🔙 Quay lại trang tải sách pdf ebook Ngoại Khoa Y Học Cổ Truyền Ebooks Nhóm Zalo TRUONG DAI HOC Y HA NOI KHO A Y HOC CO TR U YEN NGUYEN )C LIEU NHA XUAT BAN Y HOC TRUONG DAI HOC Y HA NOI ■ ■ ■ KHOA Y HOC CO TRUYEN NGOAI KHOA ■ Y HOC CO TRUYEN ■ (Tai ban Ian th tin hat co st/a chua va bo sung) NHA XUAT BAN Y HOC HA NOI - 2007 LOI Gldl THIEU Y hoc co truyen cung nhit y hoc hien dai la mot nganh hoc, trong do bao gom rat nhieu chuyen khoa. Ngoai khoa y hoc co truyen ra dcfi rat sdm, ke tit khi con ngitdi phai chong dd vdi thien nhien de duy tri siJt sinh ton va phat trien ciia minh. Theo thdi gian, chuyen nganh nay cang ngay cang ditOc xay ditng, cung co va hoan thien hcfn. Trong y hoc co truyen, quan niem ve ngoai khoa co khac vdi y hoc hien dai ngay nay, nhiing benh nam trong llnh viCc ngoai khoa khong chi bao gom nhiing benh ly phai sit dung sit can thiep ciia dao keo, bang bo, co dinh nhit: chan thitdng, gay xitcfng, tri... ma con bao gom ca nhitng benh ngoai da nhit mun nhot, benh da lieu, triing thu can... mot pham vi rong. De bao ton ban sac cua y hoc co truyen, sit phan loai, sap xep nay van ditac duy tri. Cuon Ngoai khoa y hoc co truyen da dittic xuat ban Ian thit nhat nam 2002 va dd ditdc tai ban co chinh sita va bo sung Ian thit hai nam 2006, do hai tac gia PGS. TS. Pham Van Trinh va TS. Le Litcfng Dong, la nhitng giang vien chinh chuyen sau ve chuyen nganh nay trong Khoa Y hoc co truyen - Tritdng Dai hoc Y Ha Noi bien soan chinh ly. Ngoai khoa Y hoc co truyen nham dap iing lam tai lieu tham khao cho sinh vien va cac hoc vien sau dai hoc cua khoa, cung nhit lam tai lieu tham khao cho cac ban dong nghiep quan tam tdi llnh vitc ngoai khoa y hoc co truyen. Chung tdi danh gia day la mot cuon sach co gia tri hoc tap va tham khao cho cac sinh vien, hoc vien va cac ban dong nghiep thuoc chuyen nganh y hoc co truyen. Chung tdi xin gidi thieu vdi cac ban doc cuon sach Ngoai khoa y hoc co truyen vdi tam long tran trong. PGS. TS. NGUY§N NHUOC KIM Tru’otag khoa Y hoc co truyen Truing Dai hoc Y Ha Noi 3 MUC LUC Trang Ldi noi dau 3 Chtfdng I. Bien chumg trong ngoai khoa y hoc co truyen 7 PGS. TS. Pham Van Trinh Chifdng II. Cac nguyen tac chu yeu dieu trj benh ngoai khoa 20 PGS. TS. Pham Van Trinh ChUdng III. Cac benh nhiem khuan cap tinh 41 PGS. TS. Pham Van Trinh TS. Lc Luang Dong Mun nhot 41 Oinh rau 43 Chin me 44 Viem hach 45 Viem bach mach cap 47 Nhi§m khuan huyet 48 Chifdng IV. Mot so benh ngoai khoa khac 51 PGS. TS. Pham Van Trinh TS. Le LUOng Dong Thoat thir 51 Soi mat, viem di/dng mat 55 ChiTng hoi quyet 57 Viem tuy cap tinh 58 Soi tiet nieu 61 Nhiet lam 69 Bong 70 Ro hau mon 72 Tri 76 5 ChUdng V. Benh ngoai da 01 PGS. TS. Pham Van Trinh TS. Le Luang Dong Cham 82 Vay nen 88 To dia 90 Me day 91 ChUdng VI. ThUdng khoa 94 PGS. TS. Pham Van Trinh TS. Le LUOng Dong Dieu tri niu thi/dng 97 Toa thi/dng 99 Vet thi/dng phan mem 100 Gay xi/dng 108 6 CHl/ONGI BIEN CHL/NG TRONG NGOAI KHOA Y HOC CO TRUYEN ■ ■ ■ I. QUAN NIEM VA PHAN LOAI Benh ngoai khoa thUc ra co rat s6m va co tru6c cac benh cua cac khoa khac ke ca noi khoa vi con ngUdi sinh ra phai lao dong de sinh ton cho nen trUdc tien phai xuat hien cac kinh nghiem dieu tri: tai nan lao dong, con trung va thu can... nhUng tCf xUa cac y van de lai, 6 nUdc ta chUa xep rieng ngoai khoa. O Trung Quoc thdi nha Chu xep do la dUdng khoa, thay thuoc dieu tri benh dUdng khoa goi la dUdng y. Thdi xUa cho rang cac benh sinh ra ma mat nhin thay, tay sd thay, co chiing trang cuc bo deu thuoc pham vi cua ngoai khoa (vi du: dinh, ung, thu, hau boi, tien boi, ddn doc, loa lich, ro, nham, bif6u co...). Sau nay do khoa hoc phat trien va co sU ket hdp giufa y hoc co truyen v6i y hoc hien dai cho nen pham vi ngoai khoa rong hdn, phong phu hOn (vi du: sa lam, chan thUdng, con trung va thu can, cac benh da lieu, viem tac dong mach, tri...) Trong ngoai khoa y hoc co truyen, ngUdi ta dUa vao cac benh tinh va nguyen nhan co the chia cac loai: - Loai nhiet (thuoc loai viem nhiem theo y hoc hien dai): dinh, ung, thu, ddn doc, loa lich, sdi, dau v.v. - Chan thUdng: triet thUdng, niu thUdng, toa thUdng, huyet ijf, khi tre d tang phu do chan thUdng. - Cac loai khac: nham, bong (hoa sang), lanh cong (dong sang), con trung va thu can. Ngoai ra diia vao y hoc hien dai ngUdi ta con chia ra cac benh theo vi tri ton thUdng ket hdp vcii tinh chat cua benh: - Cac benh viem nhiem da, cd, xUdng, kh6p, hach va tuyen vu. - Cac benh cap tinh. - Cac benh hau mon - trUc trang. - Cac benh da lieu. - Cac benh thuoc chan thUdng. 7 - Cac benh u. - Cac benh bong. - Cac benh bi con trung va thu can. - Cac benh ngoai khoa khac: soi gan, soi mat, soi tiet nieu, viem tac dong - tinh mach, giun chui ong mat... II. KHAI QUAT VE BIEN CHL/NG BENH NGOAI KHOA 1. Bien chufng nguyen nhan sinh benh Nguyen nhan gay benh ngoai khoa la do cac nguyen nhan ben ngoai (luc dam), cac nguyen nhan ben trong (noi nhan) va cac nguyen nhan khac (bat ngoai noi nhan) gay nen nhUng co dac tinh gay benh khac v6i noi khoa. Cu the cac nguyen nhan sau: 1.1. Nguyen nhan ben ngoai Luc dam, ta doc con goi la ngoai cam luc dam (ttic la ngoai ta) gay nen (bao gom: phong, han, thu, thap, tao va hoa xam nhap vao cO the lam ton thUdng cO the ma phat benh). Benh co the phat tai cho (cuc bo), cung co the phat ra toan than la tuy thuoc vao chi'nh khi (siic de khang) cua cO the. Chinh khi toan than hu gay benh toan than (mun, nhot toan than); chmh khi tai cho hu gay benh tai cho (nhot, ung... tai cho). Benh cuc bo chiem ty le 70 - 80%. Nguyen nhan gay benh trong ngoai khoa thudng do hoa. Nam loai ta khi khac ket hop vdi hoa de gay benh, nhufng ban than chung cung bien thanh hoa de gay benh con goi la hoa doc hoac nhiet doc. Vi vay sach Noi kinh co noi: “chinh khi con ben trong, ta khi khong lam gi dUdc”. a. Phong ta Phong ta la dUdng ta, tinh cua phong la tao nhe, tan, len tren va ra ngoai, cho nen benh 6 da thudng rai rac nhieu ndi, co khi toan than, tap trung 6 dau, co, mat, ngiia va kho hoac co vay mong hoac te bi. Vi du: phong xam nhap lam cho huyet tao, bi phu kem nuoi dUdng ma smh benh (nhu viem da than kinh, vay nen...). Phong thich hanh (di dong) ma lai bien hoa nen phat benh nhanh va thay doi vi tri, hinh dang, phan nhieu thuoc diidng chiing nen xuat hien sifng, do, dau, khong co vi tri nhat dinh hoac len kinh giat co rut, vi du: bi vet thudng cam phai phong ta gay benh noi phong co the gap trong pha 8 thtfdng phong (giong nhif uon van, neu la uon van thi can phai phong va dieu tri bang y hoc hien dai trifdc). b. Han ta Han ta la am ta, tinh chat benh 0 sau, tham, te bi, benh d can xifdng, benh phan nhieu thuoc am chutng. Dac diem benh ngoai khoa cua han la sifng ma khong cijfng, mau s&c da tham tia hoac mau da trifdc khi bi benh khong do, khong nong, dau nhieu 0 mot vi tri nhat dinh, benh am tham va nang. Vi du: nguyen nhan do han lam cho khi huyet if tre gay nen nhutc dau, chi lanh buot tai nhdt, tham chi thieu huyet nuoi difdng lam cho cd teo nho, rung dot tay hoac chan, gap trong benh thoat thuf (viem tac dong mach); hoac neu do han ta xam nhap nhieu va lau gay nen ngifng tre khi huyet lam cho toan than ctfng dd va lanh buot, do la benh dong thifOng (benh lanh cong). c. Hod ta Hoa ta thuoc difdng ta, bieu hien trieu chiing chung: ngiia, dau, Id loet... Tat ca deu do hoa, phong, han, thii, thap ta hoa hoa gay nen, phat benh dac biet nhanh va cap tinh (sifng, do, nong, dau). Vi du: nhiet vao huyet gay nen huyet nhiet, co the gay ddn doc hoac hoa nhiet doc nhif: benh dinh, thu, ung, nhot... Tuy theo vi tri ma gay chiing benh khac nhau nhif d da la ddn doc; d cd bieu la dinh, thu, ung, nhot; d kinh mach nhif viem hach; d truf6c ngUc la tien boi, d sau lufng la hau boi. Tif vi tri cua benh ma ngUdi ta co the biet cac nguyen nhan ket hdp v6i hoa, cu the: neu phat benh d bo phan tren cd the nhif: dau, mat, co, chi tren la do hoa thtfdng do hoa ket hdp v6i phong; neu d ngilc, siJdn, bung thifdng do hoa Lf lau, goi la hoa uat vi khi hoa thifdng uat d giiia cd the; neu phat benh d bo phan da6i cd the nhuf hau mon, chi dudi, sinh due, tiet nieu... thi thufdng la do hoa ket hdp vdi thap vi tinh chat cua thap la ha giang (di xuong difdi). Tuy vay khi chan doan nguyen nhan can phai ket hdp vdi trieu chufng toan than, tai cho va vi tri benh tren cd the de dieu tri mdi de lai ket qua tot. d. Thap ta Thap ta la am ta, cd tinh chat nhdt, dinh, ban due, thifdng ket hdp vdi han hoac nhiet tuy theo sif thien lech cua han hoac nhiet trong cd the va cua quy tiet (khi trdi) ma hoa han, hoa nhiet; han hoac nhiet ket hdp vdi thap thanh thap han, thap nhiet. Dac diem: neu d cd (nhuc) thi da loet nat, chay nifdc hoac chay mu; d sau thi gay ro ri, da am ifdt (vi du: thap nhiet gap d tri, loet nat, ung thung; thap han gap d chi difdi nhif: cac vet loet lau lien, ro mu...). 9 e. Tao ta Tao ta la difdng ta, dac diem cua tao la lam ton hai tan dich gay huyet tao sinh ra phong; do do phan nhieu benh phat d tay, chan va da (bi phu)... Tinh chat cua tao la bi phu kho, ne, ngiia, man, bong vay, niit ke... Vi du: neu nhiet tao xam nhap vao huyet sinh huyet tao, huyet nhiet co the gap d benh vay nen; neu huyet tao co the gap benh thap chan man tinh, da man ngifa (nhu benh a sifng, cham). f. Thit ta Thii ta la difdng ta, thifdng hiep (thap), thap bi thii chifng dot lau hoa nhiet cho nen phan nhieu phat ra d cd, da, dau, mat. Dac diem la sifng, do, nung mu, dau, gap lanh cac trieu chifng giam. Vi du: thu thap nung dot lam cho bi phu thanh rom say hoac cam phai thu doc thanh vet thifdng Id loet, mun nifdc (nhU: zona, dau...). 1.2. Nguyen nhan ben trong Nguyen nhan ben trong con goi la noi thifdng that tinh, do la nhan to tinh than, cu the la: hi (vui), no (gian), bi (buon), ai (lo), kinh (hai), khung (sd), ifu (suy nghi) bi rol loan lam cho am difdng khong dieu hoa, khi huyet khong hoa hdp, cong nang cua cac tang phu va kinh lac bi hon loan ma gay benh. Benh ngoai khoa hay gap la do lo nghl hoac tCfc gian qua do. Vi du: tinh chi khong thong, tiic gian qua do lam cho can khi uat ket, khi tre dam ngifng; hay gap tren lam sang la benh viem hach (loa lich), viem tuyen vu, tac tia sufa, u giap trang, cac khoi u... Ngoai ra con gap cac benh ngoai da nhif: viem da th&n kinh, benh san ngiia... cung do yeu to'that tinh gay nen. 1.3. Cac nguyen nhan khac a. An uong khong dieu do Hai Thifdng Lan Ong da noi: “An uong la boi dap nhiing chat cho cho thieu, an uong qua mifc thi thifdng ton tdi ty vi dao trifdng”, cho nen an uong khong dieu do cung la nguyen nhan gay benh ngoai khoa. Vi du: an nhieu thii cay, nong, beo, ngot, lam cho vi trifdng tich nhiet, hoa doc noi sinh gay nen benh Id loet, dinh, nhot, rom say...; an uong qua nhieu gay nen thifc tfch sinh benh cap tinh 6 bung nhif ngo thiic, viem tuy cap; an thiic an lanh hoac qua doi gay nen cac benh giun nhif: t&c ruot do giun, giun chui ong mat (hoi quyet)... b. Phong due Trong tap Noi kinh yeu chi Hai Thifdng Lan Ong da noi ro: “Sinh hoat la ky cifdng cua hanh dong... say dam ve sac goi la phong due qua do, tiu sac bifa bai goi la benh hao; say dam sac due qua miic thi goi la tinh can, bifa bai 10 thi tinh khi tan m an”. Nhif vay neu phong due qua do gay than khi ton thuong phong ta, han thap de xam nhap ma sinh benh (vi du: viem tuy xUdng, xifdng gay lau lien, cot trifng...). c. Ncti d Ndi d cung la nhan to" gay benh vi ndi 0 co lien quan chat che tdi luc dam va cung la yeu to" sinh ra luc dam. Vi vay benh ngoai khoa do ndi d gay nen chinh la do luc dam gay nen cac benh bieu hien giong nhif cac benh cua luc dam. d. Cac nguyen nhan khac - Chan thifdng. - Con trung va thu can. - Hoa thifdng va dong thifdng. Cac ton thifdng tren neu benh nhe thi cd, da, gan, xifdng bi ton thifdng; neu benh nang thi cac tang phu bi ton thifdng; neu benh nghiem trong hdn thi bien benh toan than. 2. Bien chufng va benh ly Benh ly la mot khai niem hieu biet ve benh, giai thfch difdc nguyen nhan gay benh trong cd the va phan tich difdc sii bien hoa cua benh, danh gia tien lifdng cua benh, cho nen no het sifc quan trong. Tren thifc te lam sang, no cd y nghia chi dao trong yeu trong chan doan, dieu tri, phong va tien lifdng benh. 2.1. Bien chiing ve khi huyet Khi huyet trong cd the giup dd lan nhau ma lifu hanh, tuan hoan trong kinh mach, d trong thi nuoi difdng tang phu, d ngoai thi nuoi difdng cd da de duy tri sU song va cd tac dung chong ngoai ta xam nhap. Vi vay khi huyet vUdng thinh, sif bao ve ben ngoai se manh thi ngoai ta khong de xam nhap; khi huyet hif yeu, sU bao ve ben ngoai se kem thi cac nguyen nhan gay benh rat de xam nhap ma gay nen benh. Sach Noi kinh ndi: "Khi thifdng thi dau, hinh (huyet) thifdng thi sifng. Sifng va dau la phan ting benh ly khong giong nhau cua hai loai khi va huyet bi ngifng tre”. Vi vay phat sinh ra ton thifdng benh ly ngoai khoa nhat thiet phai do khi huyet ngu'ng tre gay nen. Vi du trong ngoai khoa chan thifdng: khi huyet ngifng tre la nguyen nhan chu yeu phat sinh va hinh thanh benh ly sifng nong do dau hoac chay mau (vi du benh Id loet, dinh, nhot...); neu khi huyet xung thinh (du) thi d thdi ky dau de dang khoi, d thdi ky cd mu de thu nho va vd mu, d thdi ky vd mu de thu nho mieng vet thifdng va sinh cd (lien seo). 11 Vi vay khi bien chiing trong lam sang nhat thiet phai lam ro quan he khi huyet vdi benh noi ton thifdng m6i hieu difdc ban chat cua benh ma tien hanh dinh ra phUdng hu6ng dieu tri. Cac bieu hien cua ton thifdng khi huyet nhif sau: a. Khi tre Khi tu thi co hinh, khi tan thi khong co vet tich, khi gay benh thi dau, khi dau thi bat thudng. Benh thifdng gap nhif: ngifc sifdn day t\jfc, kho thd do chan thudng vao ngifc sifdn (khong co trieu chifng gay xifdng, tran khi, tran dich mang phoi, khong vd gan lach); hoac loi keo gay dau; hoac danh nhau vimg bung gay tiic bung, chifdng hdi; hoac lun gay cot song gay chifdng bung, bi dai tieu tien; hoac cung co the do tang phu bi roi loan gay khi tre nhif benh khi hif ha ham (sa cac phu tang...) b. Khi uat Khi uat trong ngoai khoa co the sinh ra tich tu; hoac khi uat hoa hoa, hoa dot chay tan dich ma thanh ddm, ddm tich lai thanh khoi. Neu khi uat ma tich tu, thanh khoi, mau sac da khong thay doi, co the thay doi theo tinh chi (vi du: viem tuyen vu, tac tia sufa, u giap trang...); neu khi uat hoa hoa, hoa dot chay tan dich thanh dam, dam se tich lai thanh khoi sifng nhUng mem (vi du: viem hach man...). c. Khi hit Khi hif tiic la difdng khi khong the thong dat cd bieu vao ben trong cd the difdc. Neu khi hif toan than gay cif dong kho khan, hay gap trong di chiing cua cac chan thifdng than kinh, cd, xifdng, kh6p... Neu khi hif tai cho thi siic chong dd tai cho yeu cho nen doc ta de xam nhap gay ra 16 loet, dinh, nhot... lam cho cac ndi bi ton thifdng kho hoi phuc (vi du: benh khi hif cua tang phu nhu ty khi hif gay nen sa cac phu tang). Neu khi hif ca tai cho va toan than nhu benh sifng mu thi kho pha mu, kho thu mieng, thd yeu, an kem, chat lifdi nhdt, mach te. d. Huyet it Theo y hoc co truyen: trong ngoai khoa ‘Thifdng khi tkc khi tre, thifdng huyet t^c huyet ngifng”. Khi tre khien huyet ngifng, huyet ngifng thi can trd khi hanh, vi vay huyet if la gay ra benh. Neu huyet ii ngifng d cd nhuc, bi phu thi sifng, dau, do (vi du: ton thifdng cd, da, day ch^ng - ton thifdng ph^n mem); neu can trd d dinh ve thi uat ma sinh nhiet, benh co trieu chiing sifng, nong, do, dau d da, cd (vi du: benh dinh, nhot, loet...); neu huyet tich d ngiic sifdn thi co trieu chiing day chifdng, dau, tiic d ngifc sifdn (vi du: benh viem difdng mat, ton thifdng viing ngiic do chan thifdng). 12 Huyet ii lau uat thanh nhiet (noi d phan difdi), huyet cung gay ra chay mau (vi du: tri chay mau). e. Huyet nhiet Huyet nhiet do huyet H lau, uat d trong ma sinh nhiet hoac nhiet doc xam pham vao huyet phan. Neu d da, cd, kh6p... thi co trieu chiing nhiet cap tinh nhif: sifng, nong, do, dau; gap trong dinh, ddn doc, nhot... do la do huyet lau uat thanh nhiet gay nen. Neu co trieu chiing chay mau thi do nhiet vao huyet nen biic huyet loan hanh ma gay ra; thifdng gap trong tho huyet, nuc huyet, do sang chan... f. Huyet hit Huyet hif thifdng xuat hien d thdi ky sau cua benh. Y hoc co truyen cho r^ng khi huf bat dung, huyet hif bat nhan, cho nen cac ndi ton thifdng ma huyet hif thi khong nuoi difdng difdc, do vay ndi ton thifdng se teo cd, ciing can kho hoi phuc van dong (vi du: cac vet thifdng ma huyet hif thi rat kho thu mieng va lien seo hoac trong cac trifdng hdp gay xifdng neu huyet hif thi se kho lien xifdng...). 2.2. Bien chiing ve can xUdng Can lien quan t6i can, xifdng lien quan t6i than, can va xifdng la ngon cua can than, difdc khi huyet on am va can than nhu difdng. Vi vay can xifdng ma bi ton thifdng thi nhat thiet ton thifdng t6i khi huyet va anh hifdng t6i can than. Nhiing ngifdi tre tuoi (nhat la liia tuoi thanh nien) co can than khi thinh, can xifdng phat trien ch&c cho nen can xifdng bi ton thifdng thi rat de hoi phuc. Ngifdi gia thi can than khi suy, can xifdng hif yeu cho nen can xifdng bi ton thifdng thi hoi phuc rat cham, tham chi khong hoi phuc. Vi vay, dieu tri benh can xifdng can phai chu y den dieu ly cua khi huyet can than lam chu. Vi du: gay xifdng giai doan dau con sifng, nong, do, dau thi can hoat huyet, hanh khi, tieu ii lam chu; den giai doan het sifng, nong, do phai chu y lam lien xifdng, lay bo can than lam chu... 2.3. Bien chiing ve tang phu Trong ngoai khoa benh co quan he chat che vdi tang phu. Benh co the tif bieu truyen vao tang phu (vi du: cac benh ngoai da, cd, can, xifdng tuy do ngoai ta gay benh nhifng neu khong dieu tri tot se gay benh d tang phu nhif dinh, nhot; neu ngifdi benh co chinh khi kem se gay sot cao, hoa mu toan than va co giat difa den txi vong...); ngifdc lai benh thuoc tang phu cung co 13 Cac benh d da, cd, xifdng, khdp du chan thifdng hay cac doc ta gay nen deu lam khi huyet t&c trd gay nen khi huyet d kinh lac ngifng tre, do vay tren lam sang phai difa vao bo vi cua difdng kinh lac ma bien chiing (vi du: benh d gay co (loet Id, nhot...) la thuoc bo vi cua difdng kinh bang quang; benh viem tuyen vu, t&c tia sQa la thuoc bo vi cua difdng kinh vi...). Nhd cac huyet n&m tren difdng kinh lac co lien quan chat che vdi cac tang phu cho nen tang phu nao bi benh se phan ting tren difdng kinh lac do, nhat la huyet chmh cua difdng kinh (vi du: benh d can ddm an huyet difdng lang tuyen thi thay dau, benh cua he thong dai tieu trifdng ma an huyet tuc tam ly thi thay dau). Ngifdi ta dtfa vao stf lien quan do de chan doan tang phu bi benh (vi du: chan doan viem ruot thifa an huyet lan vi thay dau...). Dtfa vao lien quan gitfa difdng kinh lac vdi ngu quan va vi tri ngu tang luc phu (ndi cif tru cua tang phu) de chan doan va dieu tri, vi du: - Benh d dinh dau thuoc kinh doc. - Benh d tai thuoc kinh than. - Benh d mui thuoc kinh phe. - Benh d long ban tay thuoc tam bao lac. - Benh d long ban chan thuoc kinh than. - Benh d vung lifng thuoc difdng kinh difdng. - Benh ci trong canh tay thuoc thu tam difdng kinh. - Benh phia trong dui thuoc tuc tam am kinh. - Benh phia ngoai dui thuoc tuc tam difdng kinh. Cac kinh lac lien quan chat che vdi khi huyet cho nen khi benh d kinh lac hoac cd quan nao cung co the dtfa vao khi huyet de chan doan, dieu tri va phong benh d cd quan do. + Nhieu khi, it huyet: Tam tieu kinh. Ddm kinh. Tam kinh. Than kinh. + It khi, nhieu huyet: Tam bao lac. Can kinh. 16 Tieu trifdng. Bang quang. + It khi, ft huyet: Phe kinh. Ty kinh. + Nhieu huyet, nhieu khi: Dai trifdng kinh. Vi kinh. Benh d ndi nhieu huyet, nhieu khi hoac nhieu huyet, ft khi de khoi hdn nhieu khi, it huyet hoac it khi, it huyet vi huyet nuoi difdng khi va thuc day khi hoat dong. 2.5. Bien chiing ve sitng, dau, mu, ngita Trong qua trinh dien bien cua benh ngoai khoa7trfi*dng co sifng, dau, mu va ngtia. j n^)CLl^t) a. Sitng Trong cd the ngifdi ta khi huyet tuan hanh khong ngifng, khong ndi nao khong den, khong ndi nao khong qua. Neu do nguyen nhan nao do lam khi huyet dong lai hoac ngifng tre thi tai ndi do co sifng dau. Hinh thai cung nhif mau sac d moi cho sifng deu khac nhau: cho sifng tan man thuoc hif; cho sifng cao, tap trung thuoc thiic; sifng thuoc phong thi cho sifng noi phong ma hay chay; sifng thuoc dam thi mem nhun nhif bong hoac ngoai ciing trong mem khong do, khong nong, mau da nhif thifdng. Vi il huyet ma sifng thi sac hdi hong hong hoac bam tim. Neu thanh mu thi mau sac bien doi (co the tim bam lan vang, hoac mau xanh); sifng do huyet khong chay; sifng do khi thi chay. b. Dau Dau chinh la do khi khong lifu thong nhifng khi la thong soai cua huyet, huyet la me cua khi nen khi khong lifu thong thi huyet cung khong lifu thong, cho nen ngifdi ta noi r&ng dau la do khi huyet khong lifu thong va cung tuy theo nguyen nhan ma co tinh chat dau khac nhau. Neu dau thuoc hif thi ifa xoa bop, gap lanh lai dau tang; dau thuoc han thi tu lai mot cho, mau da khong thay doi, gap nong thi b6t dau; dau thuoc nhiet thi mau hong do, gap lanh thi dau giam; vi lam mu ma dau thi vufa dau vifa sifng to, vi phong ma dau thi dau chay khap ngifdi rat nhanh, kem theo ngiia, te bi hoac kien can; vi khi ma dau thi dau chay quanh khong nhat dinh cho nao. 17 c. Lam mu Mu la do khi huyet hoa sinh ra, neu khi huyet suy kem thi khong the day doc ra ngoai dUdc. Vi the ngifdi ta noi rang stf bai nung cac chiing ung nhot, sang ung... la do chinh khi day doc ra ngoai, lam cho doc theo mu ra ngoai, cho nen benh lam mu nhif ung, nhot, thung, doc da den giai doan thanh hinh thi phai kham xet ky xem da lam mu chifa, mu 6 sau hay nong de xii ly cho dung; hoac neu co mu thi da v6 chifa va xem xet tinh chat, mui, mau cua mu. PhUdng phap kham nhot mu: lay hai ngon tay an nhe ndi sifng, neu thay bap benh la co mu, co ntfdc; an vao thay Cling ran la chifa co mu, mem nhun d trong la co mu da chin; an nhe thay dau ngay la co mu d nong, an nang mdi thay dau la mu d trong sau; da phong mong la mu d nong, mau da khong thay doi lai khong co len la mu d sau. Tinh chat cua mu: do nguyen nhan khac nhau nen tinh chat mu cung khac nhau. Ngifdi khi huyet thinh vtfdng thi mu ra dac va vang, ngifdi khi huyet hif yeu thi mu ra loang va trang. Neu mu ra nhif nifdc due .hoac nifdc bot (neu la nifdc mu thoi), do la chiing chiia difOc. Neu luc dau ra mu vang dac, sau ra mu nhif mau hoa dao roi ra nifdc do nhdt thi dd la hien tifdng binh thifdng, de thu mieng va len da non. Neu sac mu nhif dau trau hoac chay nifdc vang (hoac nifdc trong) thudng nam trong chiing chiia lau va kho. d. NgiCa Neu benh mun nhot... trudc khi vd va phat ngiia la phong ket hdp nhiet. Sau khi vd mun ma phat ngiia la binh thudng, la hien tifdng khi huyet d&n dan day du, de len da non nhifng phai ngiia nhif kien bo thi la tot. Neu benh bien ma phat ngiia cd the ndi mu chay cam phai phong ma sinh ra, dd la benh nang kho khoi. Mun nhot loi phinh nhif bot gao ma ngiia, khi gai chay nude la thuoc ty kinh cd thap, chay ra mau tUdi la ty kinh tao qua. 2.6. Phan biet benh lanh, dit vd chiing thuan nghich a. Diem lanh vd diem dii Ngifdi xifa da tong ket kinh nghiem lam sang lau dai da difa ra: - Nam dien lanh: + Tinh than tmh tao, khoan khoai, tieng ndi hoa nha thong suot, lifdi nhuan khong kho, an ngu binh thtfdng. + Cd the hoat dong nhe nhang, yen vui, khong buon buc, mong tay mong chan tifdi nhuan, khi nSm khi day yen tinh. + Mdi hoat nhuan, mu dac vang ma khong hoi thoi. 18 + Tieng noi ran roi, da de tifdi nhuan, khong ho suyen, dai tieu tien binh thudng. + Khong phat nong, mieng rang khong kho. - Bay diem dut: + Than tri buon bifc khong yen, mieng lifdi kho rao, ndi nang lfu kho, noi ton thUOng mieng rong tham den. + Than the ciing thang, mat nhin nghieng, mieng vet thifdng chay mau. + Hinh dang gay com, khong muon an, cho vet thifdng cd mu mem lom sau, khong biet dau nhiic; mu trong, it ma hoi thoi. + Da kho rop, nhieu ddm, ngong, lfu lifdi, ho suyen, canh mui phap phong. + Da den xam, co hong kho rao, buon buc, khat, biu dai co len. + Tay chan minh may phu thung, non miia, nac, ia chay, day bung. + Ndi ton thifdng loet nat, nham nhd nhif to con lifdn, mau tu nhien chay ra, tay chan quyet lanh. b. Chiing thuan, chiing nghich - Chiing thuan la ndi ton thifdng va cac chiing trang cua benh phat trien binh thifdng va tien lifdng tot. - Chiing nghich la ndi ton thifdng va cac chiing trang the hien bien chiing, tien lifdng benh xau. 19 CHttdNG 11 CAC NGUYEN TAC CHU YEU DIEU TRj BENH NGOAI KHOA ■ • Phiidng phap dieu tri benh ngoai khoa bao gom dieu tri ben trong (noi tri) va dieu tri ben ngoai (ngoai tri). Dieu tri ben trong la dieu tri toan than, dieu tri ben ngoai la dieu tri tai cho (cuc bo). Hai loai dieu tri nay thtfdng thtfdng phoi hdp vdi nhau nhiing neu benh nhe ngtfdi benh khoe thi lay dieu tri tai cho la chmh, neu benh nang thi nhat thiet phai ket hdp dieu tri toan than ket hdp dieu tri cuc bo. Du dieu tri toan than hoac dieu tri cuc bo deu phai can ctf vao the chat tinh trang cua benh nhan, nguyen nhan gay benh, nhiing yeu to" anh htfdng tdi ngtfdi benh va biet dac diem khong giong nhau trong ttfng giai doan cua benh thi mdi mang lai hieu qua trong dieu tri. I. PHL/O NG P H A P D IE U TR\ BEN T R O N G 1. Giai bieu tan ket Cd bieu la cd quan bao ve cd the, neu cd bieu bi ngoai cam ta doc xam nhap thi benh xuat hien giai doan dau la bieu chiing (tiic la khi (nguyen nhan gay benh) con d ben ngoai) cho nen phai dung phUdng dtfdc giai bieu tan ta de duoi ta khi ra ngoai. Dd la phep giai bieu tan ket, trong lam sang hay dung de dieu tri cac benh: giai doan dau cua dtfdng thung (mun nhot siing tay), Id loet, cac benh ngoai da... Phap giai bieu tan ket lai bao gom cd 2 loai: tan liidng giai bieu va tan on giai bieu. 1.1. Tan liidng giai bieu Dung de dieu tri cac chiing ngoai cam phong nhiet (ling vdi y hoc hien dai la cac loai viem nhiem da cd) hay gap mun nhot, Id loet, viem da ... trieu chiing cd sot, ndi ton thiidng dau, do, nong, siing, neu loet cung do, chay mau niidc vang, chiia vd mu, tieu tien vang, dai tien tao, reu ltfdi vang, mach phu sac. 20 Bai thuoc dien hinh Ngan kieu tan Kim ngan hoa 16g Bac ha 6g Lien kieu 12g Kinh gidi 8g NgUu bang tut 6g Cam thao 6g True diep 8g Lo can 8g Ket canh 6g Dau xi 6g Phan tich: bai thuoc co tac dung tan lifdng binh che, tiic la vifa tan lifdng thau bieu vifa thanh nhiet giai doc lam phifdng thuoc. Trong ngoai khoa rat hay dung kim ngan hoa va lien kieu lam thuoc thanh nhiet giai doc; kinh gidi dung de khu phong tr£t ngiia, kinh gidi tinh on nen tri chifng dn lanh do nhiet ket d bieu, cac vi thuoc khac deu la thanh nhiet giai bieu. Bai thuoc Ngifu bang giai cd thang Ngifu bang 8g Huyen sam lOg Bac ha 6g Lien kieu 12g Kinh gidi 8g Chi tif 8g Lan hoang thao 6g Bai thuoc nay dung de dieu tri benh do phong nhiet, hay dung benh thung ung difdng sang (ung nhot, mun, Id loet, vet thudng) d cd vai gay hoac hong hau sifng dau. Bai nay con dung trong benh d da khac nhif viem da di ling, ma chan (sdi), man me day di ling... 1.2. Tan on gidi bieu Loai thuoc nay dung de dieu tri cac chiing ngoai cam phong han (ling vdi y hoc hien dai la cac benh viem nhiem da cd nhifng khong sot nong, ton thifdng dd ft...) hay gap trong lam sang la mun nhot Id loet hay tai phat, ngifdi lanh, sd lanh, sot nong nhe hoac ndi ton thifdng dd it, khong sot nong, reu lifdi trang, chat lifdi nhat beu, mach phu khan. Bai thuoc dien hinh Kinh gidi bai doc tan Kinh gidi 8g Chi xac 6g Phong phong lOg Cat canh 8g Sai ho 12g Phuc linh 12g Khifdng hoat 10g Xuyen khung 10g Doc hoat 12g Cam thao 6g 21 Bai thuoc nay dung de dieu tri benh do phong han. Kinh gidi la thuoc tan on, tuy on nhUng khong tao, bat luan la phong han hay phong nhiet deu dung dUdc. No co tac dung phoi ngu vdi thuoc tan liidng giai bieu de tang ciidng sd tan phong nhiet. Doc hoat tinh nhuan, hoa; khiidng hoat tinh hung liet. Vi vay khiidng hoat va doc hoat cung ho trd nang cao tac dung nhiing khong nen dung liidng qua nhieu de gay nen d, nac; ve mua he cang nen dung. Chu y khi dung: neu the chat benh nhan hii nhiidc hoac benh viem loet da lau, mieng loet khong kin diidc, khien cho bieu chiing ton tai thi khong dUdc phat han qua. 2. Thong ly phap La dung thuoc ta ha lam cho doc ta tich tre theo dai tien ra ngoai, thiidng dung nhiet doc, loet Id d ly nhii viem loet triic dai trang (triidng ung) cd trieu chiing hao khat, sot, bung triidng day, dai tien tao ket, reu liidi vang nhdt, mach tram sac hoac cd chan thudng bung, ngiic gay khi tre uat nhiet, bung day trUdng, bi dai tieu tien... cung dung thong ly ta ha phap. 2.1. Ta ha + Tao ket gay d&y triidng, dau bung (ban tkc ruot hoac t&c ruot cd nang) dung bai Dai thiia khi thang Dai hoang lOg Hau phac 6g Mang tieu 8g Chi thiic 6g Goc cua bai thuoc la dai dien cua phiidng thuoc thong ly phap, dai hoang la ta ha thanh nhiet, ket hdp mang tieu cang lam tang ta ha; phoi hdp hau phac, chi thiic hanh ha khi tre cho nen chiia dau triidng bung, bi dai tien. + Chan thiidng bung gay khi tre huyet ii, bung ngiic day tiic, tao ket (roi loan hoac liet ruot do chan thudng) dung bai Noi sd hoang lien thang Chi tii 6g Cat canh 8g Lien kieu 12g Dai hoang 4g Bac ha 6g Quy than lOg Cam thao 6g Xich thiidc 12g Hoang lien 12g Moc hiidng 8g Xuyen lien lOg Binh lang 6g Bai thuoc cd tac dung thong ha ly nhiet, la dai bieu cua phiidng thuoc dieu tri thong ha ly nhiet trong ngoai khoa. 22 + Chan thiidng vung ngiic dung bai Dai thanh thang Diidng quy 10g Tran bi 6g Dai hoang 4g Cam thao 6g Mang tieu 8g Moc thong 8g Hong hoa 6g Chi xac 6g Hau phac 8g To moc 6g Bai thuoc co tac dung ta ha, tieu tre khi huyet. + Neu ton thiidng d liing dung bai Dao nhan thifa khi thang Dao nhan 8g Cam thao 6g Dai hoang 6g Mang tieu 8g Que chi 4g 2.2. N huan ha Dung trong cac benh ngoai khoa ma can nhuan trang. Bai thuoc dien hinh la Nhuan trang thang Diidng quy lOg Ma nhan lOg Cam thao 6g Dao nhan lOg Sinh dia 12g Bai thuoc co tac dung nhuan trang, difdng huyet, thanh nhiet. Chu y: khong dung phap thong ly cho phu nil co thai va ngifdi gia yeu. 3. Thanh nhiet phap Thanh nhiet phap la dung thuoc han liidng de thanh giai nhiet ta d trong cd the (ly nhiet), la phiidng phap dieu tri chu yeu trong ngoai khoa. Phiidng phap nay dung de dieu tri difdng chiing; hay dung trong benh ung thii, sang, dinh tiet, difdng thung... Tuy theo chiing trang ma van dung, thiidng co 5 loai: Thanh nhiet giai doc, thanh nhiet tao thap, thanh nhiet liidng huyet, thanh nhiet ta hoa va thanh nhiet difdng am. 3.1. Thanh n hiet gid i doc Dung trong cac benh thuoc nhiet doc, hay gap sang thung siing nong, do, dau: ha tri viem nghen, mun nhot, dinh, hau boi, tien boi... toan than sot, mieng dang, reu lifdi vang, mach sac (thuoc chiing thiic nhiet). 23 Bai thuoc dien hinh la Ngu vi tieu doc am Kim ngan hoa 16g Dia dinh 10g Cue hoa lOg Thien quy tii (thien hoa phan) 12g Bo cong anh 12g Goc cua bai thuoc la kho han thanh nhiet, thiidng dung de giai doc tieu thung trong ngoai khoa, nhat la thanh nhiet giai doc tiidng doi tot, hay dung trong sang dUdng thung (vet thiidng siing ne), co the ket hdp vdi lien kieu de tieu thung giai doc, cung thiidng them sinh cam thao de tang ciidng tinh chat giai doc cua bai thuoc. 3.2. Thanh nhiet ta hod Dung trong cac chiing sang diidng ciic thinh (riic chay). Toan than: sot cao, ra mo hoi, mieng khat, thich uong, reu liidi vang, mach sac (vi du: viem mu cd to ong, viem tuy, viem quanh hau mon triic trang). Bai thuoc dien hinh la Hoang lien giai doc thang Hoang lien 12g Hoang ba 12g Hoang cam 12g Chi tii 8g Goc bai thuoc la kho han, thanh nhiet, ta hoa; thiidng dung cac viem nhiem dang thdi ky hoa mu do nhiet doc ciic thinh. 3.3. Thanh nhiet liiOng huyet Dung d chiing benh sang diidng cd kem theo phat nhiet, tam phien, mieng khat khong muon uong nhieu, chat ludi hong hoac dd tUdi. Bai dien hinh Te giac dia hoang thang Te giac 8g Bach thiidc 12g Sinh dia 12g Dan bi 6g Goc bai thuoc la dai dien phiidng thuoc thanh nhiet liidng huyet (cd the thay ngiiu giac (siing trau) nhiing liidng 2 - 3 lang). Trong ngoai khoa thiidng dung phoi ngu vdi cac thuoc khac tuy theo tien trien cua benh nhu toan than hoa mu dung An cung ngUu hoang hoac Sai tuyet dan de thanh tam, khai khieu. 3.4. Thanh nhiet tao thap Dung cho chiing benh khdp siing dau, thap chan, sang doc, mieng dang, reu vang. 24 Bai thuoc 1: Long ddm ta can thang Long ddm thao 10g Cam thao 6g Hoang lien 12g Sa tien til 12g Chi tu 6g Moc thong lOg Sinh dia 12g Trach ta 6g DUdng quy lOg Sai ho 12g Bai thuoc cd tac dung thanh can hoa, ldi thap nhiet tiidng doi manh; tren lam sang thtfdng dung dieu tri cac mun nUdc san ngiia (bao chan thung ung). Chu y: phiidng thuoc nay la kho han, de thiidng vi khi nen khong dung qua lau. Bai thuoc 2: Giai doc hoat huyet thang Dung trong san ngiia, thap nhiet nhu viem da tiep xuc. Ton thudng dd ngiia lan rong, ndi tiep xuc chay midc vang. Lien kieu 12g Diidng quy 10g Lo can 8g Chi xac 6g Sai ho 10g Sinh dia lOg Dao nhan lOg Xfch thiidc 12g Hong hoa lOg Cam thao 6g 3.5. Diidng dm thanh nhiet Dung de dieu tri chiing benh nhiet doc, thap nhiet nhiing keo dai gay am hii. Thi du: viem tuy xiidng lau ngay, cac benh sang diidng, ung thii, chan thu'dng lau ngay gay chiing chieu nhiet, cot chiing, hao khat, ludi dd, reu vang kho, mach te sac. Bai thuoc dien hinh la Bat vi tri ba Thuc dia 12g Dan bi 8g Sdn thu 12g Phuc linh lOg Sdn diidc lOg Trach ta 6g Tri mau 6g Hoang ba lOg 3.6. Thanh cot chiing chieu nhiet Dung trong cac benh viem nhiem man tmh, xuat hien am hii chieu nhiet ma phai dung thanh nhiet giai doc, diidng am. 25 Bai thuoc dien hinh la Thanh cot tan Ngan sai ho 12g Thanh hao 8g Hoang lien lOg Tri mau 6g Miet giap 8g Chich cam thao 6g Dia cot bi lOg Tan giao 8g 4. On thong phap (on kinh thong lac phap) La dung thuoc on nhiet, tan han, thong lac. On thong phap la phiidng phap dieu tri khu tan am han tich tre. Thiidng dung de dieu tri chiing benh do phong han dam troc tich d kinh mach, can cot ma gay nen diidng khi bat hoa, khi huyet ngifng tre gay nen sang diidng Phap dieu tri: on kinh thong diidng, tan han, hoa dam Bai thuoc dien hinh la Diidng hoa thang Ma hoang 6g Nhuc que 4g Thuc dia 12g Loc giac giao 6g Bach gidi tu 6g Cam thao 6g Bao khUdng than 6g Bai thuoc cd tac dung on diidng, tan han, hoa dam, bo hif. La bai thuoc dai dien de dieu tri chiing am ung sang diidng (viem loet cd mu lau ngay); thiidng dung trong chiing benh hii han, dam ngifng tu can cot, gay siing dau khong dd (nhat la d khdp), toan than sd lanh, mieng khong khat, tieu tien trong nhieu, reu lifdi trang nhdt, mach xfch, gap trong loet Id lau lien, hif khdp, lao khdp, viem tac dong mach. Bai thuoc 2: Tieu hoat lac thang Thien nam tinh 8g Nhu hiidng 6g Xuyen khung lOg Mot diidc 6g Dia liidng 8g Thao o che 4g Dung trong cac chan thifdng lau ngay, han thap xam nhap can cot nhif trat da... Bai thuoc 3: Dai hoat lac thang Bach hoa xa 8g Dau thao o 6g Thien ma 12g Chu y: thuoc cd tinh on tao, giup diidng hai am nen benh nhan cd chiing benh am hii hoa vUdng cam dung. 26 5. Hanh khi phap La dung cac thuoc ly khi giai uat, dung trong cac benh do khi uat gay nen. Muc dich lam cho khi cd thong xifdng, khi huyet dieu hoa, tii dd dat tdi hanh tre, tieu tan, chi thong. Tuy vi tri cua khi tre ma dung phap va bai thuoc khac nhau. - Khi tre d ngUc sUdn: + Khi tre d can ddm nhif viem tui mat, soi mat, soi gan dung bai thuoc Dai sai ho thang Sai ho 12g Chi thiic 6g Hoang cam 12g Dai hoang 8g Xich thifdc 10g Sinh khiidng 6g Ban ha che 6g Dai tao 12g Bai thuoc cd tac dung giai bieu, cong ly. + Khi tre d ngiic sifdn do chan thifdng thi diing bai Sai ho sd Sai ho 12g Chi xac 6g Bach thifdc 10g Tran bi 6g Hifdng phu 6g Cam thao 6g Xuyen khung 10g Bai thuoc cd tac dung hanh khi, chi thong, dieu hoa can ty. + Khi tre d vu gay sifng dau thi diing bai Tieu nghich tan Sai ho lOg Phuc linh lOg Difdng quy lOg Cam thao 6g Bach thifdc 12g Sinh khiidng 6g Bach truat 8g Bac ha 6g Bai thuoc cd tac dung sd can, giai uat, dieu hoa khi huyet. - Khi tre d bung thi dung bai Phuc thu'dng thang Chi thiic 6g Difdng quy 10g Thanh bi 6g Xich thifdc lOg O difdc 6g Dao nhan 10g Ngu linh chi 6g Hong hoa lOg 27 Khi tre d long ngifc thi dung bai Hanh thifdng tan Sai ho 12g Xich thifdc lOg Chi xac 6g Difdng quy 10g Hanh nhan 6g Uat kim 10g Huyen ho sach 6g Dan sam 10g Qua lau bi 6g Cam thao 6g 6. Hoat huyet khti H phap La dung thuoc hoat huyet khii ift, loai trif huyet ti; co tac dung pha tich, tieu thung, chi thong. Thifdng dung trong ngoai khoa chan thiidng va cac chiing benh sang difdng ung thu co huyet \i (viem nhiem co roi loan van mach sung huyet). Cung nhu khi tre tuy theo vi tri huyet \i ma co phap va bai thuoc thuoc khac nhau. - Huyet if do chan thifdng: + Huyet ft d sifdn thi dung bai Phu nguyen hoat huyet thang Sai ho 12g Xuyen sdn giap lOg Nguyen hoa phan 12g Dai hoang tam rifdu lOg Quy vi lOg Dao nhan tam rutdu lOg Hong hoa lOg + Huyet ijf d bung thi dung bai Cach ha true thang DUdng quy 10g Dien ho sach 6g Xuyen khung 10g Ngu linh chi 8g Hong hoa 8g Chi xac 6g Dao nhan 10g Hifdng phu 6g Xich thifdc 12g 0 difdc 6g Dan bi 8g Cam thao 6g uyet if d can cd thi dung bai Sd can hoat huyet thang Khifdng hoat lOg Tuc doan lOg Phong phong lOg Thanh bi 6g Kinh gidi 8g NgUu tat 10g 28 Doc hoat 10g Ngu gia bi 8g Diidng quy 10g Do trong lOg Hong hoa 10g Dao nhan 8g + Huyet ijf d vung liing thi dung bai Yeu thiidng thang DUdng quy lOg Dien ho sach 8g Xich thUdc 12g Chi xac 6g Tuc doan lOg Hau phac 8g Tan giao 6g Tang chi 12g Moc thong 6g Moc hiidng 6g - Huyet il do nhiet: Gap trong cac chiing benh nhii: sang diidng, ung, thii... Thiidng d giai doan dau cua cac loai benh nhiet doc thap nhiet (viem nhiem), cho nen ngoai phap hoat huyet can phai dung phap thanh nhiet. Bai thuoc diem hinh la Tieu sang am Quy vi lOg Xuyen sdn giap lOg Xich thiidc 12g Bach chi 6g Nhu hiidng 12g Boi mau 8g Mot diidc lOg Phong phong lOg Cam thao 6g Thien hoa phan 10g Kim ngan hoa 12g Tao giac thich 8g Tran bi 6g Bai thuoc co tac dung la tieu ung, tan ket, hoat huyet, chi thong. 7. Chi huyet phap La dung thuoc co tac dung cam mau de dieu tri cac chiing benh chay mau nhii: tho huyet, nieu huyet, tien huyet... Chay mau d ngoai khoa thiidng la do chan thudng ma nguyen nhan la do huyet ii hoac nhiet pham vao huyet (viem nhiem) lam cho huyet loan hanh, cho nen dung thuoc chi huyet phai ket hdp thuoc dieu tri nguyen nhan. Neu chay mau do huyet ijf thi phai ket hdp thuoc hoat huyet, neu do huyet nhiet thi phai thanh nhiet, neu do ty khong thong nhiep huyet thi phai kien ty (chay mau diidi da, chay mau tieu hoa). Tuy theo vi tri chay mau ma dung bai thuoc khac nhau: 29 + Tho huyet thi dung: Bai 1: Thap tan La sen than 6g Chi tii than lOg Trac bach diep than lOg Tong hi than 12g Mao can than lOg Dan bi than 8g Tay thao can than Dai hoang than 8g Hoac bai 2: Tti sinh hoan Sinh dia lOg Sinh ha diep 12g Sinh ngai diep 12g Sinh tr&c bach diep 12g + Nieu huyet thi dung bai Dao xich than Sinh dia hoang 8g Cam thao 6g Moc thong lOg Bach mao can than lOg Dam true diep lOg Bai thuoc co tac dung liidng huyet, ldi nieu, chi huyet + Dai tien ra mau thi dung Hoe hoa than Hoe hoa than 12g Kinh gidi sao 8g Tr&c bach diep than 12g Chi xac 8g Bai thuoc co tac dung thanh ldi trang, chi huyet khai (dai tien ra mau, nhat la tri). + Tho huyet thi dung: Bai 1: Bach diep thang Trac bach diep 12g Ngai diep 8g Bao khiidng 8g Bai thuoc co tac dung on trung, chi huyet. Bai 2: Hoang tho thang Tam hoang tho 12g Phuc linh 12g Sinh dia hoang lOg A giao 12g Bach truat lOg Cam thao 6g Bao phu til 6g Chu y: a giao de rieng, dot phong, hod nitdc sdc uong. Bai thuoc co tac dung on trung, kien ty, chi huyet. 8. Nhuyen kien tan ket phap - La thuoc dieu tri cac khoi ran ctfng; neu do huyet thi dung hoat huyet, do khi thi dung hanh khi, neu do dam thi hoa dam, neu do thach thi hoa bai thach (soi). - Nhuyen kien, tan ket, hoa dam: la thuoc hoa dam, tan ket. Khi ngoai cam doc ta, ngtfdi benh htf nhtfdc, an uong khong dieu do vdi tinh chi khong thong xtfdng, khi co ngtfng tre, dich tich thanh dam, tich tu lau ngay khong tan ma thanh khoi. Tuy theo vi tri va tinh chat cua ngtfdi benh ma dung phap va thuoc dieu tri khac nhau. + Viem hach thi dung bai Nhi tran thang de tao thap hoa dam Ban ha che 6g Tran bi 6g Phuc linh 12g Chich cam thao 8g Bai thuoc co tac dung tao thap hoa dam. + Neu u d giap trang thi dung bai Hai tao ngoc ho thang Rong bien lOg Ban ha che 6g Tran bi 6g Thanh bi 6g Boi mau 8g Doc hoat 10g Lien kieu 12g Xuyen khung lOg Dudng quy 10g Cam thao 6g Hai de 8g + Neu la u thi dung bai Tieu kim ddn Bach giao htfdng 8g Dia long 12g 0 dau 6g Nhu htfdng lOg Ngu linh chi 8g Mot dtfdc 12g Dtfdng quy 10g Xa htfdng 6g Ma tien che (phan moc miet) 8g + Neu loa lich thi dung bai Tieu lich hoan de dtfdng dinh, hoa nhiet hoa dam, nhuyen kien tan ket). Huyen sam 12g Boi mau 12g Tho lich 12g 31 + Tan soi: dung bai Thach vi tan Thach vi 12g Tang bach bi 12g Moc thong 12g Hoat thach 12g Sa tien tii 12g Cam thao 6g Xich linh 8g Dung de dieu tri soi tiet nieu. 9. Trif thap ldi thuy phap (ly thap phap) Trii thap ldi thuy la thuoc co tac dung trtf thap, ldi thuy; dung de ldi nieu, tao thap, tieu thung, thong lam. Ngoai khoa hay dung trong cac chiing benh lam chiing (ngu lam, chiing thung do huyet ii), trong chan thiidng, trong nhiet doc (dinh, sang dtfdng, ung, thtf...), trong ban chan ... Tuy theo the benh ma dung khac nhau, phap nay la dieu tri trieu chiing nen phai-phoi hdp cac phep dieu tri nguyen nhan. Ty giai 12g Hoang ba 12g Sinh y di 10g Xich thtfdc 12g Dan bi 8g Trach ta 8g Hoat thach 8g Thong thao 12g Neu lam chiing co soi thi dung bai Bat chinh tan, gia them kim Xa tien tii 12g Hoat thach 12g Moc thong lOg Cam thao 6g Mach dong lOg Chi tii lOg Bien sue 8g Dai hoang 8g Bai thuoc co tac dung ldi tieu, thong lam, thanh nhiet ta hoa. + Neu do chan thtfdng thiidng thi dung bai Tam dieu tan Thtfdng truat 12g Hoang ba lOg Ngtfu tat 12g Bai thuoc co tac dung tru! thap, tieu thung. 10. Tiic phong chan kinh phap Ttfc phong chan kinh la dung thuoc de tiic phong, dinh than, chi kinh; co tac dung sd giai co rut, khai khieu tinh than. Ngoai khoa hay dung hon quyet, hon thiem dau dau chong mat, non, choang, cdn giat chan tay, mom ctfng meo, ltfng uon cong... nhtf benh chan dong nao tuy. Tuy theo the benh ma dung phep dieu tri khac ket hop. + Neu do chan thudng (chan thtfdng so nao) thi dung bai To hdp htfdng hoan Xa htfdng 6g Dinh htfdng 8g An ttfc htfdng 8g Moc htfdng 8g Tram htfdng lOg Htfdng phu 8g Hat sen 12g To hdp htfdng 6g Bach truat 12g Nhu htfdng 8g Bang phien 6g Chu sa 0,lg, goi rieng hoa ntfdc thuoc sac de nguoi uong. + Neu bi len cdn uon van (co cting, ltfng cong hoac giong dong kinh), goi la pha thtfdng phong thi dung bai Ngoc chan tan Sinh nam tinh 6g Khtfdng hoat 10g Bach chi 8g Thien ma 12g Phong phong 10g Bach phu tuf 6g Me sang, thinh thoang la het thi dung bai Thien ma cau da Thien ma 12g Thach quyet minh lOg Cau d^ng 6g Do trong 12g Ngtfu tat 12g Hoang ky 12g Chi tii 8g Ich mau 6g Tang ky sinh 16g Da giao dang 8g Phuc than 12g Bai thuoc co tac dung binh can tiem dtfdng, thanh nhiet hoa dam, dung trong chan dong nao. 11. Tiep lien xifdng phap Tiep lien xtfdng phap la phtfdng phap dung thuoc tang ctfdng tiep lien xtfdng va khtf u de dieu tri gay xtfdng Cac vi thuoc lien xtfdng: cot toai bo, tuc doan, nhu htfdng, mot dtfdc, do trong, tang ky sinh. 33 Bai thuoc dien hinh: Tiep cot to kim dan, dung ngoai. Nhu htfdng 6g Cot toai bo 12g Mot dtfdc lOg Dai hoang 12g Ttf nhien dong 6g Huyet kiet 12g B^ng sa (bop dap ngoai) Dtfdng quy 10g Bai thuoc 2: Tich cot tan Dao nhan 12g Chi tif 8g Hoang lien 12g Sinh dia 12g Kim nhi hoan 12g Hoang ba lOg Hong hoa 10g Hoang cam 12g Phong phong lOg Cam thao 6g Bo cong anh 12g Xich thtfdc lOg Ttf nhien dong 8g Tr&c bach diep 6g Dai hoang 6g Cot toai bo 12g Mao xa htfdng 6g Bac ha 6g (long tui xa htfdng) Kim ngan hoa 12g Dan bi 12g Ngoai ra con dung bai Difdc vi gia vi. 12. Thac phap Thac phap la lay phu chmh khu ta lam trong yeu, thtfdng dung trong ngoai khoa, trong vet thtfdng lau lien khong the thoat mu dtfdc; dong thdi cung la mot phtfdng phap dtfa doc ra ngoai, phong doc ta xam pham vao trong, nhtf vay tren lam sang co 2 loai thac phap. 12.1. Thac doc phap Thac doc phap la dung thuoc co tac dung giai doc va trtf mu (thoat mu) dtfdc dung khi chmh khi khong htf, mu hinh thanh khong thoat ra dtfdc, cd the con it nhiet ma can phai lam thoat mu ra ngoai. Bai dien hinh: Tau nung phap Sdn giap sao 8g Dtfdng quy lOg Tao giac thich lOg Xuyen khung 12g Hoang ky (sinh) 12g Tren lam sang thifdng them kim ngan hoa, lien kieu de thanh nhiet giai doc (hoang ky phai dung song). 12.2. Bo thac phap Bo thac phap la dung thuoc bo ich khi huyet va thac doc tau nung. Vi chinh khi hu, doc ta tich lai gay nen phu ne co mu nhifng khong thoat ra difdc. Do vay phai dung phep phu trd chinh khi va thac doc, tieu thung, sinh cd. Bai thuoc dien hinh: Thac ly tieu doc tan Sinh hoang ky 12g Bach truat lOg Dudng quy 12g Dang sam 12g Bach thifdc 12g Phuc linh 12g Xuyen khung lOg Tao giac thich 8g Bach chi 6g Ngan hoa 12g Cat canh 6g Cam thao 6g Goc bai thuoc dung khi chinh khi hif, doc ta thinh ma thanh mu. 13. Bo phap Con goi la bo ich, dieu hoa phap; muc dich la de phu chinh, khu ta. Tuy theo tinh hinh benh ma dung phap dieu tri khac nhau + Neu khi huyet deu hif thi dung bai Bat tran thang Dang sam lOg Difdng quy lOg Bach truat 12g Xuyen khung 12g Cam thao 6g Bach thifdc 12g Bach linh lOg Thuc dia 12g + Neu khi hif thi dung bai Ttf quan ta thang Dang sam lOg Difdng quy lOg Bach truat lOg Cam thao 6g + Neu huyet hif dung bai Ttf vat tii thang Difdng quy lOg Bach thifdc lOg Xuyen khung 12g Thuc dia 12g 35 + Neu am hi! thi dung bai Bo am, Luc vi Sdn thu 6g Trach ta lOg Sdn dtfdc 12g Dan bi lOg Phuc linh 12g Thuc dia 12g u diidng hu dung bai Than khi hoan Sdn thu 6g Trach ta lOg Sdn dtfdc 12g Dan bi 12g Phuc linh 12g Thyc dia 12g Nhuc que 6g Phu tii 4 g + Neu vi khi hii thi dung phap diidng vi khi. Dudng vi phap la dung thuoc phu do vi khi, khien cho vi nap thuy coc manh de dat muc dich thuc tien sinh hoa ttf nguyen. Dung vdi chiing: sau khi vd mu thi nildc vang chay, benh ngay cang nang, vet thiidng ngay cang lan rong, kho lien. Vi vay can lam het mu, thu mieng, sinh tan va sinh cd thi can phai diidng vi. Co the dung mot trong cac bai thuoc sau: Bai Til quan them tran bi, sa nhan de hoa ly ty vi. Bai Nhi tran thang gia true nhil sao, coc nha de hoa vi hoa troc. Bai Ich vi thang Sa sam lOg Ngoc true 8g Mach mon dong lOg Nildc diidng lOg Te sinh dia 12g De thanh diidng vi am. II. NGUYEN TAC DIEU TRj BEN NGOAI (DIEU TRj TAI CH6) Dieu tri ben ngoai chiem mot vi tri het sijfc quan trong trong dieu tri ngoai khoa. No khong nhiing phoi hdp vdi dieu tri ben trong de nang cao hieu qua dieu tri ma da so' cac benh dung dieu tri ddn thuan tai cho cung mang lai hieu qua. Dieu tri tai cho can phai chu y the chat ngtfdi benh, tinh chat va qua trinh tien trien cua benh de dung cac phiidng phap dieu tri khac nhau. Cac phiidng phap dieu tri tai cho gom phiidng phap dung thuoc va phiidng phap khong dung thuoc. 36 1. Phtfofng phap dung thuoc 1.1. Thuoc boi, dap - Dung thuoic ttfdi, gia dap: la 6t gia dap dieu tri mun nhot. - Beo cai gia dap dieu tri bap chuoi (viem cd ttf - Bot hoa rtfdu: boi dap ndi ton thtfdng Bai 1: Ttf hoang tan Hoang lien 1 phan Hoang cam Hoang ba 3 phan Dai hoang Tri ung thtfOng nhiet doc viem mu, u quanh hau n Bai 2: Sang ba tan Tr&c bach diep 2 phan Bac ha Dai hoang 2 phan Trach lan Hoang ba 1 phan Tri chan thtfdng, viem nhiem giai doan dau. Bai 3: Tieu stfng tan Thtfdng truat 5 lang Tran bi Khtfdng hoat 3 lang HtfOng phu Dai hoang 3 lang Cam thao 1.2. Cao ddn dau dui) 3 phan 3 phan ion. 1 phan 1 phan 3 lang 3 lang 1 lang Bai 1: Cao thong nhat (cao nhao) (ltfdng y Nguyen Tong Khoi) Bot cuc tan 8 phan Bot dai hoi 0,8 phan Bot ngai ctfu 4 phan Sap ong 2 phan Botquechi 1,6 phan Dau ve 20 phan DSp vao cac ndi ton thtfdng co tac dung hoat huyet hanh khi, tieu ti lien xtfdng thanh nhiet dung de dieu tri chan thtfdng. Bai 2: Trat da cao Nhu htfOng 5 phan Nga truat 3 phan Mot dtfdc 5 phan Dai hoi 3 phan 37 Huyet kiet 3 phan To moc 3 phan Bang phien 3 phan Huyet giac 3 phan Que chi 3 phan Gia dap vao noi ton thtfdng co tac dung hoat huyet, tieu thung de dieu tri chan thtfdng, gay xtfdng, trat khdp. Bai 3: Cao mo qua Gia dap vao vet thtfdng lau lanh, cd tac dung lam sach vet thtfdng, tang to chtic hat chong len da non. Bai 4: Cao sinh cd Bach lien 16g Nghe kho 8g Nhu htfdng 8g Chan chau 4g Quy vi lOg Bach cap 16g Hoang ddn 4g Mot dtfOc 8g Phong phong 8g Toe roi 8g Bach chi 16g Dau vting lOOOg Nau thanh cao, boi sau khi tri rung cd tac dung chong nhilm trung mau, lam lanh vet thtfdng. 1.3. Xong, ngam Dung xong khoi hoac hdi ntfdc vao nOi ton thtfOng, thtfdng dung trong benh d chan (eczema), di chting chan thtfdng, gay xtfdng, bong gan, dung giap... Bai 1. ThtfOng truat 30g Ba trau 30g Cho vao than hong dot, lay khoi hun vao ndi ton thtfOng nhtf cham, viem tinh hoan. Bai 2. Que chi 16g Day kim ngan 20g Huyet giac 20g Dai hoi 20g Dun lay ntfdc, ngam hoac xong hdi ntfdc, dieu tri di chting chan thtfdng. 1.4. Rac La dung cac bot thuoc rac vao vet thtfdng de cam mau, hut mu, lien vet thtfdng: 38 Bai 1. Phen phi 55g Bang sa 55g Hoang dang 20g Hoat thach 250g Tan nho, ray ky, rac vao vet thiidng lau lanh Bai 2: Bao sinh cd Thach cao 36g Xich thach 4g Khinh phan 36g Nhu htfdng 12g Hoang ddn 12g Mot dtfdc 12g Long cot 12g Tan nho, ray ky, rac vao vet thifdng sau kho lien kin mieng. Thuoc rac vao bui tri de gay hoai tii goi la kho tri tan. 1.5. Riia Dung cac thuoc dun sac hay vo lay ntfdc de riia, boi vao cac noi ton thtfOng Bai 1. Bo cong anh 200g Phen phi 200g Trau khong 200g Cho 2 lit ntfdc, sac cdn 1/4 1ft roi riia vet thtfdng Bai 2: Ttf hoang Hoang cam Hoang lien Hoang ba Dai hoang Lieu nhtf nhau, sac thanh ntfdc dac de riia vet thtfdng lau lien. 1.6. Tiem Dung cac thuoc da chiet xuat. 2. Phtfcfng phap khong dung thuoc - Nan, chinh: dung trong dieu tri gay xtfdng, sai khdp. - Tap luyen: dung trong dieu tri gay xtfdng, sai khdp va di chting ngoai khdp. - Thtit cat: dung dieu tri tri, cac da thit thtfa. - Chich ddn mu: dung trong ung nhot. 39 - Cham cihi: dieu tri trieu chiing va tac dung tai cho cung nhu toan than, cham te. - Xoa bop bam huyet: dieu tri co cO gay dau. - Co dinh: nep co dinh 3. Cac phufcfng phap ket hdp 3.1. Thuy cham te Dung cac thuoc nhii: lidocain, novocain..., cac thuoc vitamin nhom B hoac thuoc khac khi co chi dinh dung thuoc y hoc hien dai tiem huyet theo v hoc co truyen . 3.2. Chon chi, thuoc vao huyet Thudng dung dieu tri di chiing cua chan thiidng. 40 CHlfONG III CAC BENH NHliM KHUAN CAP TINH ■ MUN NHOT ■ ■ (sang, ung, thtf) Mun nhot do hoa doc, nhiet doc gay nen; bieu hien ra bi phu, tau ly nhiing khoi siing, nong, do, dau; y hoc co truyen co ten goi la sang, ung, thu, v.v... Mun nhot co hai loai: loai co dau va chan mun nong, siing, nong, do khu tru thiidng nhe va de chiia; loai co dau nhon, chan lan toa nhtf cai nam, siing lan toa, hinh dang bat dinh kho chiia. Tre em ve mua he hay bi mun nhot tren dau goi la thii sang, neu nhieu mun ket hop vdi nhau hinh thanh d dvfdi da dau mot khoang trong goi la mach liidn. Benh nay lau khoi, de gay bien chiing sau quang (viem xiidng). Benh cd the tai phat do cd dia huyet nhiet. 1. Trieu chufng - Giai doan mdi phat: tai cho cd siing, nong, dd, dau; toan than cd the kem theo sot, mach sac, reu liidi trang day. - Giai doan hoa mu thanh o’ mu. - Giai doan vd mu: neu la mun diidi da day thi kho vd mu roi lien da thanh seo. 2. Phep chtfa 2.1. Giai doan mdi phat Phep chiia: thanh nhiet liidng huyet, tieu doc. Cac bai thuoc: Bai 1: Thuoc dap tai cho: la cuc hoa trying gia nat vdi muoi, d&p vao mun nhot. 41 Bai 2: Tho phuc linh ThUOng nhi tti Sac uong 1 ngay 1 thang Bai 3\ Kinh gidi Kim ngan hoa Ke dau ngUa Lien kieu 20g 20g 8g 20g 16g 12g Do den sao 40g Cam thao day 8g Voi voi 12g Ha diep 16g Neu sot cao: them hoang lien 12g, hoang cam 12g, chi tti 12g; tieu tien ngan do: them sa tien tu 12g; tao bon: them dai hoang 4g - Cham ctiu: + Dung toi thai mong dat len dinh cua mun, ctiu moi ngai lien tuc cho den khi het dau (do 5 den 10 moi). + Cham cac huyet: on lifu, ha cii hii, hop coc va cac huyet a thi xung quanh mun. 2.2. Giai doan hod mu Phep chtia: thac doc bai nung (dUa doc ra ngoai, trti mu). Cac bai thuoc: Bai 1\ Thuoc dap cho pha vd mu Doc ray La xoan I Lieu nhif nhau Mu oi Gia nho, tron deu ngay dap 2 lan. Bai 2: Thuoc uong Kim ngan hoa Lien kieu Tran bi Boi mau 20g 12g 6g 8g Hoang cam Tao giac thfch Bo cong anh Cam thao 12g 12g 16g 4g Cham ctiu: khong cham ctiu. 2.3. Giai doan dd vd mu Phep chtia: khti hu sinh cd 42 Binh thifdng can rtfa sach thay bang cho moc to clitic, lien da. Neu cd the suy nhtfOc, mu khong het, nhot lau lien thi uong them cac vi thuoc bo khi huyet nhu bach truat, dang sam, hoang ky, dtfdng quy v.v.. Bai Cao dan hut mu va len da (thuoc nam va cham ctiu tri mun nhot) Cu ray dai 100g Sap ong 30g Nghe gia 50g Nhtf a thong 30g Dau vting 500ml Coc vang 1 con dot ton tinh Cho dau vting, nghe, ray dun soi den khi nghe va ray teo lai, gan bo ba cho sap ong vao dun tan sap; cho bot coc, nhtfa thong quay deu tay cho den khi tan deu, lay mot giot nho vao mot cai dia khong loe ra la dtfOc. Rtia sach mun nhot bang ntfdc la trau khong va kinh gidi. Roi lay mieng giay choc thung d gitia va phet cao len giay. Ngay dan mot lan. DINH RAU (dinh sang d mat) Dinh rau la mot dang mun nhot moc d mat hay xung quanh mdi mieng, mui. Luc dau mun be nhtf hat tam nhtfng chan sau, ngtia kho chiu, lam mu cham, neu khong biet cach chtia va giti gin can than thi dan dan stfng lan ra ca mat va xuat hien bien chtfng hoa doc nhieu tam, dam me tam khieu goi la tau hoang vdi cac trieu chtfng sot cao, dau dau, non mtfa, hon me, v.v. cd the nguy den tmh mang. Phai giti gin sach se ndi cd dinh rau: khong dtfdc chich hay cay mun khi chtfa thanh mu, kieng an cac thtic an cay nong, nhdn beo de de phong cac bien chting. Phep chtia: Giai doan dau: thanh nhiet giai doc va lifdng huyet. Cac bai thuoc: Bai 1: Bo cong anh 80g La cuc 80g Hoa cuc 80g Gia nat, loc lay ntfdc uong, ba dap tai cho. 43 Bai 2: Tti hoa dia dinh Cay rau ma 80g Hoa la cuc 80g La rau muohg 80g Bai 3: Ngu vi tieu doc am gia giam (Y tong kim giam) Kim ngan hoa 12g Ttf hoa dia dinh 6g Cue hoa 6g Lien kieu 6g Bo cong anh 6g Khi da co mu: sot cao, mieng kho, tao bon, ntfdc tieu do, mach nhanh tai cho stfng dau nhieu thi them: hoang lien 8, hoang cam 12g, chi ttf song 12g, dan bi 12g, thach cao 40g. Bai 4: Huyen sam 20g Bo cong anh 20g Sinh dia 12g Tao giac thich 16g Thach cao 40g Dan sam 12g Kim ngan hoa 40g Cham ctiu: cham ta cac huyet: hop coc, ha ctf htf, on ltfu, khuc tri, huyet hai. Ngay nay vdi thanh ttfu cua khoa hoc hien dai ve khang sinh chong nhiem trung nen khi benh nang can dieu tri ket hop y hoc co truyen vdi y hoc hien dai. Chu y: dinh rau d mdi tren de bien chtfng viem tinh mach xoang, rat nguy hiem tdi tinh mang. CHIN ME (dinh sang of tay, chan) Chm me la mot loai mun nhot moc 0 cac dau ngon tay, ngon chan; luc dau ngtia, sau stfng dd va dau. Theo y hoc co truyen, nguyen nhan do thap hoa doc ngtfng ket d trong hoac bi kim dam, d&m go ntia, cdn trung c&n... gay nen. Trieu chting: 44 + Giai doan dau stfng dau tang dan theo mach dap, sot. + Giai doan lam mu: stfng to mem do co mu, sd hoac nhin thay o mu. Neu chtfa khong kip thdi, co the bi viem xtfdng. + Giai doan cuoi: vd mu, lien seo. Phep chtfa: + Giai doan dau: thanh hoa nhiet, giai doc hay ltfdng huyet tieu doc... Cac bai thuoc: B a i l : La phu dung ttfdi 20g Cu chuoi tieu ttfdi 20g Rau sam ttfoi 20g Muoi 20g Gia nho, boc vao mot mieng gac dap vao cho chin me. Bai 2: Tdi boc vd mot nhanh, gia nho dap vao cho chin me luc dang viem (khong dung khi da cd mu). Bai 3: Kim ngan 20g Ha kho thao 16g Thach xtfdng bo 8g Kinh gidi 12g Ha thu o 16g Tao giac thich 8g Sac uong ngay mot thang. + Khi da cd mu: trfch thao mu, neu cd xtfdng chet thi loai bo. Cd the thao mong (chan, tay) neu dtfdi mong cd mu. Sau dd dung cao mo qua hoac la mo qua gia dap ngay 1 lan, cd tac dung diet trung lam sach vet thtfdng, kich thich moc to’ chtfc hat, len da non va thu mieng. VIEM HACH ■ Viem hach thtfdng gap nhtf hach d ben, hach d nach, hach d co’, hach d dtfdi ham ... Theo y hoc co truyen viem hach la do doc ta xam nhap lam be t&c kinh lac; tai cho cd huyet tf, dam tre. Doc ta tf tre khong dtfdc giai, hoa hoa gay nen hien ttfdng stfng, nong, dd, dau. 45 Theo y hoc hien dai, hach la phan ting cua cd the khi co sti nhilm trung nham ngan chan sti xam nhap lan rong va vao sau cua vi trung. Viem hach cap se het khi cac benh nhiem trung d cac vi tri cd the khoi, nhtfng d triidng hdp tre em va ngtfdi stic khoe yeu co the thay hoa mu. Trtfdng hdp nay y hoc co truyen cho rang do phong nhiet dam sinh ra. 1. Viem hach hoa mu thtfdng gap d co, dtfdi ham. Luc dau thay hach stfng to, sau thay dau, dau lan ra xung quanh, mau da dd kem them phat sot, sd lanh, nhtic dau. Phep chtia benh: tan phong, thanh nhiet, hoa dam, tieu thung. Cac bai thuoc: Bai 1: Ha kho thao 16g Cue hoa 12g Kim ngan hoa 16g Xa can 3g Bac ha 8g Tao giac thich 8g Bai 2\ Ngtfu bang giai cd thang gia giam (Dtfdng khoa tam dac tap phtfdng) Ngtfu bang tti 12g Lien kieu 12g Bac ha 8g Sdn chi 12g Boi mau 8g Kim ngan hoa 16g Bach ctfdng tam 12g Xich thtfdc 12g Ha kho thao 12g Neu sot cao them hoang cam 12g, thach cao 40g de thanh nhiet ta hoa. Hach stfng to them xuyen sdn giap 6g, gai bo ket 12g de nhuyen kien, tan ket. Neu cd viem nhiem do nhiet doc, hoa doc nhtf nhot stfng nong dd... cd the dung phtfdng phap dieu tri nhot. Hach viem se het khi nhot khoi. Cham ctfu: huyet a thi, xung quanh hach. Hach ben: them uy trung, giai khe, tuc tam ly. Hach nach: them khuc tri, hdp coc. Hach co: them phong tri, e phong, hdp coc, dtfdng lang tuyen. 2. Neu benh dien bien keo dai, tinh trang huyet nhiet, benh viem nhiem de tai phat. Phep chtia benh: thanh nhiet, ltfdng huyet, giai doc. 46 Cac bai thuoc: Bai 1: Sinh dia 12g Sai dat 16g Huyen sam 12g Bo cong anh 16g Bach mao can 12g Chi tijt 8g Kim ngan 16g Huyen sam, sinh dia, bach mao can co tac dung thanh nhiet liidng huyet; kim ngan hoa, sai dat, bo cong anh co tac dung thanh nhiet giai doc; chi tu co tac dung thanh nhiet ta hoa. Cac vi hdp lai co tac dung thanh nhiet liidng huyet, giai doc. Bai 2: Giai doc thanh nhiet thang gia giam Dai thanh diep 40g Chi tut song 12g Sinh dia 40g Kim ngan 40g Huyen sam 12g Moc thong 4g Neu sot cao thi them: thach cao 40g, hoang lien 4g. Dai thanh diep, sinh dia, huyen sam, chi tu song co tac dung thanh nhiet liidng huyet, thanh nhiet ta hoa; kim ngan hoa thanh nhiet giai doc; moc thong thanh tiet nhiet qua diidng tieu tien; them cac vi: thach cao de thanh nhiet ta hoa, hoang lien thanh tam nhiet de lam tang tac dung ha sot. VIEM BACH MACH CAP Viem bach mach cap la mot phan ijfng cua cd the triidc cac benh nhiem khuan hay cac ton thiidng d da bi boi nhiem, hay gap 6 tii chi cung xuat hien vcfi viem cac hach lympho cap. Neu viem bach mach d nong thi cd mot vet dd bat dau tijt ndi bi nhiem khuan len dan tdi dau goi hoac khuyu tay; neu viem bach mach d sau cd the thay chi bi siing phu va dau. Benh nhe khong thay dau hieu toan than; neu benh nang cd the xuat hien sot nong, sot ret, nhiic dau, mach nhanh. Phiidng phap chiia: thanh nhiet, liidng huyet, giai doc. Cac bai thuoc: B a il. Sinh dia 12g Huyen sam 12g Bach mao can 12g Kim ngan 16g 47 Sai dat 16g Bo cong anh 16g Chi tti 8g Bai 2. Giai doc dai thanh gia giam Dai thanh diep 40g Chi tii song 12g Sinh dia 40g Kim ngan 40g Huyen sam 12g Moc thong 4g Neu sot cao thi them thach cao 40g, hoang lien 4g. Cham ctiu: dung kim tam lang, rach cho xuat huyet ngang vet do, cach 1 thon rach mot vach, b&t dau tu: noi co ton thtfOng den het. Tuy vi tri viem bach mach ma sti dung cac huyet d cuc bo hay ket hdp vdi cac huyet cd tac dung chiia benh toan than nhtf hdp coc, khuc tri, uy trung, noi dinh, cdn Ion v.v.... Tai cho: phai khan trifdng chtia cac benh nhiem khuan la nguyen nhan gay chting viem bach mach. n h iI m k h u a n h u y e t Nhiem khuan huyet la mot benh thuoc dien cap ctiu noi khoa xay ra sau ton thifdng nhiem khuan cuc bo (nhot, vet thifdng phan mem, gay xifdng, thu thuat ngoai khoa...) hoac bi nhiem khuan trtic tiep (do nao mo cau v.v.). Benh nhiem khuan huyet thuoc pham vi cua chting Dinh sang tau hoang va chting Hoa doc noi ham cua y hoc co truyen. Nguyen nhan cua benh la do hoa doc manh khong khong che dtfdc, lan vao phan doanh, gay ton thtfdng tang phu va phan am cua cd the hoac do cd the suy nhtfdc, hoa doc ham d trong thtfdng gay cac chting nghiem trong nhtf thoat dtfdng (truy mach) thi can cap ctiu blng phtfdng phap cua y hoc hien dai. Y hoc co truyen chia nhilm khuan huyet lam nhieu the: the hoa doc manh, the chmh htf doc ham va the am htf noi nhiet. 1. The hoa doc manh Tifdng ting vdi thdi ky benh mdi phat, phan ting cua cd the manh. 48 Trieu chiing: sot cao, ret run, mieng khat thich uong nii6c lanh, ngiidi vat va, ra mo hoi nhieu, ngoai da co diem xt huyet, moi do, liidi do, niicfc tieu do it, tao bon, reu liidi vang kho, mach hong dai hoac huyen sac. PhUOng phap chiia: thanh nhiet liidng huyet, giai doc. Bai thuoc: Thanh on bai doc am gia giam Huyen sam 16g Kim ngan hoa 40g Sinh dia 40g Hoang lien 16g Dan bi 12g Hoang cam 16g Thach cao 40g Lien kieu 16g Dai thanh diep 16g Tri mau 12g Neu tao bon thi them dai hoang 8 - 12g. 2. The chinh hif doc ham Do siic de khang yeu, phan ling cd the kem; nang hdn thi co hien tiidng nhiem doc, truy tim mach. a. The nhe: bieu hien met moi, sac mat trang bech, ra mo hoi; sot luc cao, luc thap; sd lanh, mach nhanh nhiing yeu. PhUdng phap chiia: phu chinh, giai doc. Bai thuoc: Thac ly tieu doc thang gia giam Hoang ky 20g Nhan sam 8g Bach truat 12g Bach thiidc 12g Diidng quy 12g Phuc linh 20g Kim ngan hoa 40g Neu khong co nhan sam thi thay bang dang sam 20g. b. The nang: con goi la the noi be ngoai thoat. Y hoc hien dai cho la truy tim mach, phai dung phiiOng phap hoi siic de diia huyet ap len. Tre hon me, chan tay lanh, mo hoi nhieu, huyet ap ha, nhiet do ha, mach vi muon tuyet. Phiidng phap chiia: hoi diidng, ciiu am, co" thoat. Bai thuoc: Sam phu thang phoi hop Sinh mach tan Nhan sam 4g Ngu vi tii 8g Phu tii che 12g Long cot 16g 49 Mach mon 16g Mau le 16g Ctfu: quan nguyen, khi hai, noi quan, than mon. 3. The am htf noi nhiet • • Nhiem khuan huyet luc dau con kem them cac o ap xe 0 gan, phoi, nao, than. Trieu chtfng: sot keo dai, thtfdng khong sot cao, moi met, tr&n troc, it ngu, hay ra mo hoi trom, khat ntfdc, ntfdc tieu dd, reu ltfdi it kho, mach te sac. Phtfdng phap chtfa: dtfdng am, thanh nhiet, sinh tan, giai doc Cac bai thuoc: Sinh dia 16g Kim ngan 20g Huyen sam 16g Hoang lien 16g Mach mon 12g Tri mau 8g Sa sam 12g Thanh hao 16g Thach hoc 12g La tre 16g Thanh doanh thang gia giam Sinh dia 40g Kim ngan hoa 40g Huyen sam 20g Lien kieu 20g Dia cot bi 12g Hoang lien 6g Dan bi 12g Mach mon 12g Tri mau 12g - Neu ap xe phoi (hoa doc tai phe): cd trieu chtfng ho, kho thd thi them boi mau 12g, tang bach bi 12g, lo can 40g. - Neu ddm dac cd mu thi them true lich 30ml. - Neu ho ra mau thi them bach mao can 40g, sa sam 20g. - Neu ap xe gan cd hoang dam thi them hoang ba 12g, nhan tran 40g. - Neu viem cau than (dai it, vd nieu, phu) thi gia them la tre 12g, sa tien 16g, dang tam 4g. - Neu dai ra mau them quy ban 20g. 50 CHl/ONGIV MOT SO BENH NGOAI KHOA KHAC ■ ■ ■ t h o At THU Thoat thif la chiing viem t&c dong mach 0 chi, hau nhif chi gap 6 nam gidi, xay ra d til chi nhat la 2 chi difdi, luc dau chi lanh dan dan, kem theo dau du£ doi, lau ngay phat sinh hoai til va rung cac dot ngon tay, chan. Nguyen nhan cua benh do than khi hif ton, khi huyet suy kem gap lanh, thap lau ngay, an do beo ngot, uong nhieu rifdu... ma sinh ra hien tifdng khi tre huyet il, kinh mach dan dan be tac khong nuoi difdng difdc til chi gay hoai tii. Sif phan loai benh difdc can cii vao cac chiing tang toan than, ket hop vdi cac giai doan cua benh va difdc phan chia ra nhu sau: 1. Giai doan hif han va khi tre huyet uf (cdn goi la giai doan difdng hif han dong) Giai doan nay tifdng ilng vdi thdi ky dau va thdi ky giufa cua benh viem tkc dong mach. Trieu chiing: s&c mat xanh, ngifdi met mdi, thich am sd lanh, dau chi te lanh dau, da tr&ng xanh hay bi chuot rut, khi di thi thay dau nhifng khi nghi thi dd (dau cach hoi), nifdc tieu trong dai, dai tien long, chat lifdi dam, mach tram tri vd life. Dan dan til chi dau lien mien, dem cang dau nhieu hon, mau da d chi xanh nhdt nhat, dau chi kho, chat lifdi dd hoac cd diem tim il huyet mach tram nhifdc, tram te. Phep chiia: on kinh tan han, hoat huyet, hanh khi, thong lac. Cac bai thuoc: Bai 1: Til vat dao hong thang gia giam Thuc dia 16g Phu t\jf che 12g Xuyen quy 12g Que chi 8g 51 Xuyen khung 12g Dan sam 12g Bach thUdc 12g Ngilu tat 12g Dao nhan 8g Tang ky sinh 16g Hong hoa 8g Bach gidi tu 8g Xuyen luyen til 12g Hoang ky 12g Bai 2\ Tii dieu dung an thang gia giam (540 bai thuoc Dong y) Kim ngan hoa 16g Ngilu tat 16g Huyen sam 12g Qua lau nhan 16g Cam thao 4g Dao nhan 12g Diidng quy 20g Dan bi 12g Xich thUdc 16g Dan sam 12g Binh lang 8g Chi xac 8g Bai 3: Thong mach hoat huyet thang Sinh dia 16g Dan sam 20g Diidng quy 16g Hong hoa 12g Hoang ky 16g Nhu hiidng 8g Huyen sam 20g Mot dilOc 8g Kim ngan hoa 20g Dien ho sach 12g Bo cong anh 20g Cam thao 4g Bai 4: Co bo thang gia giam Hoang ky song 16g Diidng quy 12g Dang sam 16g Ngilu tat 16g Kim ngan hoa 40g Thach hoc 16g Neu benh nhan dau nhieu do huyet ii, them: dan sam 16g, hong hoa 8g. que chi 6g, xuyen khung 8g. Neu chi lanh, them phu til che 12g. Bai 5: Thuoc nam Dang sam 16g Dan sam 16g Bien dau 16g Que chi 6g 52 Ke huyet d&ng Huyet du NgUu tat Thach hoc 2. Giai doan nhiet doc 16g 12g 16g 12g Co nho noi Trach lan Phu t\i che 16g 12g 6g Giai doan nay tiidng ling vdi benh viem tac dong mach the hoai thii lidt co dau hieu nhiem trung. Trieu chiing: tai cho nong, siing loet, hoi thoi, dau kich liet, sot, mieng kho, ntfdc tieu do, reu liidi vang, mach hoat sac hoac huyen sac. Phep chiia: thanh nhiet giai doc, hoat huyet thong lac. Cac bai thuoc: Bai 1: Kim ngan hoa 40g Huyen sam 16g Bo cong anh 12g Dan sam 16g Hoang ba 16g Thach hoc 16g Ngiiu tat 16g Sinh dia 16g Y di 20g Voi voi 12g Thiidng nhi tii 20g Bai 2\ Thuoc ngam, riia Que chi 8g Ke huyet d^ng 12g Dao nhan 12g Tam lang 12g Dun soi ky lay ntfdc am ngam ngay 2 lan. Bai 3: Tii dieu dung an thang gia giam Kim ngan hoa 40g Dan sam 20g Huyen sam 20g Thach hoc 12g Cam thao 4g Hoang ky 12g Diidng quy 12g Ngiiu tat 12g Dang sam 12g 53 3. Giai doan khi huyet deu htf Giai doan nay tifdng ting vdi tinh trang keo dai cua benh, bieu hien: tay chan lanh, reu lifdi trang mong, mach nhu te hoan. Phep chiia: bo khi, difdng huyet, hoat huyet thong lac. Cac bai thuoc: Bai 1: Cd" bo thang Kim ngan hoa 40g Ngifu tat 16g Difdng quy 12g Hoang ky 16g Thach hoc 16g Dang sam 16g ': Bat tran thang Thuc dia 16g Bach truat 12g Xuyen khung 12g Dang sam 16g Xuyen quy 12g Phuc linh 8g Bach thifdc 16g Cam thao 4g : Thap toan dai bo’ thang (bai Bat tran them hoang ky 12g, nhuc que 4g). : Bai bo huyet trii phong va thong u cao phoi hop Ma tien che lOg NgUu tat 16g Phu tu che 16g Dd trong 16g Tran bi 8g Phong ky 12g Quy ban 16g Tan giao 12g Tung tiet 12g Doc hoat 12g Uy linh tien 12g Te tan 20g Y di 16g Phuc linh 20g Hong hoa 12g Hoang ba 16g Dao nhan 12g Dan sam 12g Quy ban 16g Miet giap 16g Moc qua 12g Hoang cam 12g Hoang ky 16g Ho cot 16g 54 Dang sam 16g Dtfdng quy 12g Cam thao 4g Sinh dia 16g Bach thtfdc 16g Que chi 8g Xuyen khung 2g Binh lang 8g Nau thanh cao, uong hang ngay, lieu ltfdng thich hdp. Cham ctiu co tac dung lam giam dau nhat thdi, tuy vi tri ton thtfOng ma chon huyet cho phu hdp. Thi du: viem tac dong mach chi dtfdi cham ctiu cac huyet sau: Huyet chinh: uy trung, thtia sdn, thai xung. Huyet phu: tam am giao, huyen chung. Ngoai ra tai cho hoai tti ngtfdi ta cdn dung cac loai thuoc md khang sinh, cao sinh cd, hoan cot cao v.v... de thay bang. SOI MAT, VIEM Ol/ONG MAT ■ ' m Soi mat, viem dtfdng dan mat cd trieu chting chu yeu la dau vung ha stfdn phai va hoang dan thuoc pham vi cua cac chting hiep thong, can khi thong va hoang dan theo y hoc cd truyen. Nguyen nhan benh do thap nhiet, do an uong khong dieu hoa va tinh chi uat ket gay ra, lam anh htfdng den cong nang bai tiet cua ddm va stf sd tiet khi hoa cua can. Day cdn dtfOc goi la chting can kinh thap nhiet v.v... Tren lam sang, soi mat va viem dtfdng mat thtfdng chia lam 4 the benh: the khi tre hay khi uat ttfdng ting vdi the viem tui mat va soi mat ddn thuan; the thap nhiet ttfdng ting vdi the viem va soi mat cd sot cao va hoang dan nhieu; the thtfc hoa ttfdng ting vdi the viem tui mat hoa mu nhiim trung, nhilm doc; the chinh htf ta ham ttfOng ting vdi the nhiem doc do viem phuc mac tran mat. Chi dinh chtia benh bang y hoc dan toe thich hdp vdi chting viem tui mat va soi mat thong thtfdng (khi tre) hoac the viem va soi cd hoang dan sot cao (thap nhiet). Trieu chting: 55 + The khi tre: vung ha sifdn phai dau tiic am 1 hoac dau nhieu nhifng co luc khong dau, mieng dang, hong kho, khong muon an uong, khong sot cao, co hoac khong co hoang dan, reu lifdi trang mong hay vang, mach huyen khan hay huyen sac. + The thap nhiet: vung ha sifdn phai dau tiic, mieng dang, hong kho, ldm giong, buon non, sot sd lanh hay cd luc sot ret, mat vang ngtfdi vang, nude tieu dd hay vang, tao bon, reu lifdi vang day, mach hong sac hay hoat sac. Phep dieu tri: thanh nhiet ldi thap (gom ca tac dung ldi mat, bai tiet soi) la chinh va sd can ly khi (de giam dau) la phu. Cac bai thuoc: Bai 1\ Kim tien thao 40g Uat kim 8g Sai ho 16g Kho luyen tii 6g Chi tii 12g Sa tien tijf 16g Nhan tran 40g Dai hoang 4g Chi xac 8g Bai 2: Long ddm ta can thang gia giam Long ddm thao 12g Sai ho 16g Hoang cam 12g Cam thao 4g Sdn chi tijt 12g Dai hoang 4g Neu khi tre, them: moc hifdng 8g, hifdng phu 8g, uat kim 8g. Neu thap nhiet gay sot va hoang dan nhieu, them: Hoang lien 12g Bo cong anh 40g Hoang ba 12g Neu dau nhieu, them: dien ho sach 12g, moc hifOng 4g. Neu non mtfa, ldm giong, them: tran bi 8g, ban ha 8g Neu tao bon, them: mang tieu 20g. Cham ciiu: cham cac huyet difdng lang tuyen, chi cau, tuc tam ly, noi quan, chifdng mon, ky mon, ddm du. Gia giam: neu non mtfa them thifdng quan; dau nhieu them trung quan; dau lifng them can du; sot cao them khuc tri, hdp coc; trifdng bung, tao bon them dai trifdng du, thien khu. Nhi cham: cham cac vi tri giao cam, than mon, tui mat, gan, vung difdi vd. 56 CH0NG HOI QUYET (giun chui ong mat) Hoi quyet la chiing benh ma nhan khi cong nang ty, vi mat dieu hoa lam cho giun chui len ong mat, gay can khi be uat, ddm khi khong van hanh, gay nen vi quan va ha siidn ben phai dau dii doi. Vi khi nghich len gay ldm giong, buon non, doi khi non ra giun dua. Day la mot benh cap ciiu ngoai khoa. Da so cac triidng hop benh diidc chiia cd ket qua bang thuoc va cham ciiu, mot so ft cac triidng hop boi nhiem phai dung thu thuat ngoai khoa. NgUdi benh ngoai dau duE doi vung ha siidn phai cdn dau nhieu 0 vung thiidng vi; dau lan Ion, khong n&m yen, cd dong tac dac biet la chong mong len trdi, hoac gac chan len titbng. Luc dau midc da thiidng trang bech, toan than lanh, toat mo hoi, chan tay lanh, buon non, cd the sot cao, mieng dang, vang da, liidi dd, mach huyen sac. Phep dieu tri: yen hoi chi thong, tay trung lam chmh. Cac vi thuoc diidc sii dung thiidng cd vi chua, cay va dang (chua, cay lam an hoi; dang lam ha hoi). Cac bai thuoc: Bai 1\ Vdi tdi lOOg va midc sach 1 lit, quay deu, de ling gan lay midc trong. Moi lit midc vdi tdi diidc hoa tan 50g diidng de uong. Kinh nghiem cua Benh vien Dong y Vlnh Phu: midc vdi nhi 500ml uong 1 lan. Moi lan uong 50ml luc len cOn dau. Mot ngay khong qua 400ml. Ty le khoi benh cd the tdi 80%. Thdi gian chiia trung binh 5 ngay. Tac dung bai thuoc an hoi, tao mdi triidng cho giun tut khoi diidng mat. Bai 2: Xuyen tieu tan: Xuyen tieu phoi kho, tan nho, ray thanh bot min. Tii 0 den 15 tuoi, moi lan uong 5g, mot ngay khong qua 20g. Vi xuyen tieu nong nen tre em cd sot phai dung them thuoc giai nhiet: rau ma, luc nhat tan. Tac dung: on trung, chi thong. 9 A Khi chua cd trieu chiing nhiet, cd the dung bai O mai hoan gia giam (cd the dung thang): O mai 5 qua Phu tii che 8g Hoang lien 12g Que chi 8g 57 Hoang ky 12g Dang sam 12g Duong quy 12g Xuyen tieu Can khtfdng Te tan 8g 8g lg Neu dau nhieu, them: moc htfdng, huyen ho, uat kim, bach thtfdc, cam thao de hoat huyet ly khi, hoan cap chi thong; neu non mtia, them: tran bi 8g, ban ha 8g; tao bon, them: mang tieu 16g; vang da, them: nhan tran 40g. Neu phat sot, reu ltfdi vang, mach sac thi giam cac vi tan on nhtf: phu ttf, que chi, te tan, xuyen tieu, can khtfdng; gia hoang lien, hoang ba, kim ngan hoa, lien kieu, nhan tran, chi ttf de thanh nhiet giai doc, so loi ddm khi. Khi dau da giam, dung Bai 4\ Ddm dao trti hoi thang O mai 16g Moc htfOng 8g Sii quan tijf 12g Chi thtfc 8g Binh lang 18g Huyen ho 12g Dai hoang 6g Hau phac 8g Ngay uong mot thang Tac dung: trti hoi, ly khi chi thong, ta ha thong trtfdng. Cham ctfu: cham ta cac huyet: Huyet chinh: tuc tam ly, chi cau, dtfdng lang tuyen, ctfu vi, thien khu. Gia giam: neu dau nhieu them lao cung; non mtia them noi quan; sot cao them hdp coc; tao bon them phuc ket. Nhi cham: cham vi tri giao cam, than mon, tui mat, gan. VIEM TUY CAP TINH Viem tuy cap tinh la mot benh cap ctiu ngoai khoa thuoc pham vi chting phuc thong va vi quan thong cua y hoc co truyen. Do an uong qua nhieu chat bo beo, do hoi trung quay dong hoac do soi ket dtfdng mat lam anh htfdng den cong nang hoat dong cua cac tang phu: can, ty, vi va ddm ma gay ra benh. Can vi bat hoa, khi cO khong thong gay chting dau dti doi: ty vi van hoa bat thtfdng sinh thap nhiet gay vang da; khi uat sinh nhiet gay sot cao, chay 58 mau. Do la nhiing trieu chiing chu yeu de can cii ma phan loai benh tren lam sang. Tren lam sang thudng xuat hien 3 the benh: 1. The khi tre Trieu chiing: mieng ding, hong kho, dau vung thtfOng vi lan sang hai mang stfdn, sot khong rd rang, reu ltfdi tring mong, mach huyen khan. The nay de lan vdi cdn dau da day, loet hanh ta trang. Phep chiia: so can ly khi. Bai thuoc: Sai ho so can tan (Canh nhac toan thtf) Sai ho 8g Thtfdc dtfdc 6g Xuyen khung 6g Tran bi 8g HtfOng phu 6g Chi xac 6g Cam thao 2g Trong phtfOng: bach thtfdc, cam thao hoa ly hoan cap chi thong; xuyen khung, htfOng phu hoat huyet chi thong. Neu cd kiem huyet ii, dau xoay mot cho, ltfdi cd diem ti huyet thi dung them: Thieu phuc true ii thang gia giam Dtfdng quy 12g Xuyen khung 4g Xich thtfOc 8g Quan que 4g Tieu hoi 7 hat (l,5g) Can khtfdng 0,8g Huyen ho 4g Bo hoang 12g Ngu linh chi 8g Trong phtfdng quy vi, xuyen khung, xich thtfdc: dtfdng vinh, hoat huyet; sinh bo hoang, ngu linh chi, mot dtfOc, huyen ho hoa ti, chi dau; nhuc que, can khtfdng, tieu hoi on kinh chi thong. 2. The thap nhiet Trieu chtfng: hoi hop tam phien, mieng khat khong muon uong, cd sot hay luc sot ret, dau vung thtfdng vi dau ben trai lan ben vai, dai it, tao bon, vang da, chat ltfdi dd, reu ltfdi vang day, mach huyen sic. The nay hay gap d benh viem tuy cap tinh the phu ne phoi hdp vdi viem tui mat. Phep chiia: sd can kien ty, thanh nhiet trti thap. 59 Bai thuoc: Sai ho 20g Chi tti 12g Chi thtfc 12g Bach thtfdc 12g Moc htfOng 8g Uat kim 8g Long ddm thao 8g Nhan tran 40g Dan sam 12g 3. The thtfc hoa Trieu chting: sot cao khong so lanh, mieng kho khat, muon uong ntfdc, dau dti doi vung thtfOng vi lan len vai, bung day trtfdng, ctf an, tao bon, tieu tien ft. Cac trieu chting thuoc viem tuy cap phu ne va xuat huyet dich tham gay viem phuc mac. Phep chtia: thanh tiet nhiet, thong phu. Bai thuoc: Dai thtia khf thang gia giam Sai ho 16g Hoang lien 8g Moc htfOng 8g Dai hoang 12g Ngay uong 1 den 2 thang. Hoang cam Bach thtfOc Dien ho sach Mang tieu 12g 12g 12g 12g Sau day xin gidi thieu cach chiia benh viem tuy cap dUa theo kinh nghiem cua nildc ngoai: PhtfOng phap chung: thtf can hoa vi, thong phu tiet nhiet (nhtfng khong dung thuoc ha qua nhieu) Cac bai thuoc: Bai 1: Dai sai ho thang gia giam Sai ho Hoang cam Chi thtfc Sinh khtfOng Gia giam: 20g 12g 12g 12g Ban ha che Bach thtfOc Dai hoang Dai tao 12g 12g 8g 5 qua Neu dau dti doi, them: xuyen luyen tti 12g, moc htfOng 12g, dien ho sach 12g. 60 - Sot cao, them: nhan tran 40g - Non nhieu, them: tran bi 8g, ban ha 8g - Bung day trtfdng, them: hau phac 8g, hoac htfdng 8g - An khong tieu, them: mach nha 12g Bai 2: Thanh di thang so" 1 (Benh vien Nam Khai, Thien Tan) Sai ho 20g Moc htfOng 20g Hoang cam 20g Dien ho sach 12g Ho hoang lien 12g Dai hoang 4g Bach thtfdc 20g Mang tieu 8g SOI TIET NIEU I. OAICI/ONG Soi tiet nieu bao gom co soi than, soi nieu quan, soi bang quang va soi nieu dao. Y hoc co truyen goi soi tiet nieu la sa lam, thach lam hoac cat lam. Soi tiet nieu gap 6 tat ca cac ltia tuoi, theo Rev frat (1976) soi tre em chiem 50% trtfdc 5 tuoi va 30% trtfdc 3 tuoi. Soi tiet nieu co tmh chat dia phtfOng nhtf chau A, chau Phi con chau Au giam ro ret. 0 Viet Nam mien Trung du hay gap hon 6 vung dong b&ng. O Trung Quoc vung Quang Dong, Ho Nam hay gap hon. Theo y hoc hien dai: nguyen nhan cua soi rat phtic tap, hien nay mot so" nguyen nhan da biet ro rang con mot so" chtfa biet ro cho nen van de dieu tri vln chtfa co phtfOng phap dieu tri dac hieu nhat la loai soi oxalat ma Viet Nam hay gap nhat. II. BENH SINH, BENH NGUYEN 1. Theo y hpc hien dai Soi tiet nieu la benh toan than, nhtfng bieu hien tai cho d he thong tiet nieu, do stf mat can bing cua muo'i khoang va the keo trong ntfdc tieu, cho nen co cac nguyen nhan sau: 61 1.1. Thieu vitamin A Nhiing te bao thtfOng bi 6 he tiet nieu bong rdi tao thanh nhan soi sau do cac muoi khoang bam vao thanh soi. 1.2. Viem nhiem Xac chet cac vi trung va cac te bao chet lang dong trong ntfdc tieu tao thanh nhan va thanh soi. 1.3. Tich tu nildc tieu lau Gay ling dong cac thanh phan muoi sinh ra soi, nguyen nhan do di dang he tiet nieu, ltfdi di tieu, nim lau tren gitfdng. 1.4. Nong do nude tieu tang Do ltfdng ntfdc dtfa vao ft hoac an nhieu cac thtfc an, do uong tang phosphat va calci nhtf: uong ft ntfdc, an nhieu cua, oc, ca, ntfdc cd nhieu muoi khoang. 1.5. Citbng tuyen pho giap trang Gay roi loan chuyen hoa phosphat va calci lam tang phosphat. 1.6. Cac yeu to khac Dd la cac yeu to": dia ly, khf hau, gen... Tuy vay tim nguyen nhan ro rang gay ra soi tiet nieu thi kho. Theo Frat (1976) tong ket: 50% khong ro nguyen nhan, 25% do di dang tiet nieu, 25% do chuyen hoa bi roi loan. *> v 2. Theo y hoc co truyen Than cd 2 loai: than am chu thuy va than dtfOng chu khf. Neu than khf day du thi ntfdc ttf than thuy xuong bang quang mdi dtfdc khf hoa ma bai tiet ra ngoai dtfdc de dang. Neu than khf htf thi khong khf hoa bang quang dtfdc, thap ngtfng tre d ha tieu, hoa dot tan dich (thuy thap) lam cho cac tap chat d ntfdc tieu ket thanh soi (sa, cat hoac thach). Soi lam thtfdng ton huyet lac gay dai ra mau, soi dong lai bang quang va than lam khf tre ma gay dau. Vi vay Dan khe tam phap ndi: “Soi phat sinh la do than khf htf lam cho bang quang thap nhiet, hoa chtfng dot thuy thap, cac chat can ba ntfdc tieu lang dong sinh ra soi”. 62 Nhu vay, benh sinh, benh nguyen va phan loai cua soi tiet nieu co lien quan vdi nhau dUOc bieu thi bang sd do sau: Sof do: Nguyen nhan sinh benh va phan loai cua soi tiet nieu 63 III. PHAN LOAI SOI TIET NIEU 1. Theo y hoc hien dai • • • Dtfa vao thanh phan cau tao soi ma chia nhieu loai: soi calci, soi oxalat... 1.1. Soi calci Co 2 loai soi calci la: phosphat calci va oxalat calci, loai soi nay hay gap d nhting ngUOi benh: Ctfdng calci nieu khong ro nguyen nhan. - Toan chuyen hoa 0 ong nieu xa nguyen phat. - Ctfdng pho giap trang. - Do benh nhan bat dong lau. - Nhiem doc vitamin D. 1.2. Soi oxalat Loai soi nay do hai nguyen nhan (d Viet Nam hay gap): Benh oxalose (cutdng oxalat nieu), cd 2 loai: + Oxalat nieu nguyen phat la do benh di truyen, de gay suy than do soi tai phat, chua cd phtfOng phap dieu tri dac hieu. + Oxalat nieu tai phat trong dd oxalat nieu khong cao, cd the kem theo acid uric nieu va calci nieu. Ctfdng oxalat nieu trong roi loan ruot non hay gap trong benh Crohn, benh cat doan hoi trang. 1.3. Soi cystin, xanthin, glucin Nguyen nhan do thieu hap thu loai cystin va cac acid amin kiem khac nhtf lysin, arginin. 1.4. Soi hon hop Loai soi nay cd can quang. 2. Theo y hoc co truyen Dtfa theo nguyen nhan cd che sinh benh ma chia hai loai la: loai khf ket va loai thap nhiet. 64 2.1. Loai khi ket La loai khi tre, huyet tf. Do than khi hif, bang quang thap nhiet, nhiet chUng dot tap chat trong ntfdc tieu ma hinh thanh soi, soi ngan can lam cho khi cO bang quang bat ldi. Vi vay gay nen khi tre, huyet tf lam cho tieu tien kho va dau. 2.2. Loai thap nhiet Do than htf gay khi hoa bang quang that thtfdng ma sinh nhiet thap, co the do soi lam ti tre ntfdc tieu hoac do thap ngoai cd the xam nhap sinh ra thap nhiet, nhiet lam cho huyet lac btic loan gay dai mau. IV. TRIEU CHlfNG VA CHAN DOAN 1. Theo y hoc hien dai V • • • - Dau that ltfng lan xuong bang quang, nieu dao, dau tang len khi nhay, neu soi di dong nhieu gay con dau quan than. - Dai kho, dai buot, dai rat. - Dai mau cuoi bai la soi bang quang, neu dai mau toan bai la soi than. - Chup XQ khong chuan bi (can thut dai trang ky) chi thay soi can quang. - Sieu am cd the thay soi. ■> \ 2. Theo y hpc co truyen 1.1. Loai khi kit - Thtfdng trieu chtfng toan than khong rd ret. - Dau nhe 0 bung dtfdi va that ltfng. - Tieu tien ra mau, dai kho. - Ltfdi reu hdi vang, chat ltfdi dd. - Mach huven khan. 1.2. Loai thap nhiet - Thtfdng cd sot, dau that ltfng bung dtfdi. - Tieu tien kho, nong rat, cd khi dau. - Dai mau, cd khi cd mu. 65 - Reu ltfdi nhdt vang hoac trang nhdt. - Mach sac hoat hay huyen sac (loai soi the thap nhiet). V. PHLfONG PHAP DIEU TRJ 1. Dieu tri cdn dau quan than Trieu chtfng: thtfdng xuat hien sau khi chay nhay, di xa. Benh nhan dot ngot dau dijf doi d vung ho that ltfng cd khi gay ttfc bung bf dai. Bien chtfng: do khi tre qua mtfc, sinh huyet tf ma gay ra soi. Phap dieu tri: pha khi, hoat huyet Thuoc uong (sic uong) Moc htfOng 20g O dtfOc 20g Cham ctfu: - The cham: than du, tam am giao, yeu du, tuc tam ly, bat lieu. - Nhi cham: huyet vung than, bang quang, nieu quan, than mon Cham ta, cd the dien cham cac huyet tren - Thuy cham b&ng thuoc novocain, lidocain 1 ong x 10ml vao huyet tren hoac dung thuoc giam dau, gian nieu quan nhtf atropin 0,5mg + morphin 50 - lOOmg. 2. Dieu tri soi theo noi khoa 2.1. Chi dinh - Kich thtfdc soi < 1cm d nieu quan. - Tren phim soi ttfOng doi nhan. - Benh nhan mac benh < 5 nam. - Nhieu soi, mo hoac tan soi khong het. - Chong tai phat. - Cong nang cua than binh thtfdng hoac ton thtfOng nhe, soi thtfdng mot ben. - Benh nhan khong chiu noi phau thuat" vi tuoi cao, toan trang suy yeu. 66 2.2. Phitcfng phap dung thuoc uong 2.2.1. The khi tre Phap dieu tri: hanh khi, ldi tieu, thong lam, hoa soi. Bai thuoc bai xuat soi: Thach vi tan gia giam Thach vi 12g Tang bach bi 12g Moc thong 8g Phuc linh 12g Sa tien tu 12g Chi tii 12g Hoat thach 16g Kim tien thao 12g Cam thao 6g Neu dieu tri lau soi khong ra dtfdc thi linh chi. gia: xuyen sdn giap, bo hoang, ngu Neu than dtfdng htf thi gia them: phu ttf, nhuc que, bo cot chi. Than am htf thi gia them: ntf trinh tii, ha lien thao, ky ttf, thuc dia. - Bai thuoc tan soi: Miet giap 10-40g Hoat thach 20-40g Y di 2 0 -40g Thtfdng truat 12-40g Kim tien thao 40-80g Ha kho thao 12-20g Bach chi 12-20g - Bai tan soi tong hdp dung cho ngtfdi gia yeu: Chi xac 12g Hau phac 12g Kim tien thao 40g Sa tien 40g Thanh bi 12g Trach ta 12g Ngtfu tat 12g Tam lang 20g Nga truat 20g Bach chi 12g 2.2.2.Than hii thuy it: ttfOng dtfdng than tf ntfdc cua YHHD Du cong nang cua than kem do soi hoac sau khi dung bai soi hoac mo lay ■) \ O n soi cung cd the chtfa bang y hoc cd truyen Phuc bon ttf 40g Thuc dia 16g Thd ty ttf 12g Ha thu o 20g Bach gidi ttf 12g Tang phieu tieu 12g 67 Bo cot chi 12g Bach chi 12g Quy ban 12g Hoang tinh I2g NgUu tat 12g Bach mao can 12g Thiidng truat 20g Sinh hoang ky 40g 2.2.3. The thap nhiet: Phap dieu tri: thanh nhiet thap, thong lam, bai tan soi Thuoc dieu tri: - Thuoc bai xuat soi: Sa tien 12g Kim tien thao 16g O dtfdc 4g Dia dinh 12g Hoat thach lOg Tang bach bi 8g Bo cong anh 16g Thach vi 12g Chi ttf 8g Moc thong 16g Hau phac lOg Cam thao 6g Phuc linh 12g - Thuoc tan soi: dung bai “Bat chinh tan gia giam” Kim tien thao 16g Hoat thach 12g Ngiiu tat 16g Dai hoang 4g Nhu hiidng 8g Bien sue 12g Sa tien 16g Ky ttf 12g Moc thong 12g 2.3. Phiidng phap dieu tri ho trd - Uong nhieu midc: trong thdi gian dieu tri phai bao dam liidng midc vao cd the ttf 1500ml - 3000ml. - Van dong tuy theo stfc khoe ma phai van dong nhieu ft nhii: nhay day doi vdi soi be than va nieu quan, chay doi vdi soi bang quang. - Dieu chinh pH midc tieu (pH = 5-7). + Soi urat: han che an thit, dung loai muoi lotin, lam midc tieu kiem tmh bang uong them bicarbonat. + Soi oxalat: han che an cua, oc, ca. 68 + Soi phosphat: han che an trtfng, suta; lam ntfdc tieu toan tinh bang an uong chanh, cam. - Chong nhiem trung. 3. Ket luan - Dieu tri soi tiet nieu b&ng phtfOng phap y hoc co truyen co ket qua nhtfng phai theo doi chtfc nang cua than va co chi dinh dung. - Chong tai phat thi nen uong cac thuoc nhtf: re co tranh, ngtfu tat, kim tien thao, lieu b&ng nhau, 1 thang uong 1 lieu trinh la 7 ngay. NHIET LAM Nhiet lam la mot trong nam chtfng lam trong y hoc co truyen. Nguyen nhan la do thap nhiet, ue troc xam nhap bang quang hoac do an nhieu chat cay nong, uong nhieu rtfdu, thap nhiet don xuong bang quang phat thanh nhiet lam. Neu do tieu tien khong thong, thap nhiet don tf chat can thi thanh sa lam roi thanh thach lam nhtf da neu tren. Trieu chtfng cua nhiet lam la tieu tien nong, buot, tieu tien nhieu lan, ntfdc tieu mau vang do, ha vi co cang, trtfdng dau, ctf an; kem theo phat sot, phat ret, eo ltfng moi, dau, reu ltfdi vang nhdn, mach nhu sac. Phep dieu tri: thanh nhiet loi thap, thanh nhiet giai doc, thong lam Cac bai thuoc: Bai 1: Kim ngan hoa 16g Tho phuc linh 12g Ty giai 12g Hoang ba 10g Hoang cam 10g 0 dtfOc lOg Dan sam lOg Huyen ho 12g Chi xac 6g Hau phac 8g Moc thong 12g Bai 2: Luc nhat tan Cam thao 1 phan Hoat thach 6 phan Hai vi tan bot, uong moi ngay 15-20g 69 Bai 3: Bat chinh tan (Cue phtfdng) Sa tien ttf Cu mach Bien sue Hoat thach Son chi Chich thao Moc thong Dai hoang (say) Tat ca 16 lang, moi lan dung 2 dong can sac vdi dang tam thao, uong bo ba. Trong bai cd bien sue, cu mach, moc thong, sa tien tu, hoat thach de thong lam loi thap; dai hoang, sOn chi, cam thao tieu de thanh nhiet ta hoa. Neu kem theo nong, ret cd the ket hdp bai Tieu sai ho thang de hoa giai thieu dtfdng: Sai ho 12g Hoang cam 9g Nhan sam 6g Ban ha 9g Neu thap nhiet lau ngay hai den phan am thi gia: sinh dia, tri mau, bach mao can de dudng am thanh nhiet. BONG Bong la mot benh thuoc dien cap ctfu ngoai khoa do nhieu nguyen nhan gay ra: nhiet, hoa chat (acid, vdi) va cac yeu to vat ly khac nhtf dien, tia btfc xa... Mtfc do nang nhe cua bong dtfdc xac dinh theo do nong sau cua ton thtfOng (thtfdng chia ra 3 do) va dien tich ton thtfOng cua bong (nhe, trung binh, nang, rat nang). Bong nang phai dtfOc cap ctfu kip thdi bang cac phtfOng phap cua y hoc hien dai. Sau day xin gidi thieu stf phan loai theo cac giai doan cua bong va phtfdng phap chtfa bong bang y hoc co truyen. 1. Giai doan am htf dtfofng thoat (hay giai doan choang do bong) Trieu chtfng: xuat huyet ttfdng d da thanh not phong, phien tao, bi dai hoac dai it, tinh than uy mi, thd ngin, sic mat tring bech, tay chan lanh. huyet ap ha, reu ltfdi kho, mach vi te sac. Phep dieu tri: dtfdng am sinh tan, hoi dtfOng ctfu thoat. 70 PhtfcJng thuoc: bai Sam phu thang ket hdp vdi Sinh mach tan gia giam Nhan sam 8g Mach mon 12g Phu ttf che 12g Sinh dia 16g Ngu vi ttf 6g Huyen sam 16g 2. Giai doan hoa doc (hay giai doan boi nhiem) 0 giai doan nay tuy theo mtfc do nhe, nang ma ngtfdi ta chia ra: a. Ta nhiet thitdng dm: sot, mat dd, ltfdi kho, mieng khat, an khong ngon, chat ltfdi dd, reu ltfdi vang, mach hoat sac. Phep dieu tri: dudng am, thanh nhiet giai doc. Bai thuoc: Hoang lien 16g Chi tu 8g Vd nuc nac 12g Sinh dia 16g Kim ngan hoa 16g Mach mon 16g Bo cong anh 20g Thach hoc 16g Ket hdp dung thuoc AD 73 boi tai cho. AD 73 la nhtf a mot loai cay moc 0 vung Hoang Lien Sdn, Bic can, Cao Bing, Lang Sdn v.v... Dd la cay xoan rting, dtfdc dung d dang thuoc md hoac bot, cd tac dung chtfa bong do 1, 2, 3 lam thanh mot mang phu vet thtfOng, khong phai bang, sat trung, tao dieu kien tot cho viec moc to chtic hat, lien da, khi khoi ttf bong ra. b. Hod ciCc thinh'. vet bong bi nhiem trung nang, ntfdc vang ra nhieu, sot cao, ret run, mdi met, tam phien, bung trtfdng, ntfdc tieu it hay vo nieu; cd the me sang hay co giat, ltfdi dd, mdi dd, reu ltfdi vang, mach te sac. The nay phan nhieu ttfdng tfng vdi the dam hoa nhieu tam, dam me tam khieu. Phep dieu tri: can ket hop vdi y hoc hien dai de dieu tri, tai chd vin dung AD 73. 3. Giai doan khi huyet deu hif (hay giai doan hoi phuc cua benh) Trieu chtfng: toan than gay yeu, met mdi, da mat xanh, chat ltfdi nhat, mach nhtfdc hay nhu hoan. Phep dieu tri: bo khf huyet. 71 Cac bai thuoc: Sam bo" chmh 16g Thuc dia 12g Bach truat 12g Tran bi 8g Ky tu 10g Y di 16g Hoai sdn 16g Ha thu o 12g Sa sam 12g Ke huyet ding 12g Bai 2: Bat tran thang gia giam. Bai 3: Tai cho riia vet thiidng Cay cong cong (xuyen tam lien) 20g Nau vdi 500ml riia hang ngay. Hoac: hoang ba, sa sang tu (lieu bang nhau), nau riia hang ngay. Hien nay nhd ket hdp giCia y hoc co truyen vdi y hoc hien dai da thu diidc nhieu ket qua trong cong tac chiia bong nhii dung cac loai cao sinh cO, chong nhiem trung tai cho, va da, chay than nhan tao v.v... RO HAU MON ■ Ro hau mon la mot benh kha pho’ bien d vung hau mon, thiidng diing sau tri. Benh do ap xe vung hau mon hoac tri viem xii ly khong tot sinh ra. Benh hay gap 0 nam gidi, diidc biet tu! thdi Hypocrate (cach day 500 nam triidc Cong Nguyen). 6 Viet Nam benh nay da diioc Dai danh y Tue Tinh va Hai ThiiOng Lan Ong mo ta, da xay diing diiOc nhieu bai thuoc dieu tri. Ro hau mon theo y hoc co truyen cdn cd ten giang lau, tri lau (ro do tri) hoac tri sang. 1. Benh sinh benh nguyen Trong cac y van deu thong nhat nguyen nhan chu yeu la thap nhiet uat ket d giang mon lam cho khf huyet van hanh khong thong xiidng hoac cd the khf huyet da hii san cho nen thap nhiet uat ket, ket hop vdi khf huyet hii va khong thong xiidng, nung nau ma sinh ra siing, cd mu vi nuoi diidng kem nen xuat hien loet nat thanh lo, dan dan khoet sau thanh ong gay nen ro hau mon. 72 2. Phan loai nl'i Dua vao benh sinh, benh nguyen ma chia ro hau mon lam cac the sau: - The thap nhiet. - The am hif noi nhiet. - The trung khf bat tuc. - The khf huyet liidng hii. 3. Chan doan ro hau mon theo y hoc hien dai • • • • - Vung hau mon co lo ro chay niidc vang, hoac niidc mu, so ltfdng 16 ro o co the co 1 - 2 hoac 3 lo. v t - Bom hoi hoac xanh metylen se xac dinh diidc lo ro trong va diidng ro. 4. PhuWng phap dieu tri Theo y hoc co’ truyen co 2 nguyen tac dieu tri phai ket hop vdi nhau, do la: dieu tri toan than (noi tri) va dieu tri tai cho (ngoai tri).' i 4.1. Dieu tri toan than Dtfa vao the benh de dieu tri: - The thap nhiet: < r i t , v / + Trieu chiing: benh mdi mac hoac dot cap; tai lo ro sitng, nong, do, dau, chay niidc vang hoac mu dac; sot nong, reu liidi vang nhot, chat liidi do, mach hoat sac. + Chan doan: Bat cifOng: thuc nhiet. Nguyen nhan: thap nhiet. + Phap dieu tri: thanh nhiet trii thap, giai doc bai nung sinh cO. + Bai thuoc: Thac ly tieu doc tan Sinh hoang ky 12g Diidng quy 12g Tao giac thfch 12g Bach truat 12g Kim ngan hoa 16g Phuc linh 16g Cat canh 12g Dang sam 16g Bach chi 8g Bach thifdc 12g Xuyen khung 8g 73 - The am hii noi nhiet: + Trieu chiing: benh mac lau ngay, ngtfdi gay, da moi kho, liidng •» . quyen do, sot ve chieu, trong ngiidi hao nong, dai tien tao, tieu tien vang, lo ro khong nong do, chay dich mu loang hoac ii6t di'nh, reu liidi vang kho, chat luoi do, mach vo liic hoac te sac. + Chan doan: Bat cUdng: hii nhiet Nguyen nhan: am hii + Phap dieu tri: dudng am thanh nhiet, bai nung sinh cd. + Bai thuoc: Thanh cot tan. Thach cao 8g Ngan sai ho 6g Miet giap 12g Hoang lien 8g Dia cot bi 12g Cam thao 4g Tri mau 12g Tan giao 8g Gia them diidng quy 8g, hoang ky 12g, thiiOng truat lOg. - The trung khi bat tuc: + Trieu chiing: ngiidi gay, met moi, cO nheo, lo ro tham ii6t, chay dich nhon, khong siing nong do, an it; reu liidi vang, chat liidi nhat beu, mach tram te. + Chan doan: Bat ciiOng: ly hii Nguyen nhan: khf huyet hii + Phap dieu tri: bo khi ich huyet, bai nung sinh co. + Bai thuoc: Bat chan gia vi Ding sam 12g Thuc dia 12g Bach truat lOg DutOng quy lOg Cam thao 16g Xuyen khung 12g Bach linh 12g Bach thiidc 12g Gia them hoang ky lOg, tao giac thich 8g, kim ngan 12g. 74 4.2. Dieu tri tai cho Trong y hoc co truyen co nhieu vi thuoc, bai thuoc dieu tri va cac cach dieu tri. - Cach that lo ro: + 6 doi nha Minh (Trung Quoc): dung soi co dai luon qua 2 lo dtfdng ro, roi dung thuoc thanh nhiet khtf hu sinh cd, dieu tri niia thang soi co tut ra la khoi. Cach nay sau nay sii dung trong that rao lo ro. + Dung 7 - 8 soi chi luon xuyen lo ro, moi ngay that mot soi sao cho sdi cuoi vtfa that het cho lo ro. - Cach khtf hu sinh c0 (kinh nghiem gia truyen 1: ong lang Tri 6 Thuy Nguyen, Hai Phong): dung thach tin che thanh que, dat vao dtfdng ro cho den khi dtfdng ro bi pha huy hoan toan. Tai bien cua phtfOng phap nay la sot cao, vung hau mon stfng tay, rat de nhiem doc thach tin, do vay khong dung dtfOc ma hien nay da cam dung (Vien Y hoc cd truyen VN da nghien ctfu). - Cach ngam rtfa: + Dung la trau khong tuoi, sac dac, ngam vung ro. + Theo dai danh y Tue Tinh: dung phan ngtfa trang. gia nat vdi muoi, mdi thtf 1/2, dem sao nong, dap vao lo ro khi khoi thi thdi (cach nay chtfa nghien ctfu). Ndi chung cac cach chtfa tai cho, gidi thieu d tren khong stf dung hien nay dtfdc, nen dung that hoac mo cua y hoc hien dai va dung thuoc noi tri cua y hoc cd truyen. Xin gidi thieu mot phtfOng phap dieu tri ket hop y hoc co truyen vdi y hoc hien dai cd ket qua tot (de tai nghien ctfu cua bac si CKII Pham Van Sdn) nhtf sau: Thuoc ngam: La trau khong 50g Phen phi 5g *> o Cho 2 lit ntfdc dun soi de ngudi, de ngam vung ro hang ngay. Thuoc uong: bai Thac ly tieu doc Hoang ky lOg Phuc linh 12g DtfOng quy lOg Bach truat 10g 75 Ngifu tat lOg Dang sam 12g Xich thifdc lOg Kim ngan hoa 10g Sac uong ngay 1 thang That ong ro: dung bao cao su OK, dung que tham ro, luon qua ong ro va buoc. Trifdc khi buoc that can rach da theo difdng ro de chong dau, vong cao su sau 10 - 12 ngay tii rung, mieng lo ro hd, neu lien bap cau thi dung gay te, cat loc. Sau do ngam va uong thuoc trung binh 25 ngay la khoi. Ket qua khoi 97%, dd 3%, khong khoi 0%, phifdng phap nay co the ting dung rong rai nhat la tuyen cd sd. 6. Ket luan Dieu tri ro hau mon quan trong van la dieu tri tai cho, loai bo ong ro bing ph&u thuat hoac that md ong ro, co the ket hdp vdi thuoc ngam va thuoc uong bang y hoc co truyen. Cd le day la phifdng phap hiiu hieu nhat. TRI Tri la mot benh man tinh do cac tinh mach triic trang hau mon bi gian va sung huyet thanh mot bui hoac nhieu bui, tuy vi tri tinh mach d tnic trang hay hau mon diidc phan chia tren lam sang thanh tri noi hay tri ngoai. Nguyen nhan gay ra tri bao gom: viem dai trang man tinh gay tao bon thifdng xuyen dai tien ran nhieu; viem gan, xd gan man tinh gay sung huyet tinh mach; cac benh nghe nghiep do diing lau hoac cd thai lam trifOng liic cd thanh bung va thanh tinh mach bi giam gay gian tinh mach v.v... Vi sung huyet de gay thoat quan, chay mau, lam cho ngifdi benh thieu mau, boi nhiem nen ngifdi benh cd trieu chifng nhilm khuan. Tren lam sang can cif vao tinh trang cac bui tri, xuat huyet va nhilm khuan de phan loai the benh va cach chiia. Cac giai doan cua tri noi va tri ngoai difdc phan chia nhii sau: Tri noi: chia lam 4 thdi ky: 1. Bui tri chiia ra ngoai, dai tien ra mau tiidi, cd trifdng hdp chay mau nhieu gay thieu mau. 2. Khi dai tien bui tri ldi ra, sau dd tri lai co diidc. 76 3. Khi dai tien bui tri loi ra, di xong khong tii co len diidc. 4. Bui tri sa ra ngoai, sau dai tien phai dung tay day len nhiing khi lao dong nang, ngoi som lai sa xuong (thiidng kem theo sa tnic trang). Tri ngoai: nam d ria hau mon, dUdc phu bdi da hau mon; mat do thiidng ran (do viem tac, huyet khoi tinh mach). Hau het benh nhan bi tri ngoai thudng den kham trong tinh trang viem cap tinh, huyet tac, huyet khoi tinh mach vdi trieu chiing noi bat la dau dii doi, kem theo cuc ran canh hau mon. Phiidng phap chiia benh tri cd hai loai: dung thuoc uong de chong chay mau, chong nhiem khuan, lam nho bui tri; dung thuoc va cac thu thuat ngoai khoa de gay hoai tuf bui tri, rung va cat cac bui tri, loai bo huyet khoi. I. CHITA TRl BANG PHlTONG PHAP BAO TON Ap dung chiia: tri noi thdi ky 1 va 2 (thdi ky 3, 4 dieu tri noi khoa ft ket qua) cd xuat huyet, tri ngoai thdi ky 3 cd viem tac tinh mach va boi nhiem, tri 0 ngiidi gia va phu mi sinh de nhieu lan. 1. Tri noi xuat huyet hay the huyet xi Trieu chiing: di ngoai xong huyet ra tiing giot, dau, tao bon. Phiidng phap chiia: liiOng huyet chi huyet, hoat huyet khii ii. Cac bai thuoc: Bai 1: Hoa hoe sao den 16g Kinh gidi sao den 16g Sinh dia 12g Huyen sam 12g Co nho noi sao 16g Trac bach diep sao 16g Bai 2: Hoat huyet dia hoang thang gia giam Sinh dia 20g DiiOng quy 12g Xich thu'Oc 12g Hoang cam 12g Dia du 12g Hoe hoa 12g Kinh gidi 12g Tao bon them: hat vting den 12g, dai hoang 4g. Bai 3: Tti vat dao hong gia giam Sinh dia 12g Dudng quy 8g Bach thu'Oc 12g Xuyen khung 8g 77 Hong hoa Hoe hoa Chi xac Dai hoang 8g 8g 8g 4g Dao nhan 8g Trie bach diep 12g Hat vting 12g Cham ciiu: trtfdng ctfdng, thti lieu, tieu trtfdng du, dai trtfdng du, tuc tam ly, tam am giao, thtfa sOn, hop coc. 2. Tri ngoai bi boi nhiem hay the thap nhiet Trieu chiing: vung hau mon stfng do dau, bui tri stfng to dau, dai tien tao, ntfdc tieu dd. Phiidng phap chtia: thanh nhiet ldi thap, hoat huyet, chi thong. Cac bai thuoc: Bai 1: 12g Hoang dang Rau diep ca 16g Kim ngan Chi tti sao den Kinh gidi Bai 2: Hoa hoe tan gia vi Hoa hoe Kinh gidi sao den Xich thtfOc Sinh dia Cam thao Bai 3: Chi thong thang gia giam 16g 12g 12g 12g 16g 8g 16g 4g Hoe hoa Chi xac Trac bach diep Chi xac Kim ngan hoa Dia du 12g 8g 12g 8g 16g 12g 12g 12g 12g 6g 78 Hoang ba 12g Dao nhan 8g Dtfdng quy 8g Sinh dia 16g Cham ciiu: cham cac huyet tren, ta phap. Hoang lien Xich thtfdc Trach ta Dai hoang 3. Tri lau ngay gay thieu mau, tri d ngtfdi gia (the khf huyet deu hif) ^ ' V • w w w 1 Trieu chiing: dai tien ra mau lau ngay, hoa mat, u tai, sac mat trang bdt, reu luoi trang mong, mach tram te, cO the met moi, doan hoi, tu ra mo hoi. Phtf&ng phap chiCa: bo khf huyet, thang de, chi huyet. Cac bai thuoc: Bai 1: Dang sam 16g Bach truat 12g Hoai sdn 16g Bien dau 12g Ha thu o 12g Ke huyet dang 12g Hoa hoe soa den 8g Huyet chi 6g Kinh gidi sao den 12g [ vat thang gia vi (neu huyet hif) Thuc dia 12g Xuyen quy 12g Xuyen khung 8g Bach thUdc 12g Dia du 12g A giao 8g Hoang ky 12g Cam thao 4g trung fch khf thang gia giam Dang sam 16g Cam thao 4g Dia du sao den 8g Hoang ky 12g Sai bo 12g Hoe hoa sao den 8g Difdng quy 8g Tran bi 6g Bach truat 12g Thang ma 8g Kinh gidi sao den 12g II. CHUfA TRl BANG PHlfONG PHAP CHONG VIEM, CHONG CHAY mAu TAI ch 6 vA lA m HOAI TIT RUNG TRI 1. Cao dan tieu viem, giam dau Loai thuoc nay bao gom cac vi nhif: hoat thach, long cot, boi m&u, chu sa, bang phien. 79 2. Thuoc lam hoai tvf rung tri a. Kho trT tan: Thach tin 160g Than sa 360g Phen chua 400g O mai 100g Tan bot: rac vao tri. Chi dinh: tri noi thdi ky 2,3. Chong chi dinh: tri ngoai, tri noi thdi ky 1, 2 (neu tien liiOng sau khi boi thuoc tri co vao trong) ung thii tnic trang hau mon, tu! thdi ky 4 xO chai. b. Thit bui trT: Tiem dung dich minh phan 8% chiia tri noi, tri ngoai cac thdi ky. Thdi ky mot, thdi ky hai tiem ft tit 0,5-lml cho mot bui tri nhiing tong lieu khong qua 3ml. Ngoai tac dung hoai tu bui tri nhanh, no cdn tac dung cam mau tot. Thi du chay mau d thdi ky 1 tiem 0,5 - lml; thdi ky 2 tiem 0,5 - 2ml; thdi ky 3 tiem 0,5 - 3ml. Cd the tiem til 3 - 7 lan. Trong nhiing nam gan day, d nhieu niidc da ket hdp ca y hoc dan toe va y hoc hien dai chiia tri cd ket qua rat tot. 80 CHLfONG V BENH NGOAI DA DAI CUONG Benh ngoai da bao gom cac bieu hien di cam ngoai da nhtf dau, ngtfa, nong, rat, te bi hoac thtfc the nhu ban, chan, chay ntfdc vang, not phong... . Benh ngoai da co lien quan mat thiet den toan than, do vay chtfa benh ngoai da cung dtfa tren co sd bien chtfng luan tri. 1. Ngtfa phan nhieu do phong gay nen, khi chtfa thtfdng dung cac vi thuoc thuoc nhom khu phong nhtf: phong phong, kinh gidi, bac ha, ngtfu bang tu, uy linh tien, thtfOng nhl ttf, bach ctfOng tam, toan yet... 2. Da dd, nong, rat thtfdng do nhiet sinh ra. Neu do nhiet doc sinh ra thi khi chtfa dung cac vi thuoc cd tac dung thanh nhiet giai doc nhu kim ngan, bo cong anh, sai dat, lien kieu, thtfOng nhl tii, tho’ phuc linh... Neu do viem khong gay mu dung cac thuoc thanh nhiet ltfng huyet nhtf: sinh dia, huyen sam, dia cot bi... 3. Da phu ne, tiet dich, not phong, chay ntfdc ... thtfdng do thap gay nen. Thap ket hop nhiet vdi bieu hien chay ntfdc vang, mu vang... khi chtfa thtfdng dung cac vi thuoc cd tac dung thanh nhiet tao thap nhtf: thtfOng truat, kho’ sam, hoang ba, hoang lien phoi hop cac thuoc kien ty trtf thap hoac cac thuoc cd tac dung loi nieu nhtf bach linh, bach truat, hoat thach, sa tien ttf... 4. Neu da kho, troc vay, ntft ne, long toe kho, rung...thtfdng do huyet tao gay ra thi dung cac thuoc dtfdng huyet nhuan tao de chtfa nhtf: bach thtfOc, sinh dia, ha thu o, cd nho noi... 5. Neu cd ban chan, noi cue, tf huyet d da, thtfdng do huyet tf sinh ra, dtfdc dung cac thuoc hoat huyet de chtfa nhtf dan sam, tao giac thich, dao nhan... 6. Tren thtfc te lam sang, cac trieu chtfng hay xuat hien cung mot luc vdi nhau nhtf chay ntfdc vang (do thap nhiet), ngtfa stfng dau (do phong va huyet tf) la do cac nguyen nhan ket hop vdi nhau gay benh, dieu tri phai phu hdp vdi benh canh lam sang. Phep tri thtfdng dung khu phong, thanh nhiet, hoat huyet. 81 Mot so benh ngoai da xay ra cap tmh hoac hay tai phat do co the mat thang bang ve am dtfdng, khi huyet, tan dich, khi chtfa benh ngoai viec chtfa vao nguyen nhan benh ben ngoai con phai chu trong dieu hoa cong nang hoat dong cua co the bi roi loan va do tinh trang di tfng nhiem khuan (huyet nhiet) gay ra. Ngoai viec dtfng cac thuoc thanh nhiet giai doc, con phai dtfng cac thuoc thanh nhiet ltfdng huyet de chtfa (nhtf benh di tfng ban chin do lanh va do phan ve khf cua co the bi yeu gay ra). Ngoai viec dung cac thuoc trti phong han con dtfng cac thuoc bo khf nhtf hoang ky, dang sam,v.v... de chtfa. Khi chtfa benh ngoai da con can ctf vao cac giai doan benh va tinh trang tieu. ban, hoan, cap cua benh ma chtfa nhtf cac benh viem nhiem da lau ngay co the gay chtfng am htf huyet tao thi luc dau dung thuoc thanh nhiet sau dung thuoc dtfdng am nhuan huyet de chtfa, benh man tmh nhtf cham bi boi nhiem thi phai dung cac thuoc thanh nhiet giai doc de chtfa v.v... Cung nhtf y hoc hien dai, cac thuoc va cac dang thuoc chtia benh ngoai da tai cho cua y hoc co truyen rat phong phti. Co the liet ke cac dang thuoc va cac thuoc thong thtfdng nhtf sau: 1. Dang thuoc bot: gom cac vi thuoc diet khuan, thu sap, chong viem. chong ngtfa nhtf hoat thach, thanh dai, phen phi, v.v... 2. Dang thuoc ntfdc dung de bang, rtfa vet thtfOng cd tac dung tieu viem trtf mu, thu sap... nhtf ntfdc la xoan, ntfdc sa sang ttf, ntfdc la nhoi v.v... 3. Dang thuoc ngam rtfdu cd tac dung tieu doc, chong ngtfa, chong tf huyet d cuc bo nhtf thuoc sa sang, to moc, long nao v.v... 4. Dang thuoc md, thuoc dau de diet khuan tieu doc, lam mem da, v.v... gom cac vi thuoc thanh nhiet giai doc, tieu viem, nhuan tao, nhtf md hoang lien, md panmatin. 5. Dang thuoc cao gom hai loai: cao mem va cao rin de boi, bang va dan vao ton thtfdng d mat da. 6. Dang thuoc xong ntfdc hay xong khoi nhtf khoi thtfOng truat chtfa cham do tiep xuc, ntfdc ca gai va kinh gidi de xong chtfa ngtfa. CHAM Cac sach y hoc cd truyen deu da cd md ta benh nay, chia lam 2 loai cap tmh va man tmh, cdn gap d tre em cdn bu va tuy theo vi tri cd the cdn cd cac ten khac nhau. 82 Nguyen nhan do phong, nhiet va thap ket hdp vdi nhau ma gay nen benh. Phan loai cac the benh va cach chtfa nhtf sau: 1. The cap tinh Do phong phoi hdp vdi nhiet va thap. Trieu chtfng ban dau xuat hien da hdi dd sau mot thdi gian ngan da noi cuc, xuat hien mun ntfdc, tiet dich, sau dd dong vay va khoi. The cap tinh dtfdc chia lam hai the nho: a. Thap nhiet: da hong, do, ngtfa, nong rat kem theo mun ntfdc, chay ntfdc vang. Phep chtfa: thanh nhiet hoa thap Cac bai thuoc: Bai 1: Tho phuc linh 16 g Nhan tran Kho sam 12 g Kim ngan hoa Hoang ba 12 g Thuong nhl tii Ha kho thao 12 g Hoat thach Bai 2: Thanh nhiet hoa thap thang gia giam Hoang cam 12g Kho sam Hoang ba 12g Sinh dia Bach tien bi 12g Kim ngan hoa Phuc linh bi 12g Dam true diep Hoat thach 20g Bai 3: Vi linh thang gia giam (Chtfng tri chuan thing) Hau phac 12g Trach ta Tran bi 8g Trtf linh Phuc linh 12g Bach tien bi Nhan tran 20g Bai 4: Tieu phong dao xich thang (Y tong kim giam) gia giam 20 g 16 g 12 g 8 g 12g 20g 20g 20g 12g 12g 12g Ngtfu bang ttf 12 Sinh dia 16g Bac ha 4g Bach tien bi 8g Hoang lien 12g Hoang ba 12g 83