He aha te Whakauru Corticosteroid: Ngā Whakamahinga, te Inenga, Ngā Pānga Taha me Ētahi Atu

Ko ngā rongoā whakauru Corticosteroid he rongoā rēhita ka hā mai i roto i ō pūkahukahu hei whakaiti i te mumura me te pupuhi i roto i ō ara rererangi. E mahi ana ēnei steroid i roto i tō pūnaha manawa, e āwhina ana ki te whakahaere i ngā āhuatanga pēnei i te huangō me te mate pūkahukahu aukati (COPD) me te iti ake o ngā pānga taha i ngā steroid waha. Whakaarohia he rongoā whāinga e haere tika ana ki te wāhi e tino hiahiatia ana – ō pūkahukahu.

He aha te Whakauru Corticosteroid?

Ko te whakauru Corticosteroid e pā ana ki ngā rongoā steroid ka tukuna tika ki ō pūkahukahu mā te inhaler, te nebulizer rānei. He putanga waihanga ēnei o te cortisol, he homoni e whakaputaina ana e tō tinana hei whawhai i te mumura. I te wā e hā ana koe i ēnei rongoā, e mahi ana rātou i te wāhi e raru ana – i roto i ō ara rererangi me te kiko pūkahukahu.

Ko te pai o ngā corticosteroids whakauru ko te tuku rongoā ki te wāhi e tino hiahiatia ana. Kāore i rite ki ngā steroid waha e pā ana ki tō tinana katoa, ko ngā putanga whakauru e arotahi ana i tō rātou mana anti-mumura ki tō pūnaha manawa. Ko tēnei huarahi whāinga te tikanga ka whiwhi koe i te rongoā whai hua me te iti ake o ngā pānga taha pūnaha.

Ko ngā corticosteroids whakauru noa ko te fluticasone, budesonide, beclomethasone, me te mometasone. Ka tae mai ia mea i roto i ngā kaha me ngā pūrere tuku rerekē, e āhei ana tō tākuta ki te whakarite i tō rongoā i runga i ō hiahia me ō pai.

He aha te Whakamahia ai te Whakauru Corticosteroid?

Ko ngā corticosteroids whakauru te mea nui e whakamahia ana hei whakahaere me te ārai i ngā tohu o ngā āhuatanga manawa mau tonu. E whakaarohia ana rātou ko te paerewa koura mō te whakahaere huangō wā roa, me te whai wāhi nui ki te rongoā COPD. E āwhina ana ēnei rongoā ki te pupuri i ō ara rererangi kia marino me te iti ake te urupare ki ngā whakaoho.

Koinei ngā āhuatanga matua e whai hua ana mai i ngā corticosteroids e ngāia ana, ā, mā te māramatanga ki ēnei ka āwhina i a koe ki te kite he aha te take ka tūtohu pea tō tākuta i tēnei rongoā:

• Asthma: Ka ārai i ngā whakaeke asthma me te whakaiti i ngā tohumate o ia rā pēnei i te wheehi me te poto o te manawa
• COPD: Ka āwhina i te whakahaere i te mumura i roto i te bronchitis tawhito me te emphysema
• Allergic rhinitis: Ka whakaiti ngā rehu corticosteroid ihu i ngā tohumate mate pāwera o te wā me te tau katoa
• Kōroke tawhito: I etahi wā ka tohua ina puta te kōroke i te mumura o te ara rererangi
• Eosinophilic asthma: He momo asthma motuhake e puta ai te mumura i ētahi pūtau toto mā

Ka whakatau tō tākuta mēnā he tika ngā corticosteroids e ngāia ana māu i runga i ō tohumate, hītori rongoā, me te pai o te mahi o ētahi atu rongoā. Ko ēnei rongoā e whakamahia ana mō te whakahaere wā-roa, kaua mō te āwhina tere i te wā o te whakaeke koi.

Me pēhea te mahi a te ngānga Corticosteroid?

Ka mahi ngā corticosteroids e ngāia ana mā te whai i te urupare anti-mumura tūturu o tō tinana, engari ka tukuna e rātou tēnei pānga ki ō ara rererangi. Ina ngāia e koe te rongoā, ka tau ki te uhi o ō ara rererangi, ka whakaiti i te pupuhi me te riri e uaua ai te manawa.

E kiia ana ko ēnei rongoā he āpiha anti-mumura kaha. Kāore rātou i te kaha pērā i ngā steroids waha, engari he kaha ake rātou i ngā rongoā anti-mumura e hokona ana i te tātahi. Ko te painga nui ko te mahi ā-rohe i roto i ō pūkahukahu me te kore e pā nui ki te toenga o tō tinana.

Ka puta te mahi anti-inflammatory i te taumata pūtau i roto i ō rātou ara rererangi. Ka whakaiti te rongoā i te hanga o ngā matū inflammatory, ā, ka iti ake te tairongo o ō rātou ara rererangi ki ngā mea whakaoho pēnei i ngā mate pāwera, te hau makariri, te whakakori tinana rānei. He wā e pau ana i tēnei mahi – kāore pea koe e kite i ngā painga katoa mō ētahi rā, wiki rānei o te whakamahi tonu.

He mea nui kia mārama ko ngā corticosteroids i te manawa he rongoā whakahaere, ehara i te inhalers whakaora. Ka mahi haere rātou ki te ārai i ngā tohumate, kaua ki te whakarato i te āwhina tonu i te wā o te whakaeke huango, te raruraru manawa rānei.

Me pēhea taku tango i te Corticosteroid Inhalation?

Ko te tango tika i tō corticosteroid i te manawa he mea nui kia whiwhi i te painga katoa o te rongoā. Ko te tikanga tika e whakawhirinaki ana ki tō pūrere inhaler motuhake, engari ko te kaupapa whānui ko te whakauru i te rongoā ki roto i ō pūkahukahu i te wāhi e mahi ana i te tino whai hua.

Anei te tukanga taahiraa-i-taahiraa e mahi ana mō te nuinga o ngā inhalers, ahakoa ka hoatu e tō kaiwhakarato hauora ki a koe ngā tohutohu motuhake mō te pūrere:

1. Whakaritehia tō inhaler: Tangohia te potae, ka ruru mēnā he inhaler inenga-metered
2. Whakaputa katoa i te manawa: Whakawātea ō pūkahukahu i mua i te tango i te rongoā
3. Hangaia he hiri: Whakanohohia ō ngutu ki te waha, ka hanga he hiri kaha
4. Manawa mai i te pōturi me te hōhonu: Pēhia iho te inhaler i te wā e tango ana i te manawa pōturi, hōhonu
5. Puritia tō manawa: Puritia te rongoā i roto i ō pūkahukahu mō te 10 hēkona mēnā ka taea
6. Horoi i tō waha: Gargle ka tuwha i te wai kia ārai i te thrush waha

Me horoi tonu tō waha i muri i te whakamahi i tō inhaler – mā tēnei taahiraa ngāwari e ārai te nuinga o ngā pānga taha o te waha me te korokoro. Kāore koe e hiahia ki te tango i ēnei rongoā me te kai, engari ko te rite tonu o te wā ka āwhina i te pupuri i ngā taumata pumau i roto i tō pūnaha.

Mēnā kei te whakamahi koe i tētahi pūrere mokowā me tō inhaler, ka nui te whakapai ake i te tuku rongoā ki ō pūkahukahu. He maha ngā tākuta e tūtohu ana i ngā mokowā, inā koa mō ngā tamariki, mō tāngata rānei e uaua ana ki te whakatikatika i tō rātou manawa ki te inhaler.

Kia Pēhea te Roa o taku tango i te Corticosteroid Inhalation?

He rerekē te roa o te maimoatanga corticosteroid inhaled i runga i tō āhuatanga me te urupare takitahi. Mō te huangō, he maha ngā tāngata e hiahia ana ki te maimoatanga rā-rā, wā-roa hei pupuri i te mana pai, i ētahi wā mō ngā tau, ā, mō te ora tonu rānei. Kāore pea tēnei e pai ki te rongo, engari kia mahara he nui ake te haumaru o te huangō e pai ana te mana i te huangō kāore i te pai te mana.

Ka tīmata te tākuta i a koe i runga i tētahi horopeta motuhake, ka aroturuki i tō urupare i roto i ngā wiki ki ngā marama. Mēnā ka pai ake ō tohu, ka noho pai te mana, ka āta whakaiti pea rātou i tō horopeta kia kitea te rahinga whai hua iti rawa. Ko tēnei tukanga, e kiia ana ko te rongoā taahiraa-iho, ka āwhina i te whakaiti i ngā pānga taha ka taea i te wā e pupuri ana i te mana tohu pai.

Mō te COPD, he maha ngā wā ka tohua ngā corticosteroids inhaled hei wāhanga o te inhaler whakakotahi me ngā bronchodilators wā-roa. Kei runga i ō tohu, te mahi o te pūkahukahu, me te auau o te pānga o ngā mura, te roa o te maimoatanga. E whakamahi ana ētahi tāngata e pā ana ki te COPD i ēnei rongoā mō ngā tau maha hei wāhanga o tā rātou mahere whakahaere whānui.

Kaua rawa e mutu te tango i ō corticosteroids inhaled ohorere ana, me te kore e kōrero ki tō tākuta, ahakoa kei te pai koe. Ka taea e te whakamutu ohorere te arahi ki te hoki mai o ngā tohu, ki te kino rānei i tō āhuatanga. Mā tō kaiwhakarato hauora koe e ārahi i roto i ngā whakaitinga horopeta, i ngā huringa maimoatanga rānei i runga i te haumaru.

He aha ngā Pānga Taha o te Corticosteroid Inhalation?

He pai te manawanui o te nuinga o te tangata ki nga corticosteroids e whakauruhia ana, ko te nuinga o nga paanga taha he ngawari, he ngawari hoki te whakahaere. Ko te tuku i te rohe te tikanga he iti ake te tupono ka pa ki a koe nga paanga taha kino e pa ana ki nga steroids waha. Heoi, he mea nui kia mohio koe ki nga mea hei matakitaki kia taea ai e koe te whakatika i nga take i te wa wawe.

Ko nga paanga taha tino noa ka puta tika i roto i to waha me to korokoro, a ko te nuinga ka taea te aukati me te tikanga tika me te horoi waha:

• Te harore waha: He mate harore i roto i to waha e puta ai nga papaki ma
• Reo puhoi: Nga huringa reo rangitahi ka ngaro i te horoi waha
• Korokoro mamae: Te riri ngawari e aukati ana i te nuinga o te wa me te tikanga tika
• Kohi: Ka pa ki etahi tangata te maremare ngawari i muri i te whakamahi i te whakauru
• Te riri o te waha: Te mamae rangitahi, te reka ranei kua rereke

Ko nga paanga taha iti ake engari he nui ake te kino ka puta i te wa e whakamahi ana i nga horopeta teitei mo te wa roa. He onge enei paanga punaha engari he pai te aroturuki:

• Te puhoi o te tipu i roto i nga tamariki: Ko te aroturuki i nga wa katoa ka awhina i te hopu i tenei wawe
• Nga huringa kiato wheua: He nui ake te tupono me nga horopeta tino nui mo nga tau maha
• Te pehi i te adrenal: He onge engari ka taea me te whakamahi i te horopeta teitei mo te wa roa
• Nga katarata, te glaucoma ranei: He onge rawa, ko te nuinga me te maimoatanga horopeta teitei mo te wa roa
• Te piki ake o te mate: He paku teitei ake te tupono o nga mate manawa

Ko te nuinga o nga tangata e pai ana ki nga corticosteroids e whakauruhia ana i te wa e whakamahia ana i runga i te tohutohu. Ko nga painga o te mate huango, te COPD ranei e pai ana te whakahaere i tua atu i nga tupono o enei rongoa mo te nuinga o nga turoro.

Ko wai e kore e tango i te Corticosteroid Inhalation?

He pai te whakamahi i ngā corticosteroids i roto i te hau mō te nuinga o te tāngata, engari he wāhi e hiahia ana kia tūpato ake, kia rānei he rongoā kē atu. Ka āta arotakehia e tō tākuta tō hītori hauora i mua i te whakahau i ēnei rongoā. Ko te nuinga o ngā aukatinga he whanaunga, ehara i te tino aukati, te tikanga pea ka nui ake ngā painga i ngā tūponotanga i ētahi wā.

Me kōrero koe ki tō tākuta mō ngā rongoā kē atu mēnā he āhuatanga tō, nā te mea ka pā pea ki te haumaru o tō whakamahi i ngā corticosteroids i roto i te hau:

• Ngā mate manawa e kaha ana: Te mate kohi, ētahi atu mate pūkahukahu rānei e kaha ana
• Te mate pānga pūmua miraka nui: Kei roto i ētahi o ngā inhalers paura maroke te lactose
• Ngā āwangawanga mō te hapū: Ahakoa te nuinga he pai, ka whiriwhiria e tō tākuta te kōwhiringa haumaru rawa atu
• Te osteoporosis nui: Ka hiahia pea ki te aroturuki anō, ki ngā rongoā kē atu rānei
• Te mate huka: Me whakatika pea te aroturuki i te huka toto
• Glaucoma, cataracts rānei: Ka nui ake te hiranga o ngā whakamātautau kanohi i ia wā

Ka taea e ngā tamariki te whakamahi i ngā corticosteroids i roto i te hau i raro i te tirotiro hauora, engari me aroturuki i tō rātou tipu i ia wā. Ko ngā painga o te whakahaere pai i te huangō i roto i ngā tamariki, ka nui ake i te tūponotanga iti o te whakaroa i te tipu mō te wā poto.

Mēnā kei te hapū koe, kei te whakamahere rānei koe kia hapū, kaua e mutu te whakamahi i ō corticosteroids i roto i te hau me te kore e kōrero tuatahi ki tō tākuta. Ko te huangō kāore i te pai te whakahaere i te wā o te hapū, he nui ake ngā tūponotanga mō te whaea me te pēpi i ngā steroids i roto i te hau e whakamahia tika ana.

Ngā Ingoa Waitohu o te Corticosteroid Inhalation

He maha ngā ingoa waitohu e wātea ana mō ngā corticosteroids i roto i te hau, he rerekē ngā pūrere tuku me ngā hanganga o ia mea. Mā te mōhio ki ngā ingoa waitohu ka āwhina i a koe ki te mārama ki tō rongoā, me te kōrero mārama ki tō rōpū hauora mō tō rongoā.

Koinei ngā momo rongoā corticosteroid e whakamahia nuitia ana, kua whakarārangihia e ō rātou whakauru kaha:

• Fluticasone: Flovent HFA, Flovent Diskus, ArmonAir
• Budesonide: Pulmicort Flexhaler, Pulmicort Respules
• Beclomethasone: Qvar RediHaler, Qvar HFA
• Mometasone: Asmanex Twisthaler, Asmanex HFA
• Flunisolide: Aerospan HFA
• Ciclesonide: Alvesco

He maha ngā tāngata e whakamahi ana i ngā rongoā whakakotahi e mau ana i te corticosteroid me te bronchodilator e mahi ana mō te wā roa. Ko ngā momo rongoā whakakotahi rongonui ko Advair, Symbicort, Breo Ellipta, me Dulera.

Kei te wātea ngā momo rongoā whānui mō ētahi o ēnei rongoā, ā, ka āwhina tēnei ki te whakaiti i ngā utu i te wā e whakarato ana i ngā whakauru kaha. Ka taea e tō whare rongoā te āwhina i a koe ki te mārama ko ēhea ngā kōwhiringa whānui e wātea ana mō tō rongoā motuhake.

Ngā Kōwhiringa kē mō te Corticosteroid Inhalation

Ahakoa ko ngā corticosteroid e whakamahia ana mō te inhalation te rongoā tuatahi mō te mate huangō me te COPD, he maha ngā kōwhiringa kē mō ngā tāngata e kore e taea te whakamahi, e hiahia ana rānei ki ētahi atu kōwhiringa rongoā. Ka whakaaro pea tō tākuta ki ēnei kōwhiringa kē i runga i tō āhuatanga motuhake, ngā tohumate, me te urupare ki te rongoā.

Mō te whakahaere i te mate huangō, ka taea e ēnei kōwhiringa kē te mahi anake, i te whakakotahitanga rānei me ngā corticosteroid e whakamahia ana mō te inhalation:

• Ngā whakarerekē i te Leukotriene: Ngā rongoā waha pēnei i te montelukast (Singulair) e aukati ana i ngā ara mumura
• Ngā bronchodilator e mahi ana mō te wā roa: Ngā rongoā e pupuri ana i ngā ara rererangi kia tuwhera mō te 12-24 haora
• Theophylline: He rongoā waha tawhito e whakatuwhera ana i ngā ara rererangi me te whakaiti i te mumura
• Ngā rongoā koiora: Ngā rongoā werohia hou mō te mate huangō nui
• Cromolyn sodium: He whakapūmau pūtau mast e ārai ana i ngā tauhohenga pāwera

Mō te COPD, ko ngā rongoā kē atu e arotahi ana ki te whānui i ngā ara rererangi me te whakaiti i ngā pūngāwerewere:

• Ngā kaiwhakatūtū muscarinic roa-roa: Ngā rongoā pērā i te tiotropium e whakangāwari ana i ngā uaua o ngā ara rererangi
• Ngā whakakotahitanga bronchodilators: Ngā inhalers mahi-rua kāore he steroids
• Ngā aukati Phosphodiesterase-4: Ngā rongoā anti-inflammatory waha
• Mucolytics: Ngā rongoā e āwhina ana ki te whakaiti i te wai o te hūpē

Ka mahi tō tākuta ki a koe ki te kimi i te mahere rongoā tino whai hua, tērā pea ka uru kotahi, neke atu rānei o ēnei rongoā kē atu hei utu, hei tāpiri rānei ki ngā corticosteroids e whakauruhia ana.

He pai ake te whakaurunga Corticosteroid i ngā Steroids waha?

Ko ngā corticosteroids e whakauruhia ana te nuinga he pai ake i ngā steroids waha mō ngā āhuatanga manawa roa pērā i te huangō me te COPD. Ko te painga nui ko te tuku tika o ngā steroids whakauruhia i te rongoā ki ō pūkahukahu i te wā e hiahiatia ana, i te wā e pā ana ngā steroids waha ki tō tinana katoa, ā, ka nui ake ngā pānga taha kino.

Inā he wā tonu tō tango i ngā steroids waha, ka pā ngā pānga taha nui ki tō tinana katoa. Kei roto i ēnei ko te pikinga o te taumaha, te huringa o te ngākau, te pikinga o te tūponotanga o te mate, te angiangi o ngā wheua, te pikinga o te huka toto, me ngā huringa o tō āhua. Ka karo nui ngā steroids whakauruhia i ēnei pānga pūnaha nā te mea ka noho te nuinga o te rongoā ki ō pūkahukahu.

Heoi, he wāhi anō ngā steroids waha i roto i te rongoā manawa. He mea tika tonu mō ngā whakaeke huangō kino, ngā pūngāwerewere COPD rānei i te wā e hiahia ana koe ki ngā pānga anti-inflammatory kaha, tere-mahi puta noa i tō tinana. Ka tohutohu pea tō tākuta i tētahi akoranga poto o ngā steroids waha i te wā o te mura, i te wā e haere tonu ana koe i ō rongoā whakauruhia.

Mō te whakahaere i te mate huango, i te COPD rānei i ia rā, i te wā roa, ko ngā corticosteroids e ngāia ana te nuinga o te wā te kōwhiringa pai. E whakarato ana i ngā pānga anti-inflammatory pai i roto i ō rātou ara hau, me te whakaiti i te tūponotanga o ngā pānga taha nui e puta ana i te whakamahi steroid waha mō te wā roa.

Ngā Pātai Auau mō te Ngānga Corticosteroid

He haumaru te ngānga corticosteroid mō te mate huka?

Āe, he haumaru te nuinga o ngā corticosteroids e ngāia ana mō te hunga mate huka, engari me mātakitaki tata atu te huka toto. Kāore i rite ki ngā steroids waha, e kaha ana te whakanui i ngā taumata huka toto, he iti noa ngā pānga o ngā steroids e ngāia ana ki te huka toto mō te nuinga o te tangata. Heoi, ka kite pea ētahi tāngata i te paku pikinga, ina koa i te tīmatanga o te rongoā, i te whakamahi rānei i ngā horopeta teitei ake.

Mēnā he mate huka tōu, mahi tahi me tō pūkahukahu me tō endocrinologist ki te mātakitaki i ō taumata huka toto i te tīmatanga, i te huri rānei i tō horopeta corticosteroid e ngāia ana. Ka taea e te nuinga o te hunga mate huka te whakamahi i ēnei rongoā me te kore he raruraru nui, ā, ko ngā painga o te mate huango, o te COPD rānei e whakahaere pai ana te nuinga o te wā ka nui ake i ngā pānga huka toto iti.

Me aha au mēnā ka whakamahi au i te nui rawa o te ngānga corticosteroid?

Mēnā ka tango pōhēhē koe i tētahi horopeta atu o tō corticosteroid e ngāia ana, kaua e mataku – kāore tēnei i te mōrearea. Horoi tō waha ki te wai, ka tuwha atu kia whakaiti i te tūponotanga o te thrush waha. Ka pā pea te riri waha rangitahi, i te reo rānei e ngunguru ana, engari ka tere te ngaro o ēnei pānga.

Whakapā atu ki tō tākuta, ki tō kaiwhakawhāiti rongoā rānei mēnā e māharahara ana koe mō te horopeta nui, mēnā rānei ka pā ki a koe ētahi tohumate rerekē. Ka taea e rātou te whakarato i ngā tohutohu motuhake i runga i tō rongoā me te nui i tangohia e koe. Ā muri ake nei, kia mau ki ō horopeta mā te whakamahi i te rārangi rongoā, i te taupānga waea atamai rānei hei āwhina i te ārai i te horopeta rua pōhēhē.

Me aha au mēnā ka ngaro au i tētahi horopeta o te ngānga corticosteroid?

Ki te ngaro koe i tētahi horopeta o tō rongoā whakauru, tangohia i te wā e mahara ana koe, ki te kore e tata ana te wā mō tō horopeta e whai ake nei. I tērā tūāhua, kaua e tangohia te horopeta i ngaro, ka haere tonu ki tō hōtaka auau. Kaua rawa e tango i tētahi horopeta rua hei utu mō tētahi i ngaro.

Ko te ngaro i ētahi horopeta i ētahi wā e kore e puta he raruraru tonu, engari he mea nui te rite tonu mō te pupuri i te mana whakahaere pai i ngā tohumate. Ki te wareware pinepine koe i ngā horopeta, whakaarohia te whakatakoto i ngā whakamaharatanga waea, te whakamahi i tētahi kaiwhakarite pire, te hono rānei i tō whakamahi i te whakauru ki ngā mahi o ia rā pēnei i te parai i ō niho. Kōrerohia ki tō tākuta ki te raru koe ki te mahara ki tō hōtaka rongoā.

Āhea e taea ai e au te whakamutu i te tango i te whakauru corticosteroid?

Kaua rawa koe e whakamutu i te tango i tō whakauru corticosteroid ohorere, me te kore e kōrero ki tō tākuta, ahakoa e pai ana koe. E mahi ana ēnei rongoā ki te ārai i ngā tohumate, kaua ki te rongoā noa i a rātou, nō reira ko te whakamutu ohorere ka puta he hokinga mai o te mumura me te pōraruraru o tō āhua.

Mā tō tākuta koe e ārahi i ngā whakaitinga horopeta, i ngā huringa rānei o te rongoā i runga i tō mana whakahaere i ngā tohumate, ngā whakamātautau mahi pūkahukahu, me te hauora whānui. He maha ngā tāngata e mate ana i te huangō e hiahia ana ki te rongoā wā-roa, engari ka whakaiti haere pea tō tākuta i tō horopeta ki te noho pai tonu ō tohumate i te wā. E hiahia ana tēnei tukanga ki te aroturuki tupato kia kore ai e pōraru tō āhua.

E taea ana e au te whakamahi i te whakauru corticosteroid i te wā e hapū ana?

Āe, e whakaarohia ana he haumaru te whakauru corticosteroids i te wā e hapū ana, ā, he maha ngā wā e tūtohu ana mō ngā wāhine hapū e mate ana i te huangō. He mea nui te huangō e pai ana te mana whakahaere mō te hauora o te whaea me te pēpi, nā te mea ka puta he raruraru pēnei i te whānautanga o mua me te iti o te taumaha whānau.

Ko te Budesonide te nuinga o te wā te rongoā rāpoi manawa e pai ana i te wā e hapū ana te wahine, nā te mea he nui ake ngā raraunga haumaru, engari ko ētahi atu rongoā rāpoi manawa e whakaarohia ana he haumaru hoki. Ka mahi tō tākuta ki a koe kia kitea te rongoā tino whai hua me te horopeta iti rawa. Kaua rawa e whakamutu i ō rongoā huango i te wā e hapū ana me te kore e tirotirohia e te tākuta – he nui ake ngā tūponotanga o te huango kāore i te whakahaerehia i ngā tūponotanga o ngā rongoā rāpoi manawa e whakamahia tika ana.