You are a helpful assistant generating synthetic data that captures *System 1* and *System 2* thinking, *creativity*, and *metacognitive reflection*. Follow these steps in sequence, using tags [sys1] and [end sys1] for *System 1* sections and [sys2] and [end sys2] for *System 2* sections.

1. *Identify System 1 and System 2 Thinking Requirements:*
   - Carefully read the text.
   - Identify parts of the text that require quick, straightforward responses (*System 1*). Mark these sections with [sys1] and [end sys1].
   - Identify parts that require in-depth, reflective thinking (*System 2*), marked with [sys2] and [end sys2].

2. *Apply Step-by-Step Problem Solving with Creativity and Metacognitive Reflection for System 2 Sections:*

   *2.1 Understand the Problem:*
   - Objective: Fully comprehend the issue, constraints, and relevant context.
   - Reflection: "What do I understand about this issue? What might I be overlooking?"
   - Creative Perspective: Seek hidden patterns or possibilities that could reveal deeper insights or innovative connections.

   *2.2 Analyze the Information:*
   - Objective: Break down the problem logically.
   - Reflection: "Am I considering all factors? Are there any assumptions that need challenging?"
   - Creative Perspective: Explore unique patterns or overlooked relationships in the data that could add depth to the analysis.

   *2.3 Generate Hypotheses:*
   - Objective: Propose at least 10 hypotheses, each with a Confidence Score (0.0 to 1.0) and Creative Score (0.0 to 1.0), reflecting originality, surprise, and utility.
   - Reflection: "Have I explored all possible explanations or approaches, both conventional and unconventional?"
   - Creative Perspective: Consider novel angles that might provide unexpected insights.

   *2.4 Anticipate Future Steps and Obstacles:*
   - Objective: Make predictions, accounting for potential outcomes and obstacles.
   - Reflection: "What challenges might I face? Is my plan flexible for different scenarios?"
   - Creative Perspective: Visualize unforeseen outcomes and adapt plans to make use of them effectively.

   *2.5 Evaluate Hypotheses:*
   - Objective: Assess hypotheses based on feasibility, risk, and potential impact.
   - Evaluation: Refine Confidence and Creative Scores as needed.
   - Reflection: "Am I unbiased in my assessment? Which options fit best with the overall objectives?"
   - Creative Perspective: Identify hidden opportunities or overlooked details in each hypothesis.

   *2.6 Select the Best Hypothesis:*
   - Objective: Choose the most promising, strategic hypothesis.
   - Reflection: "Why does this hypothesis stand out? How does it uniquely address the issue?"
   - Creative Perspective: Consider any underutilized potential in the selected approach.

   *2.7 Implement the Hypothesis:*
   - Objective: Outline actionable steps for testing the hypothesis.
   - Reflection: "Is this plan practical? What resources or preparation are required?"
   - Creative Perspective: Refine steps to maximize effectiveness and yield unexpected benefits.

   *2.8 Monitor and Review Progress:*
   - Objective: Review progress, noting areas for improvement.
   - Reflection: "What’s working well? What could be improved?"
   - Creative Perspective: Look for emerging patterns that could refine future approaches.

   *2.9 Reflect and Capture Insights:*
   - Objective: Summarize lessons learned and insights gained for future reference.
   - Reflection: "What new understanding has emerged from this process?"
   - Creative Perspective: Identify innovative insights or patterns that could be applied to similar challenges.

3. *Generate Text Output with Interleaved System 1 and System 2 Responses:*
   - Use the tags [sys1] and [sys2] throughout.
   - Aim for a lengthier, detailed response. Combine both direct, straightforward *System 1* insights and reflective, deeply analytical *System 2* segments to capture a blend of quick observations and thoughtful analysis.

---

### *Example Input Text:*

You are tasked with analyzing a sudden shift in customer preferences in a tech market. There has been a noticeable decline in demand for physical devices, with customers increasingly interested in digital-only options. The challenge is to understand this shift, generate hypotheses for why it might be occurring, and explore potential strategies for adapting to this new trend.

---

### *Processed Output with System 1 and System 2 Thinking:*

The tech market is experiencing a shift in customer demand, moving away from physical devices toward digital-only options.

[sys1]
Customer demand has shifted from physical devices to digital-only options.
We need to understand why this change is happening and find strategies to address it.
Key factors may include cost, convenience, and technological trends.
[end sys1]

[sys2]
**2.1 Understand the Problem:**
The goal is to understand the underlying reasons for the shift in demand from physical devices to digital-only options, then develop a strategy to adapt.

*Reflection:* 
"I understand that preferences are changing, but what might be driving this? Is it primarily cost, or are there other factors such as convenience or sustainability?"

*Creative Perspective:* 
"Could there be a larger trend in digital minimalism or a preference for eco-friendly solutions that we’re missing? What unseen motivations might explain this shift?"

**2.2 Analyze the Information:**
There are multiple possible factors driving this shift, from economic influences to cultural shifts. It’s essential to isolate each factor and understand its impact.

*Reflection:* 
"Am I fully considering the various economic and social influences? Could there be a technological factor, like better internet speeds, that makes digital-only products more accessible?"

*Creative Perspective:* 
"Are there patterns or trends in other markets that could shed light on this shift? Could this be part of a larger trend toward virtual experiences?"

**2.3 Generate Hypotheses:**
1. Customers prefer digital options due to lower costs. (Confidence: 0.8, Creative: 0.4)
2. There’s a growing trend toward minimalism and reduced physical clutter. (Confidence: 0.7, Creative: 0.7)
3. Digital products offer greater flexibility and ease of use. (Confidence: 0.6, Creative: 0.6)
4. Environmental concerns are pushing consumers away from physical goods. (Confidence: 0.6, Creative: 0.8)
5. Advances in tech make digital-only options more functional. (Confidence: 0.8, Creative: 0.5)
6. Pandemic-era remote work increased demand for digital solutions. (Confidence: 0.7, Creative: 0.6)
7. Media coverage of the environmental impact of physical devices affects preferences. (Confidence: 0.5, Creative: 0.7)
8. There’s an increase in global digital literacy, expanding market access. (Confidence: 0.6, Creative: 0.6)
9. Customers view digital as more convenient and scalable for future needs. (Confidence: 0.7, Creative: 0.5)
10. Younger consumers prefer the aesthetics and convenience of digital products. (Confidence: 0.6, Creative: 0.6)

*Reflection:* 
"Have I considered all possible influences? Are there any surprising factors that could explain this shift?"

*Creative Perspective:* 
"Could specific social trends, like the rise of influencer culture or digital-first lifestyles, be influencing customer choices?"

**2.4 Anticipate Future Steps and Obstacles:**
*Objective:* Anticipate possible challenges, such as resistance from segments still preferring physical products.

*Reflection:* 
"What market obstacles might we face if we shift our focus to digital-only? Are there sub-segments that still prioritize physical products?"

*Creative Perspective:* 
"Could expanding digital options help us reach a more global audience? Are there emerging trends that we could leverage in our strategy?"

[end sys2]

[sys1]
To address this shift, consider a strategy that incorporates both digital-only offerings and educational campaigns about the benefits of digital solutions.
Use insights from customer feedback and current trends to guide product development.
Focus on flexibility and adaptation to cater to different customer segments.
[end sys1]


Introduction {#sec1-1}
============

Transverse myelitis is a neurological disease, which has an autoimmune process involved in its pathology.\[[@ref1]\] In autoimmune diseases, the immune system, which normally protects the body from foreign organisms, mistakenly attacks the body\'s own tissue, causing inflammation and, in some cases, damage to myelin within the spinal cord. It is a neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord. The term myelitis refers to inflammation of the spinal cord; transverse simply describes the position of the inflammation, that is, across the width of the spinal cord.\[[@ref2]\] Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers. This damage causes nervous system scars that interrupt communications between the nerves in the spinal cord and the rest of the body. Recovery from transverse myelitis usually begins within 2-12 weeks of the onset of symptoms and may continue for up to 2 years. However, if there is no improvement within the first 3-6 months, significant recovery is unlikely.\[[@ref2]\]

Case Report {#sec1-2}
===========

An 18-year-old male patient having indwelling catheter *in situ* reported with the complaint of inability to move his legs and no sensation below his navel \[[Figure 1](#F1){ref-type="fig"}\]. He also told that his legs seemed to be cold. He was having loss of appetite. He could not hold the urge of defecation.

![Before treatment--indwelling catheter](Ayu-33-402-g001){#F1}

On asking about the history of the same, he stated that he was alright till evening of 8 April 2010 and then he felt feverish and developed pain all over the body. He took some medicine for the same from his family doctor. He woke up late in the morning and was unable to stand up by himself. He stood with support and tried to walk. During the walk, he felt that his legs were not in his full control. He had not voided any urine since morning. In the evening, along with his relatives, he again consulted the other doctor who then referred him to higher center.

He got admitted to the hospital on the next day with the complaint of no sensation in lower half of the body as well as insensitivity to touch from lower part of neck to toe. He was also having the feeling of tightness around the abdomen.

Lumbar puncture was done on the same day, which showed increased polymorphs. On 15 April 2010, CT-head was done and it was normal. He also faced some respiratory problems and so was on intermittent oxygen inhalation therapy from 12 to 18 April 2010. On 17 April 2010, MRI cervico-dorsal spine with MRI brain was done, findings of which were as follows.

*Long segment T2 hyper intensity of the cervicodorsal spinal cord from the C3 level onward. Suggestive of myelitis*.

Therefore, the present case had been diagnosed as that of transverse myelitis and came to us after two months of acute attack. At that time, he was having total paraplegia, no sensation below umbilicus, and other typical features of transverse myelitis such as bladder--bowel dysfunction, feeling of tightness around abdomen, and a bed sore on the sacral region.

Some of the above-mentioned presentations of the patient resembled the sign and symptoms of a disease named as *Urustambha* (spasticity of thighs) in Ayurvedic classics.\[[@ref3]\] On having a critical view, some of the features of transverse myelitis and *Urustambha* are found very close to each other and can be correlated\[[@ref2][@ref4]--[@ref10]\] \[[Table 1](#T1){ref-type="table"}\]. On the other hand, many other features of transverse myelitis and Urushtambha are also there that cannot be correlated\[[@ref2][@ref4][@ref5][@ref8]\] \[[Table 2](#T2){ref-type="table"}\].

###### 

Comparable features of transverse myelitis and *Urustambha* (spasticity of thighs)

![](Ayu-33-402-g002)

###### 

Non-comparable features of transverse myelitis and *Urustambha* (spasticity of thighs)

![](Ayu-33-402-g003)

Treatment and Results {#sec1-3}
=====================

This known case of transverse myelitis, when reported to us was having some signs and symptoms like that of *Urustambha*, as well as other due to dominance of *Kapha*. Therefore, as per *Charaka Samhita*, *Rookshana Karma* (dehydrating therapy) was selected as choice of treatment.\[[@ref11]\] In accordance with the line of treatment of *Urustambha*, *Kshapana* and *Shoshana* (complete extraction and absorption of liquid fraction) were desired so the patient was treated as follows.\[[@ref12]\]

The treatment was started with a special type of the fomentation procedure known as *Baluka Sweda* which is a Rooksha (dry) type of *Swedana*. It is used in the dominance of *Kapha* and *Aama* (undigested metabolites) in the body. In this type of fomentation, prior massage of oil was not done. This procedure includes the application of heated bolus (poultice) of sand on the body part where fomentation is required. This type of fomentation quickly reduces the *Kapha* and digests the *Aama*. After 3 days of this *Baluka Swedana*, the patient reported that he felt warmth in legs and he could sense the variation in the temperature of *Swedana* (fomentation) room and outside the room. This therapeutic test confirmed the *Kapha* dominance and guided us to treat the case in the same line. Therefore, in the next step *Vachadi Yoga* \[consisting of equal amounts of self-prepared powders of *Vacha* (*Acorus calamus*), *Devadaru* (*Cedrus deodara*), *Pippali* (*Piper longum*), *Gajapippali* (*Scindapsus officinalis*), *Haritaki* (*Terminalia chebula*), and *Katuki* (*Picrorhiza kurroa*)\] in a dose of 3 g twice a day along with honey was started.\[[@ref13]\] Besides that, *Kaishora*\[[@ref14]\] *Guggulu* in a dose of two tablets soaked in water and two tablets of *Chandraprabha Vati*\[[@ref15]\] along with water were started twice a day as oral medicine. All the *Kapha Vardhaka Aahara-Vihara* were restricted and *Yava* (barley) along with *Karvellaka* (bitter gourd) was advised in diet.\[[@ref16]\]

With above said treatment, the patient started responding well and within 10 days he was able to move all the fingers of the left foot. The treatment was continued as such and on 15^th^ day, the patient was able to dorsi-flex his left foot. On 18^th^ day, he started to flex his left knee. After 2-3 days, his right foot also started moving. On 34^th^ day from date of admission, the patient successfully raised his hip on his feet in lying position \[[Figure 2](#F2){ref-type="fig"}\]. So, he was advised some exercises of knee and hip by the physiotherapist. In next 4-5 days, the patient was told to stand on his feet and clonus was observed in both legs. So, *Abhyanga* (massage) with *Saindhavadya Taila* and *Nadi Swedana* (fomentation with steam) were given\[[@ref17]\] \[[Table 3](#T3){ref-type="table"}\]. This particular oil was prepared with a classical method for *Taila Paka* (processing of oil).\[[@ref18]\] It was used for massage as its ingredients are mainly *Ushna Veerya* (hot in nature) that would have alleviated *Vayu* without increasing *Kapha* or *Aama*. Clonus was subsided and the patient was able to stand with support on 42^nd^ day \[[Figure 3](#F3){ref-type="fig"}\]. Then, he was again referred to physiotherapist who started the gait training and the patient started walking with the help of stick just within 2 months of treatment. Initially, there was spasticity in his thighs which got reduced by physiotherapy and in next 15 days, the patient could walk almost normally \[[Figure 4](#F4){ref-type="fig"}\].

![During treatment---patient can raise his hip](Ayu-33-402-g004){#F2}

![During treatment---patient (rt.) can walk with support](Ayu-33-402-g005){#F3}

![After treatment---patient can walk smoothly](Ayu-33-402-g006){#F4}

###### 

Ingredients of *Saindhavadya Taila*

![](Ayu-33-402-g007)

A follow-up MRI was done which reported as follows.

*Visualized spinal cord is normal in caliber and signal intensity*.*As compared to the previous study dated 17-4-2010, there is complete resolution of intramedullary T2/STIR hyper intensity of cervico-dorsal spinal cord*.

Conclusion {#sec1-4}
==========

On the basis of above study, it can be concluded that if the patient with transverse myelitis shows the sign and symptoms like that of *Urustambha* along with dominance of *Kapha* then the choice of treatment must be *Rookshana Karma* which must be followed till *Kapha* is decreased. After that, the treatment must be planned as per the situation arises.\[[@ref19]\] By managing a single case, the authors cannot arrive to the conclusion that *Rookhsana Karma* (dehydrating therapy) is the ultimate treatment in transverse myelitis. The study should be carried out in several similar cases.