(<' =7<I'<: =.7 .(G' )75 <';7<5'+ 75.'< </:I 8(-57<: 87< dNc /)8'-5/7) ()+ =.7 <';7<5 (
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87< =.7? :'<7-7)G'<:/7) (85'< 'J;7:1<' =(: )75 +7-1?')5'+> N) 7<+'< 57 ;<'G')5 dNc
/)8'-5/7)H /5 /: -</5/-(& 57 1:' M5()+(<+ K<'-(15/7): =/5. 'G'<F ;(5/')5> 2TS3
,.'<' <'?(/): ( :/9)/8/-()5 </:I 78 /)8'-5/7) /) 5.' .'(&5.-(<' =7<I;&(-'> N) CPPSH 5.'<' ='<'
4QSHQQD ;'<-15()'71: ()+ ?1-7-15()'71: 'J;7:1<': 57 ;75')5/(&&F /)8'-5/71: :1E:5()-':
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;(5/')5 'G(&1(5/7) 57 +'5'<?/)' 5.' &/I'&/.77+ 78 'J;7:1<' 57H 7< 5.' ;<':')-' 78H dOc 7< dNc
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Testing
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8(&&/)9 /)57 ./9. </:I -(5'97</': -() -7)5/)1' 57 E' 5':5'+ <'91&(<&F (: ;(<5 78 <715/)' ?'+/-(&
-(<'> ,':5/)9 /: ':;'-/(&&F /?;7<5()5 87< 5.7:' =.7 8(&& /)57 5.' 87&&7=/)9 -(5'97</':U
C> K'<:7): /) ;<78'::/7): =/5. ( ./9. </:I 78 'J;7:1<'>
A> K'<:7): =.7 .(G' .(+ ( :'J1(&&F 5<():?/55'+ +/:'(:'>
T> ,.7:' =.7 .(G' ( ./:57<F 78 /)]'-5/7) +<19 1:' ()+ :.(<'+ )''+&':>
b> %') =.7 .(G' .(+ :'J =/5. 75.'< ?') :/)-' CP4Q>
D> %') ()+ =7?') =.7 .(G' 5<(+'+ :'J 87< ?7)'FH 877+H +<19:H 7< 75.'< /5'?:>
S> K'7;&' =.7 .(G' .(+ ?1&5/;&' :'J ;(<5)'<: ()+ 1:'+ /)5<(G')71: /)]'-5'+ +<19:>
4> M'J1(& 7< )''+&'R:.(</)9 ;(<5)'<: 78 5.' (E7G'>
Q> #)F =7?() 5./)I/)9 78 E'-7?/)9 ;<'9)()5>
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[7< :;'-/8/- /)87<?(5/7) 7) 5':5/)9 87< dNc -.'-I =/5. F71< &7-(& .'(&5. +';(<5?')5.
Reporting
# 1)/87<? -(:' +'8/)/5/7) ()+ -(:' <';7<5 87<? /: )7= 1:'+ /) (&& 8/85F :5(5': 87< 5.' <';7<5/)9 78
+/(9)7:'+ -(:': 78 #NWM> Y'G/:/7): /) 5.' +'8/)/5/7) 78 -&/)/-(& #NWM .(G' E<7(+')'+ 5.' <()9' 78
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()+ :;'-/8/-/5F 78 5.' +'8/)/5/7) 7G'< 5.' ;(:5 AB F'(<:>
The HIV Infection Process
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-(1:':i ;'<:/:5')5 -719. 5.(5 /: )75 (::7-/(5'+ =/5. :?7I/)9 7< /)8&1')\(i ()+ 8&(5 7< <(/:'+;/9?')5'+ &':/7): 7) 5.' :I/) <()9/)9 /) -7&7< 8<7? 8(/)5 ;/)I 57 <'+H E<7=)H 7< E&1'> %()F 78
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/) #NWM ;(5/')5:>
,.' -&/)/-(& ;<':')5(5/7): 78 #NWM ;(5/')5: G(<F 'J5'):/G'&F> N)+/G/+1(&: ?(F ;<':')5 =/5. dNc
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CbP
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CDB
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CDC
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CDA
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CDD
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CDQ
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CDP
5. Summary of Prevention of Disease Transmission in Acupuncture
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CSB
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C4T
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Recommendations
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C4b
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C4D
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Alcohol Swab Method
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Options for Skin Preparation
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C4S
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Part VI:
Cleaning and Pathogen Reduction Techniques inHealthcare and AOM Practice Locations
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1. Disinfectants
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CPB
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Classifications of Disinfectants
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Types of Disinfectants
Chlorine and Chlorine Compounds
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CPC
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CPA
Hydrogen peroxide
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Iodophors
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EPA and FDA Approval of Disinfectants
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CPT
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CPb
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Safety Guidelines for Disinfecting Reusable Medical Equipment
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ABB
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References
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ACb
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ACD
3. Recordkeeping
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ACS
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ACP
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References
C> $--1;(5/7)(& d'(&5. ()+ M(8'5F #+?/)/:5<(5/7) 2$Md#3> Y'91&(5/7): 2M5()+(<+: AP"[Y3i
M5()+(<+: 87< (&& 7--1;(5/7):>
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y57-y&'G'&{Ce;yI'FG(&1'{CPCB> #--'::'+ W'-'?E'< ABCA>
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ABCC>.55;U``===>-+->97G`.(/`:'55/)9:`715;(5/')5`715;(5/')5R-(<'R91/+'&/)':>.5?&
#--'::'+ *7G'?E'< ABCA>T> $--1;(5/7)(& d'(&5. ()+ M(8'5F #+?/)/:5<(5/7) 2$Md#3> *''+&':5/-I M(8'5F ()+ K<'G')5/7)
#-5> [<'01')5&F #:I'+ m1':5/7):>.55;U``===>7:.(>97G`)''+&':5/-I:`)''+&'8(0>.5?&>
#--'::'+ #;</& ABCT
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.55;U``===>7:.(>97G`;&:`7:.(='E`7=(+/:;>:.7=y+7-1?')5g;y5(E&'{:5()+(<+:e;y/+
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S> $Md# M5()+(<+: 87< O&77+E7<)' K(5.79'):> d'(&5.-(<' 6)G/<7)?')5(& Y':71<-' "')5'<>
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4> $--1;(5/7)(& M(8'5F ()+ d'(&5. Y':71<-' X7-(57<> d'(&5.-(<' 6)G/<7)?')5(& Y':71<-'
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AA4
Part VIII – Appendices
Appendix A: Glossary/Abbreviations,.' 87&&7=/)9 /: ( &/:5 78 +'8/)/5/7): 78 5'<?: ()+ (EE<'G/(5/7): 5.(5 (<' 1:'+ /) 5./: ?()1(&>
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AAQ
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ATT
Appendix B: Where to Find More Information['+'<(& "W"H :5(5' $Md# 788/-':H ()+ &7-(& .'(&5. +';(<5?')5: (<' (G(/&(E&' 57 9/G'
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Index
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(99<(G(5/7) 78 :F?;57?:H bH PH PQ
#NWMH CbH C4H 44H CbTH C4AH C4SH C4QH CPT
(&-7.7& :=(EH 4CH 4AH C4bH C4DH AbC
(&-7.7&RE(:'+ .()+ :()/5/\'<H SPH 4QH QDH QSH CD4H
CDQH CSPH C4BH CQP
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(:';5/- 5'-.)/01':H J/GH CH SPH CASH AA4
(1579')71:H CSH CTA
E(-5'</(H 4PH CTCH CTAH CbPH CDCH CDTH CSPH C4BH C4CH
C4AH C4SH CQDH CPCH CPSH AA4H AAQH AAPH ATBH ATCH
ATAH AbA
E(-5'</(& &7(+H 4TH C4B
E(-5'</(& :;7<':H AAQH AAPH ATB
E/7.(\(<+ 5<(:.H TSH T4H AbD
E/7.(\(<+71: =(:5'H QSH CP4H AB4H ACCH ACAH ACTH
ACbH AAD
E&''+/)9H TH bH TPH bQH DBH D4H SPH QbH PAH PTH PSH CCbH
CCQH CCPH CABH CATH CAbH CA4H CAQH CQCH CQAH CQTH
CPSH AB4H AbbH AbDi N)5'<)(&H Cb
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CAbH CA4H CTAH CTTH CTbH CTDH CTSH CT4H CTQH CbBH
CbCH CbbH CbSH CDTH CSQH C4BH C4AH C4SH C4QH CQBH
CQCH CQTH CPCH CP4H CPQH CPPH ABBH ABSH AB4H ABQH
ACCH ACTH AbCH AbTH AbD
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CbSH CSQH C4CH C4AH C4TH C4SH CQBH CQCH CQTH CP4H
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"')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) 2"W"3H
TSH bPH DbH 4bH 4SH PCH CASH CA4H CTTH CTSH CT4H
CTQH CbbH CbDH CbSH CDSH CDQH CSQH C4AH C4TH C4bH
C4DH C44H C4QH CQBH CQAH CQPH CPBH CPTH CPbH CP4H
ABbH ABSH ACTH ATT
-.'?/-(& 9'<?/-/+':H CPBH CPAH ATB
-./&+ 7< '&+'< (E1:'H AAC
-.&7<.'J/+/)'H 4AH C4DH AbC
-&'() 8/'&+H SQH 4BH 4bH 4DH 4SH 44H QAH QTH QbH QSH Q4H
QQH QPH PBH PAH PbH PDH PSH CCQH CABH CATH CADH CAPH
CDPH C4DH C44H CQPH AAQH AbbH AbD
"&'() *''+&' ,'-.)/01' 2"*,3H C4H SQH SPH 4DH 4SH PDH
CA4H CTCH CTQH CbAH CDCH CDPH C44H ABbH ABSH AA4
-&'() 5'-.)/01'H AAQH Abb
-&'()/)9 (--/+')5(& :;/&&:H CP4
"&7:5</+/1? +/88/-/&'H CD4H CDQH CPC
-&75./)9H 4QH PAH C44H CP4H ABQ
-7??1)/-(E&' +/:'(:'H ABbH AAC
-7)8/+')5/(&/5FH C4PH ABbH ABDH ACPH AAb
-7)5(?/)(5/7)H PH DBH 4BH 4AH 4SH 44H QSH PAH PQH CADH
CASH CA4H CDCH CDQH C4AH C4bH C4SH CQAH CQTH CQPH
CPSH ABBH AAQH AbB
-1;;/)9H bH TCH TAH TTH TbH TDH TSH T4H TPH bQH DTH CCbH
CCDH CC4H CDDH C4SH CQTH CPbH CPSH CPPH AAAH AADH
AbCH AbAH AbbH AbD
-15()'71:H TH D4
+/:/)8'-5()5H C4H TSH DbH SBH 4bH 44H PDH P4H CCQH CA4H
CDAH CD4H CDQH C4bH CQPH CPBH CPCH CPAH CPDH CP4H
ABCH ABAH AAQH AAPH AbBH AbA
'--.F?7:/:H TCH TAH TPH bBH DAH CCbH CAbH AAQ
'&'-5</-(& :5/?1&(5/7)H bTH bDH bSH DPH AAP
')9/)''</)9 -7)5<7&:H 4bH CDSH AB4H ABQH ACb
8(/)5/)9H TH bH 4H bTH PTH CA4H AbB
8/<' +';(<5?')5 <'91&(5/7):H ABbH AAb
87<9755') )''+&'H bH Q
81)9/H CbPH C4CH ATB
9&7G':H C4H TDH TSH T4H DBH D4H SPH 4bH 4SH QbH PAH PDH
PSH CCbH CCQH CCPH CABH CAAH CATH CASH CA4H CAPH
CbbH CbQH CDAH CD4H CDQH C44H CQCH CQAH CQTH CP4H
ABBH ABDH ABSH ABQH ACTH AAb
9&15(<(&+'.F+'H CPC
Z<71; # M5<';57-7--1: 2Z#M3H CDT
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Ab4
91( :.(H DAH DTH DbH CAbH CADH CPbH CPDH CPSH ABCH
AAAH AADH AbAH Abb
.()+=(:./)9H SPH 4BH 4bH 4SH 4QH 4PH PCH PbH P4H CTbH
CDAH CDTH CDDH CD4H CDPH CSBH CSQH CSPH C4BH C4CH
C4AH C4TH CQAH CQPH ABSH ABQH ACbH AAQH ATA
d(\(<+ "7??1)/-(5/7) M5()+(<+H ABbH ACB.'(&5.-(<' (::7-/(5'+ /)8'-5/7): 2d#N3H CTCH CbPH CSPH
C4CH ATT
.';(5/5/:H TH bH CbH ADH bQH 44H QBH PCH CASH CTCH CTTH
CTDH CTSH CTPH CbBH CbCH CbAH CbQH C4CH C4AH C4TH
C4SH C4QH C4PH ABQH ACPH ATTi .';(5/5/: # 2d#c3H
CTbi .';(5/5/: O 2dOc3H bQH QBH PCH CASH CTTH CTbH
CTDH CTSH CT4H CTQH CTPH C4QH C4PH CQPH CPAH ABDH
AB4H ABQH ACPi .';(5/5/: " 2d"c3H ADH QBH PCH CASH
CTPH CbBH CbCH C4Qi .';(5/5/: W 2dWc3H CbCi
.';(5/5/: 6 2d6c3H CbA
.';(5/5/: O 2dOc3H bQ
.'<;': :/?;&'J G/<1: 2dMc3H TbH CbQH CDbH CDD
dNK##H ABD
dNcH QBH PCH CTCH CTTH CTPH CbBH CbTH CbbH CbDH CbSH
Cb4H CbQH C4CH C4AH C4TH C4SH C4QH C4PH CPCH CPAH
ABDH ATbH AbT
.71:'I'';/)9H CPSH ABCH ABQH AAT
.F9/')'H CTbH CTQH C4SH C44i .()+H 4bH CASH CD4H CDQH
CSQH CSPH C4BH C4bH CQAH CQTH ABSH AAbi
<':;/<(57<FH CDSH ABSH AAb
.F;7-.&7</5' :7&15/7)H CPBH CPCH CPAH CP4H CPQH ABAH
AAQ/??1)' :F:5'?H PCH CTCH CTTH CT4H Cb4
/?;'5/97H CDT
/)8'-5/7)H TH bH CbH CSH AbH ASH TTH TbH TSH T4H bQH bPH
DPH SBH SbH S4H 4AH 4TH 4bH 4SH QBH QQH PCH CBAH CADH
CASH CA4H CTCH CTAH CTTH CTbH CTDH CT4H CTQH CTPH
CbBH CbCH CbbH CbDH Cb4H CbQH CbPH CDAH CDTH CDbH
CDDH CD4H CDQH CSBH CSQH C4bH C44H C4QH C4PH CQPH
CP4H ABDH ACCH ACPH AA4H AAQH ATB
/)8'-5/71: (9')5H 44H CTCH CTAH CTTH C4CH C44H CQBH
CPB
/)8'-5/71: +/:'(:':H SbH CA4H CTCH CTAH C44H CQBH ATC/)8&1')\(H CDDH C44H CP4
/)87<?'+ -7):')5H ABbH ABDH AACH AAA
/)]'-5/7):H CASH CA4H CAPH C4bH CQC
/)]1<FU E&77+ G'::'&:H CSi -')5<(& )'<G71: :F:5'?H CDi
.'(<5H CTi )'<G' /)]1<FH TH SDi 7<9()H CTi
;'</;.'<(& )'<G':H CDi 5/::1'H CD
&()-'5H C4H TCH TAH TDH bQH bPH DBH SQH 4bH 4SH QBH PDH
PSH CCbH CCQH CCPH CABH CATH CDPH C4SH CPPH AB4H
ACTH ATAH AbTH Abb
?(5'</( ?'+/-(H A
?'+/-(& =(:5'H 4bH QDH QQH ACAH AAD
?'5./-/&&/)R<':/:5()5 M5(;.F&7-7--1: (1<'1: 2%YM#3HCSH 4PH CTTH CDAH CDT
?7J(H J/JH AbH ADH ASH A4H APH SQH CBCH CBAH CBTH CBbH
CBDH CBSH CB4H CBQH CBPH CCBH CCCH ACCH AAAH AADH
ATBH AT4H Abb
?7J( :?7I'H ADH A4H CBA
%F-7E(-5'</( 75.'< 5.() 51E'<-1&7:/: 2%$,3H CDTH
CDb
*""#$%H JGH JG/H JG//
)''+&' ?()/;1&(5/7)H SH 4H CDH bTH PDH P4
)''+&':5/-IH QH 4DH 4SH 44H QBH QCH PAH CABH CTSH CbbH
C44H CQCH CQTH AbBH AbT*''+&':5/-I M(8'5F ()+ K<'G')5/7) #-5 2*MK#3H ABS
)7<7G/<1:H CDSH CD4
$Md#H CTQH CQBH CQCH CQAH CQPH CPTH CPQH ABBH ABbH
ABDH ABSH AB4H ACBH ACCH ACAH ACTH ACbH AAAH ATDH
AbD
;(-'?(I'<H bbH bSH b4H Abb
;(<':5.':/(H T
;(5/')5 <'-7<+:H ACDH AAD
;'<:7)(& ;<75'-5/G' '01/;?')5 2KK63H TDH 4bH CCbH
CCQH CCPH CASH C4PH CQBH CQTH ABBH ABCH ABSH ABQH
AAbH ATB;'5'-./('H TCH TAH TPH bBH DAH DbH CCbH CAbH CADH AAAH
AAQ
;&1? E&7::7?`z:'G')R:5(<zH C4H TAH D4H SPH 4bH 4SH
QBH CAAH CPPH ATCH ATA
;)'1?75.7<(JH bH CBH CAH TAH 4PH PDH AT4H ATQ
KKWH C44
;1E&/- .'(&5. :'55/)9:H PCH PA
</:I <'+1-5/7)H JGH ABbH ABD
<1E'8(-5/7)H Ab
M(8'5F Z1/+'&/)':U #99<(G(5/7) 78MF?;57?:H CBi
#G7/+ [/<' "1;;/)9 O1<):H TDi #G7/+ $<9() ()+"')5<(& *'<G71: MF:5'? N)]1<FH CDi #G7/+
K)'1?75.7<(JH CAi #G7/+ ,/::1' N)]1<FH CSi
O&77+&'55/)9H DBi O<7I') *''+&'H CPi "1;
W/:/)8'-5/7)H TQi "1;;/)9H TPi W/:/)8'-5/)9
Y'1:(E&' %'+/-(& 601/;?')5H CPbi W/:/)8'-5/7) 78
Z1( M.( ,77&:H DDi 6(< :''+:H STi Z1( M.(H DTi
d()+ M()/5(5/7)H SPi d'(5 ,.'<(;/':H AQi
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AbQ
N)5<(+'<?(& *''+&':H SBi %7J( O1<) K<'G')5/7)H
ASi %7J( O1<) ,<'(5?')5H A4i %7J( M?7I'
Y'(-5/7)H A4i *''+&' "1;;/)9H bBi *''+&'
Y'?7G(&H Pi K&1? O&7::7? ,.'<(;FH D4i K<';(</)9
()+ %(/)5(/)/)9 ( "&'() [/'&+H 4Bi K<'::,(-I:H SBi
K<'G')5 O<1/:/)9H O&''+/)9 ()+ c(:-1&(< N)]1<FH DiK<'G')5 "1;;/)9 #+G'<:' 6G')5:H bBi K<'G')5
"1;;/)9RY'&(5'+ N)8'-5/7):H TSi K<'G')5 [(/)5/)9H
4i K<'G')5 N)8'-5/7)H C4i K<'G')5 *''+&' M/5' K(/)H
Si K<'G')5/)9 6# #+G'<:' 6G')5:H bDi K<'G')5/)9
6&'-5</-(& N)]1<F +1</)9 6#H bSi K<'G')5/)9
6J-'::/G' %1:-&' "7)5<(-5/7) +1</)9 6#H bDi
K<'G')5/)9 N)5'<8'<')-' =/5. ( "(<+/(- K(-'?(I'<
W1</)9 6#H bSi MI/) K<';(<(5/7)H 4Ti M51-I *''+&'H
Qi ,1/ *(H SD
:.(<;:H SQH 4TH 4bH 4SH 4QH CASH CQPH CPTH CPPH ABBH
ACCH ACAH AAQ:.(<;: -7)5(/)'<H 4TH 4bH QBH QCH QbH QDH QSH Q4H QQH
PAH CPPH ABCH ABQH ACb
:7(; ()+ =(5'<H TDH TSH T4H DbH SPH 4CH 4AH 4QH PCH
CD4H CDQH CSQH CSPH C4BH C4AH C4bH C4DH CQTH CPDH
CP4
M$#K )75':H AC4H AAD
:;/&&:H QbH CQTH CPSH CP4H CPQH CPPH ABC
M5()+(<+ K<'-(15/7):H JG//H SQH 4bH 4SH 44H PbH CT4H
CbAH CbbH CbDH CbSH CbQH CDDH CDSH C4CH C4TH C44H
CQBH CQCH ABBH ABbH ABSH AAAH AAbH ATCH ATD
!%"@C&,/7/77).H bH CTCH CTAH CDCH CDAH C4CH C4AH C4S
M5(;.F&7-7--1: (1<'1:H CSH TbH TDH CDA
:5'</&()5H CPBH CPCH CPAH CPS
:5'</&'H TH C4H CQH ASH TDH D4H DPH SBH SQH SPH 4BH 4bH
4DH 4SH 44H 4QH 4PH QCH QAH QTH QbH Q4H QPH PBH PCH
PbH PDH PSH CBAH CBSH CCQH CAAH CA4H CAQH CAPH CbTHCDPH CSBH C4CH C44H CPBH CPTH AA4H AAQH ATCH ATAH
AbBH AbCH AbAH Abb
:5'</&/\(5/7)H 4QH CPTH ABDH ATA
M5<';57-7--1:H CTCH CDCH CDT
:51-I )''+&'H bH 4
,WK &(?;:H A4H CCA
5<'(5?')5 <'-7<+:H ACDH ACQH ACP
%)R$17),/.*. OG3PH bH CTTH CbPH CDBH C44H CQBH CPCH
ATb
1)/G'<:(& ;<'-(15/7):> !$$:5()+(<+ ;<'-(15/7):H
!$$:5()+(<+ ;<'-(15/7):G(--/)(5/7)H CTTH CTbH CTSH CT4H CTQH CbCH CDBH CDSH
CDPH C4bH ABDH AB4
G(--/)'H QBH CTDH CT4H CTPH CbCH CbAH CbQH CQCH ABQ
G/<1:H CTCH CTTH CbTH CbPH C4CH C4AH C4SH C4QH CQPH
CPCH AAQH AAPH ATA
=7<I;&(-' G/7&')-'H ABb
j/;R&7-I E(9:H QS
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