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REFLEXOLOGY RESEARCH
SINUSITIS
"Reflexology massage" was found to be as effective as nasal
irrigation for alleviation of chronic sinusitis in a University
of Wisconsin School of Medicine study. Dr. Andrew Weil's Self Healing
reports, "After two weeks of daily treatment, more than 70
percent of those who practiced either form of nasal douching reported
improved symptoms. But surprisingly, the group that practiced reflexology
massage - where pressure is applied to the feet or hands but may
produce changes elsewhere in the body - appeared to fare equally
well. The unexpected results for this technique may prompt further
research." ("The Saline Solution?" Self Healing,
January 2002, page 2)
"Reflexology massage" was utilized as a control in the
testing of two nasal irrigation study groups, nasal irrigation with
a bulb syringe and nasal irrigation with a nasal irrigation pot.
One hundred fifty individuals were randomly assigned to one of the
three groups. "Groups one and two performed daily hypertonic
saline irrigation for two weeks with one method (bulb syringe
or nasal irrigation pot) and then switched to the other method
for the
following two weeks. Irrigation devices were collected and
cultured after two weeks of use. Group three (the control)
performed reflexology
massage daily for two weeks. Data was collected prospectively
including pre-treatment Medical Outcomes Study Short Form,
pre and post-treatment
Rhinosinusitis."
"Overall,
36 percent of subjects reported decreased use of sinus medication
(decongestants, antihistamines, pain relievers, and nasal
sprays) during the study with no measurable difference
between the three groups. Conclusions: The study demonstrated
that daily nasal
irrigation with hypertonic saline offers patients an inexpensive
treatment protocol that improves chronic sinusitis symptoms.
During the study, a number of patients decreased or eliminated
medication.
The choice of preferred irrigation protocol was likely
linked to the randomization among patient subjects. It is unclear
whether the
improvement found in patients in the reflexology massage
group reflects a therapeutic, placebo, or combination of effects.
All the findings
highlight the complex interactions of managing chronic
sinusitis symptoms."
(Diane
G. Heatley MD, Glen E. Leverson PhD, Kari E. McConnell
RN, and Tony L. Kille (the University of Wisconsin School of
Medicine,
Madison, WI) "Nasal Irrigation for the Alleviation of Sinonasal
Symptoms," presented Monday, September 25, 2000,
at the American Academy of Otolaryngology--Head and
Neck Surgery
Foundation Annual
Meeting/Oto Expo, being held September 24-27, 2000,
at the Washington, DC Convention Centre) (www.askdrbob.com/archives/reference/sinus.htm)
AMENORRHEA (absence of menstrual bleeding)
* Ninety-five cases of amenorrhea were divided into two groups,
a foot reflex therapy treatment group of 50 and a control
group of 45 with participants using traditional Chinese
medicine tablets.
The effective rate of the foot reflex therapy group was 96%
compared to the control group rate of 33%.
Xiu-hua,
Xu, "Analysis of 50 Cases of Amenorrhea Treated by
Foot Reflex Therapy," (19)96 Beijing International
Reflexology Conference (Report), China Preventive Medical
Association
and the Chinese Society of Reflexology, Beijing, 1996,
p. 36
ARTHRITIS
Forty-two cases
of acromioclaviclar (shoulder) arthritis received thirty-minute
sessions of foot reflexology once a day for
15 days. At the finish, 8 were "cured," 20 were "distinctly
effective" and 14 cases were "improved."
Zhi-xian,
Ma and Jin-li, Zhang, "Foot Reflexology in the
Treatment of Acromioclavicular Arthritis, (19)96 Beijing
International Reflexology Conference (Report), China Preventive
Medical Association
and the Chinese Society of Reflexology, Beijing, 1996, p.
55
BIOFEEDBACK ASSESSMENT
"Proactive
health-care services emphasize health promotion and the prevention
of disabling conditions, Currently in Thai society,
the number of elderly with deteriorating health has increased.
Therefore, self-care health promotion activities have become
essential in order for the elderly to maintain their well-being.
The purpose
of this study was to investigate the effects of foot massage
with biofeedback. Foot massage, a Thai primary self-care custom,
has
been found to enhance blood circulation, relaxation, and one's
own healing power. In addition, touch has been found to stimulate
secretion of endorphins and reduce pain and anxiety. It appears
therefore that foot massage, or reflexology, promotes a healthy
lifestyle for all age groups. An experimental study, utilizing
a pilot project in elderly health care, was employed to investigate
the effects of biofeedback using foot massage. A pretest/post-test
quasi-experimental design was used. The sample consisted of four
mean and 16 women (age group 61-69). Four trained researchers
massaged the feet of the subjects and measured vital-sign changes.
Biofeedback
was also investigated before and after the foot massages. Results
showed that the average biofeedback and temperature were lower
before than after the foot massage (P<0.01). The average pulse
rate, respiratory rate and blood pressure, however, were found
to be higher before rather than after the foot massage (P<0.01).
It was concluded that the foot massage provided good circulation,
relaxation and comfort. All subjects expressed positive feelings
when they received the foot massage (i. e. "It is very nice
that foot massage can relieve my joint pain, I an happy and comfortable.")
These findings appear to indicate that foot massage is
beneficial both for physical and mental conditions. Foot
massage, however,
is just one key to achieving a full range of primary health-care
services. It needs to no only be performed by nurses. Families
also, can provide foot massage for the elderly, anywhere
and anytime."
Jirayingmongkol
P, Chantein S, Phengchomjan N, Bhanggananda N, "The
effect of foot massage (reflexology) with biofeedback: a pilot
study to enhance health promotion," Nurs Health
Sci, 2002 Aug;4(Suppl):A4 (PMID: 12153420) CONSTIPATION
Forty residents
of a "lodging house of the aged people" were
studied for effects of foot reflexology on digestive processes.
20 were diagnosed as constipated and 20 were not. Five
days before the foot reflexology treatment all were given a carbon
tablet
and observed for the length of time required to begin
and end black
stool. All received 10 days of foot reflexology treatment.
The carbon tablet was administered again and a comparison was
made
between the elimination times before the treatment and
after. After treatment, the interval between taking the carbon
tablet
and first
black stool for the constipation group changed from an
average of 45 hours to an average of 34 hours. The interval until
last
black stool changed from 77 hours to 51.5 hours. The non-constipation
group remained unchanged in average times for first black
stool and changed from 57.5 hours to 46 for last black stool
after
hours after treatment.
Yuru,
Yang; Lingyun, Chao; Guangling, Meng; Scuwe, Cao; Jia-Mo,
Hao and Suhui, Zhang, "Exploring the Application of Foot Reflexology
to the Preventions and Treatment of Functional Constipation," 1994
China Reflexology Symposium Report, China Reflexology Association,
Beijing, p. 62
DYSMENORRHEA (painful menstrual cramps)
Thirty-six cases of dysmenorrhoea showing abdominal
pain during menstruation were treated with foot
reflexology. Following treatment,
those who were cured (showed disappearance of all conceal
sometimes with no relapse in 3 months) included
(a) 3 of the 4 cases experiencing
dysmenorrhoea under 1 year (average: 9.4 sessions), (b) 14
of the 22 cases experiencing dysmenorrhoea from
1 to 10 years (average
13.1 sessions), (c), 7 of the 11 over 10 years (average:
17.3 sessions). Those who showed marked effectiveness
(showed improvement
of clinical symptoms, most of which disappear) included (a)
1 under 1 year, (b) 5 from 1 to 10 years and (c)
3 over 10 years.
Those who shoed effectiveness (amelioration of symptoms,
some pain) included (a) 3 from 1 to 10 years and
(b) 1 over ten years.
All cases showed effect (change after treatment).
Wang
Jixizng, "Clinical Observation on the Treatment for 36
Cases with Dysmenorrhoea by Foot Reflexotherapy," 1998
China Reflexology Symposium Report, China Reflexology Association,
Beijing, pp. 56-57
Foot reflexology was applied to 17 teenagers, 14-17
years old with a history of amenorrhea for 1 to
4 years. Foot reflexology
was
applied twice for thirty to forty minutes. Application
to the
17 during the first menstrual cycle showed a cured rate
of 3, a significant
rate of 13 and an effective rate of 1. Application to the
14 during the second menstrual cycle, showed a cured rate
of 6,
a significant
rate of 7 and an effective rate of a. Application to the
8 during a third cycle showed 8 cured, 2 significantly
effected and 1 effected.
Wang
Lan-xian, "Treatment of Amenorrhea by Foot Reflex Therapy
during Menstruation," (19)96 Beijing International
Reflexology Conference (Report), China Preventive Medical
Association and
the Chinese Society of Reflexology, Beijing, 1996, p.
36
ECZEMA
Reflexology was applied to the feet of 32 cases of eczema daily.
28 cases fully recovered, 2 got better and 2 showed no improvement.
Gu
Hanqing, Xu Yazhen, "Treatment of Eczema with Reflexology
- Report of 32 Cases," 1998 China Reflexology Symposium
Report, China Reflexology Association, Beijing, pp. 66-68
FATIGUE
Twelve athletes were divided into two groups: a foot reflexology
group and a control group. The test group received daily reflexology
sessions. Both groups underwent the same athletic training and
were observed for sleeping, appetite and reactions to training.
The reflexology group showed better qualities of sleep, better
appetite and quicker recovery from fatigue and muscle soreness.
Jianguo,
Liu and Jingshun, Zhang, "Foot Reflex Zone Massage
in Recovery of Fatigue in Athletes," 1994 China Reflexology
Symposium Report, China Reflexology Association, Beijing, p.
98 (Xian City, Shan'xi, China)
HEADACHE
Results of study: 19% of headache sufferers ceased taking medication
following reflexology work. According to a large nationwide research
study undertaken in Denmark, reflexology treatment has a beneficial
effect on patients suffering from migraine and tension headaches.
The study was conducted at the Department of Social Pharmacy,
The Royal Danish School of Pharmacy in co-operation with five
reflexology associations. 220 patients participated with treatment
being given by 78 fully trained reflexologists across the country.
in cooperation with five different reflexology societies FDZ
(Danish Reflexologists Association), LNF (National Forum for
Natural Healing), SFFF, (Association of Scandinavian Reflexologists),
SAB (Union of Complementary Therapists) and OZ (Union of Reflexologists).
The project description was approved by the National Board of
Health's Council concerning complementary treatment and the project
was financed by the Ministry of Health, Director and Mrs. E.
Danielsens's Fund together with Pool and Lottery Funds distributed
by the Ministry of Education. Headaches remain the most common health problem amongst the
adult population and it has been estimated that they
are the reason for
the loss of three million working days every year. Reflexology
is renowned for its ability to help relax and calm patients and
for this reason it was considered an interesting therapy to study
for the treatment of tension headaches and migraine.
Of all the patients who took part in the study, 90 percent
said that they had taken prescribed medication for
their headaches
within the month prior to the commencement of the study and,
of them,
36 percent had experienced side effects from the medicines.
81 percent of the prescribed medicine in the acetvlsalicyclic
acid
and paracetamol group was taken at least twice a week and 72%
of the stronger migraine medicines were taken at least once
a fortnight
which indicates that the majority of the patients were suffering
from moderate to severe symptoms. 34 percent had taken medications
for ailments other than headaches.
Three months after a completed series of reflexology
treatments, 81 percent of patients confirmed that
reflexology had either
cured (16%) or helped (65%) their symptoms. 19 percent of
the patients
re-ported that they had been able to completely dispense
with the medications they had been taking before
the study.
The reflexologists also found that there was a strong link
between headaches and the gall bladder, stomach, bladder,
and endocrine
hormone meridians. At the end of the study the patients who
benefited from the treatment showed less stress on the reflex
points for
the ovaries, small intestine, bladder, stomach, liver and
kidneys than they had experienced on their first treatment.
The likelihood
of successful cure was found to be greatest for: a) those
patients whom the reflexologist found no stress on the reflex
zones
of the uterus or gall bladder, and b) younger patients who
had suffered
from headaches for a short period of time.
Brendstrup,
Eva and Launsø, Laila, "Headache and Reflexological
Treatment," The Council Concerning Alternative Treatment,
The National Board of Health, Denmark, 1997
IBS
* "Reflexology
does not help patients with Irritable Bowel Syndrome (IBS),
a study has found. the complementary
therapy, in
which points in the feet are massaged in a particular way to
ease discomfort in other parts of the body, was assessed
in a study
published in the British Journal of General Practice."
"Thirty-four
patients with IBS were recruited from four GP practices.
The study was approved and carried out in consultation with
reflexologists. Half the patients received six 30-minute
reflexology treatment
sessions. The other half saw heath care staff for the same
amount of time but received no reflexology treatment. Patients
were
asked to record symptoms for two weeks before their first session, two
weeks after and for a fortnight three months after their treatment
had ended. Severity of abdominal pain, constipation or diarrhoea
and bloating were measured but the Leeds team, led by Dr. Philip
Tovey, said none showed reflexology made no positive difference."
Dr. Tovey
of the School for Healthcare Studies at the University
of Leeds (p.a.tovey@leeds.ac.uk), noted
that "While due caution
would be exercised in generalising from a single study, the
nature of the data is such that clear conclusions
can be drawn. However,
more research is needed, not only to test these initial findings
but also to extend the range of participants to, for instance,
those newly diagnosed with IBS Reflexology in particular
remains not just under-researched but almost un-researched
- something
that is quite startling given the extent of its use."
(Reported
December 31, 2001 at http://news.bbc.co.uk/hi/english/health/newsid_1723000/17232900.stm)
MENOPAUSE
* "Seventy-six women between 45 and 60 years, reporting menopausal
symptoms. Methods: Women were randomised to receive nine sessions
of either reflexology or non-specific foot massage (control) by
four qualified reflexologists over a period of 19 weeks. Main outcome
measures: The Women's Health Questionnaire (WHQ), the primary measure
s being the subscores for anxiety and depression. Severity (visual
analog scale (VAS) a n frequency of flushes and night sweats. Results:
Mean (SD) scores for anxiety fell from 0.43 (0.29) to 0.22 (0.25)
in the reflexology group and from 0.37 (0.27) to 0.27 (0.29) in
the control group over the course of treatment. Mean (SD) scores
for depression fell from 0.37 (0.25) to 0.20 (0.24) in the reflexology
group and from 0.36 (.023) to 0.20 (0.21) in the control (foot
massage) group over the same period. For both scores there was
strong evidence of a time effect (P<0.001) but no evidence of
a time-group interaction (P>0.2). Similar changes were found
for severity of hot flashes and night sweats. In the control
group, 14/37 believed they had not received reflexology. Conclusion:
Foot
reflexology was not shown to be more effective than non-specific
foot massage in the treatment of psychological symptoms occurring
during menopause."
(Williamson
J, White A, Hart A, Ernst E., "Randomised controlled
trial of reflexology for menopausal symptoms," BJOG, 2002
Sep; 109(9):1050-5)
Eighty-two women diagnosed with menopause were randomly
divided into two groups. Forty-two women received
foot reflexology
and forty received foot reflexology with auricular point
magnet adhesion.
Thirty-minute session were provided daily for 60 days.
Among women provided with foot reflexology at the
conclusion of the study, 17 (40.48%) of the women
had fully recovered,
20 (47.62%)
had significantly recovered, 4 (9.25%) had effective results
and 1 had ineffective results.
Among women provided with foot reflexology and auricular
magnet adhesion at the conclusion of the study, 9 (22.5%)
of the women
had fully recovered, 16 (40%) had significantly recovered,
9 (22.50) had effective results and 6 (15%) had ineffective
results.
Sun
Jianhua, "Observation on the Therapeutic Effect of 82
Cases of Climacterium Syndrome (menopause) Treated with Reflexotherapy," 1998
China Reflexology Symposium Report, China Reflexology
Association, Beijing, pp. 60-61
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MIGRAINE
"Foot
reflexology is defined as massage of zones on the feet
which correspond to different parts of the body. A
medline-search yielded
no literature in the field of foot reflexology. Indications for
and results of foot reflexology have been extrapolated from case-descriptions
and two pilot studies with small samples. One study (Lafuente
et al.) found foot reflexology to be as helpful to
patients with headaches
as medication (flunarizine), yet foot reflexology was fraught
with fewer side effects than medication. In a second
study (Eichelberger
et al.) foot reflexology was used postoperatively on gynaecological
patients. The intervention group showed a lesser need for medication
to enhance bladder tonus than did the control group. The literature
describes foot reflexology as enhancing urination, bowel movements
and relaxation." Foot reflex zone massage (Kesselring A,
Institut fur Pflegeforschung, Bern.)
In a blind random
trial, (Lafuente) "examined 32 patients
between the ages of 15 and 57. There were 25 women and 7 men
randomly assigned to two groups. One group was given a placebo
and received
reflexology treatments two times a week for two or three months,
The other group received Flunarizin treatment (a selective
calcium entry blocker with calmodulin binding properties and
histamine
blocking activity that has been effective in preventing migraines)
and massage of a non -specific area twice a week for 12 sessions.
patients were evaluated at the end of the study and again three
months after the study. It was concluded that the reflexology
treatment was at least as effective as the Flunarizin treatment
and may be
classified as an alternative non-pharmacological therapeutic
treatment that would be particularly appropriate to those patients
that were
unable to follow pharmacological treatment."
(Testa,
Gail W., "A Study on the Effects of Reflexology on
Migraine Headaches" August 2000 (http://members.tripod.com/GTesta/Dissertationall.htm)
Lafuente A et al (1990). Effekt der Reflex zonenbehandlung
am FuB bezuglich der prophylaktischen Behandlung mit Flunarizin
bei an
Cephalea-Kopfschmerzen leidenden Patieten.Erfahrungsheilkunde.
39, 713-715.
Heydenreich
A., Institution: Abteilung Neurologie, Wilhelm-Pieck-Universitat,
Rostock, "Treatment of migraine with controlled reflex methods
and stimulation therapy," Schweiz Med Wochenschr
Suppl, 62: 88-93 (1994) Authors: [Review] [0 refs] [German]
Zeitschrift fur
Arztliche Fortbildung. 82(24):1247-9, 1988.
MeSH Terms: English Abstract; Female; Flunarizine/therapeutic
use; Foot*; Genital Diseases, Female/surgery; Headache/therapy;
Headache/drug
therapy; Human; Massage/methods*; Postoperative Complications/therapy;
Reflexotherapy/methods*; Urination Disorders/therapy
MILK SECRETION IN NEW MOTHERS
Two groups of new mothers were followed for satisfactory lactation.
A treated group of 100 was given foot massage within 30 hours
after delivery and 17 were given foot massage from 30 to 120
hours after for 10 to 15 minutes a day. No treatment was given
to a group of 100 women. In the treatment group, lactation was
initiated in 43.47 hours (+12.39 hours). In the control group
it was 66.97 hours (+28.16 hours). In 72 hours satisfactory lactation
was documented in 98% and 67% respectively in the two groups.
Foot massage was found help avoid use of drugs in lactation that
may be harmful to the baby.
Siu-lan,
Li, "Galactagogue Effect of Foot Reflexology in 217
Parturient Women," (19)96 Beijing International Reflexology
Conference (Report), China Preventive Medical Association and
the Chinese Society of Reflexology, Beijing, 1996 p. 14
PAIN
Reflexology was
applied to 60 individuals from ages 1 to 73 who were experiencing
pain. Sessions lasted 20 minutes
to 40 minutes.
the pain resulted from Toothache (6), headache (8), sore throat
(50), stiff neck (40), shoulder pain/old wound (2), breast pain
(2), chest & rib pain (2), dysmenorrhoea (3), abdominal pain
(5), wrist and leg pain (19), and joint pain in limbs. Following
one session 18 of the 60 were healed. 11 were healed following
2 or 3 sessions, 22 were effectively treated after 2 or 3 sessions.
Reflexology was ineffective for 9 cases after 1 to 3 sessions.
Jin
Hui, "Reflexology Applied as a Pain-Killer - Observation
of 60 Cases," 1998 Beijing International Reflexology Conference
Report, China Reflexology Association, Beijing, p, 86-88
POST SURGICAL PAIN
Results
of study: Post surgical patients who receive foot massage
and medication report "significantly less" agony
than those on painkillers alone.
"Foot
Rubs Easing Pain," Third Age. com, December 4, 1998
POST SURGICAL CARE
"This
randomized-controlled study examined the effects of foot
massage on patients' perception of care received following
surgery. The
sample of 59 women who underwent laparoscopic sterilization as
day case patients were randomly allocated into two groups. The
experimental group received a foot massage and analgesia post-operatively,
whilst the control group received only analgesia post-operatively.
Each participant was asked to complete a questionnaire on the
day following surgery. This examined satisfaction, memory and analgesia
taken. The 76% response rate was comparable with other patient
satisfaction studies following day-case surgery. Statistical
analysis showed no overall significant difference in the pain experienced
by the two groups; however, the mean pain scores recorded following
surgery showed a significantly different pattern over time, such
that the experimental group consistently reported less pain following
a foot massage than the control group. This study has attempted
to explore the use of foot massage in a systematic way and is
therefore a basis for further study."
Hulme
J, Waterman H, Hillier VF, "The effect of foot massage
on patients' perception of care following laparoscopic sterilization
as day case patients," J Adv Nurs. 1999 Aug;30(2):460-8
(Stockport Acute Services NHS Trust, Anaesthetic Department,
Stepping Hill
Hospital, Stockport, England) PMID: 10457249
POST SURGICAL RECOVERY
Reports that Eichelberger et. al. demonstrated that reflexology
enhances urination, stimulates bowel movements and so aids recovery.
Patients who received reflexology also showed a much less need
for medication than patients in the control group. (Eichelberger
G (1993) Study of foot reflex zone massage. Alternatives to tablets.
Krankenpfiege - Soins Infirmiers. 86, 61-63)
Kesselring, A. Fussrelszonemassage. Schweiz med Won\chenschr
suppi (Switzerland) 1994, 62, pp. 88-93
The study's
goal was to test if foot reflexology (FR) affects the well-being,
voiding, bowel movements,
pain, and/or sleep
in women
who underwent an abdominal operation. 130 subjects were randomised
into three groups. For five days they were exposed to fifteen
minutes of FR, foot/leg massage (FM) or talking respectively.
Results show
that the women in the FR group were more able to void without
problems, after the indwelling catheter had been removed
than did women in
the comparison groups. There was also a tendency in the FR-group
for the indwelling catheter to be removed earlier than in
the other groups. In comparison the FR-subjects slept
worse than
the others.
FM showed significant results in the subjective measures
of well-being, pain and sleep."
Kesselring
A., Spichiger E., Muller M, "Foot Reflexology:
an intervention study, Pflege 1998, Aug; 11(4):213-8 (PMID:
9775925)
"The
aim of the study was to investigate the possible usefulness
of foot reflexology on the recovery after a surgical
intervention. 130 patients participated in the study. They
underwent abdominal
surgery under full anaesthesia for different, but exclusively
gynaecological reasons. Foot reflexology investigated in this study was
applied only for a few days for each patient. The following
parameters
were recorded: the subjective, self-assessed, general
condition, pain intensity, movement of the bowels, micturition
and sleep
beginning
on the day before the operation until day 10. Two other
treatments served as controls, a simple massage of the
foot or a personal
conversation. The simple massage turned out to be a relaxing,
positive experience, whereas foot reflexology had various effects, some
of them even negative. The conclusion was that foot reflexology
is not recommended for acute, abdominal post surgical
situations in gynaecology because it can occasionally trigger
abdominal
pain."
Kesselring
A., "Foot Reflexology massage: a clinical study." Forsch
Komplementarmed 1999 Feb; 6 Suppl 1:38-40 (PMID: 10077716)
PMS
Results of study: Reflexology improves the symptoms of 46% of those
suffering from PMS.
Oleson,
Terry and Flocco, William, "Randomized Controlled
Study of Premenstrual Symptoms Treated with Ear, Hand, and Foot
Reflexology," Obstetrics and Gynaecology, 1993;82(6):
906-11
PSORIASIS
A 21 year-old college student had experienced widely spreading
skin lesions over 14 years. Numerous Western and traditional
Chinese medicines had failed to effect the psoriasis. One to
two treatments a week were applied for 50 minutes. After 14 treatments
change was evident in the four largest lesions. After 15 courses
of treatment all lesions disappeared.
Xi-guang,
Xu and De-zhao, Liu, "Treatment of Psoriasis with
Foot Reflexology," 1994 China Reflexology Symposium Report,
China Reflexology Association, Beijing, pp. 91-92 (Tianjin,
China)
RHINITIS
Foot reflexology
was applied daily to three cases of rhinitis for 30 minutes.
After three sessions symptoms
had subsided
even for
a patient experiencing rhinitis for 20 years. A course
of 10 sessions was applies to "consolidate the
effect. Symptoms had not returned two years later
for this patient.
Xiu,
Ma, "Observation on the Treatment of Rhinitis with Foot
Reflexology," 1994 China Reflexology Symposium Report,
China Reflexology Association, Beijing, p. 139 (Tianjin,
China)
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