🔙 Quay lại trang tải sách pdf ebook Sổ tay y học cổ truyền Ebooks Nhóm Zalo GS. TRAN THUY TS. VU NAM KHOA Y HOC CO TRUYEN - TRUONG DAI HOC Y HA NOI SO TAY Y HOC CO TRUYEN NHA XUAT BAN V HOC GS. TRAN THUY - TS. VU NAM TRUONG DAI HOC Y HA NOl - KHOA Y HOC CO TRUYEN ■ ■ ■ ■ SOTAY Y HOC CO TRUYEN (Tai ban Ian thii nhat) NHA XUAT BAN Y HOC HA NOI - 2006 LCfl NOI DAU Thuc hien nghi quyet cua Dai hoi Dang cong san Viet Nam lan thur IV, lan V, lan VI... Nghi quyet 266/CP cua Hoi dong chinh phu ve viec phat trien y hoc dan toe co truyen, nhSm xay dung nen Y hoc Viet Nam, can cuf muc dich va yeu cau dao tao cua Bo Y te nude cong hoa xa hoi chu nghia Viet Nam cho cac Truong Dai hoc Y, chung toi bien soan tap tai lieu y hoc co truyen vdi muc dlch giup cho cac sinh vien y khoa co tai lieu tham khao va hoc tap ve y hoc dan toe co truyen theo chUOng trinh cai cach. Muc dich yeu cau cua tai lieu ve mat ly thuyet la ndm duoc nhufng diem co ban cua nen y hoc dan toe, chu yeu la cham cufu va thuo'c nam, ve mat thuc hanh la suf dung cham cufu va thuoc nam de chufa mot so benh thuc/ng gap d cac khoa lam sang (chu yeu la noi, ngoai, nhi, phu, lay... thufemg gap de phuc vu muc tieu cham soc sufc khoe ban dau). Noi dung tai lieu gom 5 phdn: Plian I: Tinli hinh y hoc co truyen; chu trUong ket hap y hoc liien dai voi y hoc co truyen cua dan toe va nhUng bien phdp tien lianli de xay dung nen y hoc Viet Nam cua Dang va Nha nilac. Phdn II: Khai niem ve ly luan y hoc co truyen. Phdn III: Cac pliUang phdp chiCa benli kliong dung thuoc: cham ciCu, xoa bop va mot so cach cham khac. Phan IV: Thuoc nam va mot so bai thuoc nam thudng dung. Phan V: Ap dung cham ciCu va thuoc nam de chUa mot so doing benh hay gap De giup cho viec suf dung tot tai lieu nay chung toi xin gidi thieu yeu cau cua tifng phan nhu sau: 3 Phan I: Nam duoc tinh hinh phat trien cua nen y hoc dan toe co truyen chu trifong dudng loi ket hop y hoc hien dai vori y hoc dan toe co truyen cua Dang va Nha nude, y nghla va bien phap thuc hien. Tren co sd nhufng nhan thufc xay nay xay dung cho hoc sinh long tu hao dan toe, tin tudng dudng loi sang suot cua Dang va Nha nude quyet tarn hoc tap ly luan, suf dung cac phuong phap chufa benh cua y hoc co truyen tang them kha nang phong chufa benh cho nhan dan, tdng budc day manh viec ket hop y hoc hien dai vdi y hoc co truyen trong cong tac phong benh, chufa benh, dao tao can bo, nghien cufu khoa hoc cua nganh. Phan II: Hieu duoco mot so' khai niem ca ban ve ly luan y hoc co truyen bao gom mot so" hoc thuyet nhu am duong, ngu hanh, con ngUdi va tu nhien... tang tuong, kinh lac; cac nguyen nhan gay benh; phuong phap chan doan, phep tac chufa benh lam ca sd cho viec hoc tap va chufa benh bang cham curu va thuoc nam. Phan III: Ve cac phuong phap chufa benh khong dung thuoc can thay ro loi ich cua tifng phuong phap co tac dung tot trong viec chufa nhieu chufng benh khong gay doc hai va tiet kiem cho ngifdi benh. 1. Ve cham cdu va cac phuong phap khac can hieu co che va tac dung cua phuong phap diTa tren co sd cua hoc thuyet than kinh the dich chi dao cho viec hoc tap, tien hanh cham cufu duoc de dang nhanh chong phai ndm chSc duoc ky thuat cham va cufu de dam bao duoc ket qua cua phuong phap nhd duoc vi trl cua 90 - 120 huyet thudng dung theo tdng vung co the va mot cong thufc de chiJa mot so chufng benh. Ngoai ra tai lieu con gidi thieu ve phuong phap cham te de phau thuat cham d loa tai, tiem thuoc vao huyet va gidi thieu so luoc ve he thong kinh lac vdi 14 dudng kinh, cac huyet da hoc, de ngudi hoc co the tham khao cac sach va tai lieu cham cdu xuat ban trong nude va ngoai nude theo quan niem Y hoc co truyen. 2. Ve xoa bop: Tai lieu gidi thieu tom tdt mot so' thu thuat xoa bop, chu yeu la phuong phap bam huyet de chufa mot so' chufng benh, mot cach do'n gian gop them kha nang chufa benh khong dung thuoc. Phan IV: Ve thuoc Nam va cac bai thuoc, can nam tmh chat, tac dung chufa benh cua ttfng loai thuoc co trong niidc, van dung duoc moi lien he chat che ve tac dung cua cac vi thuoc hien co de ke don chufa mot sd chufng benh theo benh danh cua Y hoc hien dai. 4 Tat ca cac vi thuoc co trong nifdc va cac bai thuoc duoc ghi lai theo kinh nghiem cua cac co sd y te da thtfa ke va da dtroc ufng dung chufa benh co ket qua. Phan V: Tren co sd ly luan ve cham cufu va thuoc nam da neu of cac phan tren tai lieu hudng din cach chufa benh theo ly luan cua y hoc co truyen ket hop vdi y hoc hien dai de chufa mot so' chdng benh theo benh danh cua y hoc hien dai d cac khoa noi, nhi, lay, phu, ngoai... tuy theo cac chuyen khoa cua cac y bac si va cac liiOng y ma nghien cufu ap dung cho thlch hop. Bien soan mot tai lieu ve y hoc co truyen kho tranh khoi nhufng thieu sot. Trong qua trinh suf dung tai lieu nay chung toi mong muon nhan diioc nhieu y kien dong gop phe binh cua cac ban dong nghiep nhat la cac vi luong y, cac bac si chuyen khoa y hoc co truyen, cac can bo giang day cua cac triidng dai hoc, trung hoc va anh chi em sinh vien y khoa de bo sung cho tai lieu ngay cang hoan chinh hon. c A c t A c g iA 5 TAM BIEU CAN TRANH CUA NGUCil THAY THUOC (Lai ran cua Dai Y ton Hai Thitgng Lan Ong) 1. Co benh nen xem xet da roi mdi boc thuoc, hoac vi ngai dem mi/a vat va khong chiu tori tham ma da cho phaong, do la cai toi ladi. 2. Co benh nen uong thuT thuoc nao do mdi ciJu duoc nhang so ngudi benh ngheo tung, khong tra duoc von nen chi cho loai thuoc re tien, do la cai toi bun xin. 3. Khi thay benh chet da ro, khong bao thac, lai noi lo mo de lam tien do la cai toi tham. 4. Nha thay benh de chufa, noi doi la kho, le ladi chau may doa cho ngudi ta so de lay nhieu tien do la cai toi lCfa doi. 5. Nha thay benh kho, dang le bao thac, roi het sufc cufu chufa, nhung lai so mang tieng khong biet thuoc va lai chufa ch&c da thanh cong ma da nhu the thi khong duoc hau loi nen kien quyet khong chiu chufa den noi ngadi ta bo tay chiu chet do la toi bat nhan. 6. Co trUdng hop ngudi benh, ngay thudng co bat binh vdi minh, khi mac benh phai nhd den minh, lien nghi ra y nghi oan thu, khong chiu chufa het long do la cai toi hep hoi. 7. Lai nhu thay ke mo coi goa bua, ngudi hien, con hiem ma ngheo doi om dau thi cho la chufa mat cong vo ich, khong chiu het long, do la cai toi that dufc. 8. Lai nha xet benh con Id md, sac hoc con non da cho thuoc chda benh do la cai toi dot nat. (Trfch tom tat trong am an so 10 cua Hai Thadng Lan Ong) 6 PHAN I TINH HINH Y HOC CO TRUYEN VA CHU TRl/ONG KET HOP Y HQC CO TRUYEN V(5l Y HOC h ie n d a i c u a d a n g v A n h A nU<3c I. TINH HINH Y HQC CO TRUYEN Dan toe ta da co tren 4.000 nam lich suf, co nhieu truyen thong xay dang dat nadc, danh giac giuf nadc, phat trien van hoa. Trong qua trinh chien dau va lao dong nhan dan ta co nhieu kinh nghiem ve phong benh, chCfa benh de bao ve sdc khoe. Qua cac then ky lich suf cua dan toe, nen y hoc co truyen Viet Nam khong ngting phat trien. 1. Then ky dung nadc (theri ky Hong Bang 2900 nam trade CN) Trinh do y hoc cua cha ong ta da tien bo nha biet dung cong thac nhuom rang de bao ve rang lau ben, biet an trau de klch thich than kinh chong lanh, biet lam banh trOng (mot mon an bo de daqc lau). Ddi Thuc An Daong Vaong, co Laong y Thoi Vi da dung phep cau de chda lao hach d co. 2. Thoi ky dau tranh gianh doc lap lan tha nhat (tU 111 trade CN - 937 sau CN) Y hoc Trung Quoc daoc truyen sang ta, cac sach thuoc, vi thuoc daoc dem sang va cac thay thuoc sang ta de chaa benh. Ngaoc lai nhieu vi thuoc nha Y di, Tram haong, Uat kim (cu nghe), To moc, v.v... cac bai thuoc nha Cao ngoc long cung daoc daa sang Trung Quo'c. Trong suot 1.000 nam dau tranh gianh doc lap dan toe, cha ong ta mot mat phat huy truyen thong y hoc dan toe, mat khac tiep thu Trung y, xay dang nen y hoc dan toe Viet Nam. 3. Thoi ky doc lap: Ngo, Dinh, Le, Ly, Tran, Ho (nam 932 - 1407). Nen y hoc dan toe phat trien, bieu hien nha: - Xay dang to chac y te, dat cac chac tadc y te tir trung aong den dia phaong. 7 - Thuoc nam, cham cuTu daoc chu trong tU thofi ky nha Ly va nha Tran - Co nhieu danh y soan tac pham y hoc. Danh y co: Chu Van An (Tran), Nguyen Dai Nang (Ho) noi tieng nhat la cu Tue Tinh (Tran) vdi tac pham "Nam daoc than hieu" (Nam daoc tri nam nhan) chu traong ngadi Viet Nam dung thuoc nam, chong ta tadng sung bai thuoc b&c va y hoc nadc ngoai, la ngadi thay thuoc dau tien de cap den van de y va daoc (bao gom) viec sau tam cac vi thuoc nam, tong ket kinh nghiem chda benh thuoc nhieu khoa lam sang mot cach toan dien. Cu Tue Tinh daoc ngadi daong thdi ca tung la bac dai thien, dai nho dai y, dai daoc, ngadi ddi sau coi la vi thanh thuoc nam. 4. Thdi ky gianh doc lap lan tha hai (1407 - 1427) Thoi ky nay tuy ngan nhang rat tai hai doi vdi nen van hoa nadc ta vi phong kien nha Minh co chinh sach tieu diet van hoa dan toe, dong hoa ngadi Viet Nam. Chung vo vet sach vd, daa cac si phu, danh y Viet Nam ve nadc (Cue dadng di cao cua Tran Nguyen Dao, Daoc thao tan bien cua Nguyen Chi Tan...) Y hoc do do khong phat trien. 5. Thdi ky doc lap lan tha hai: (Hau Le, Tay Son, Nguyen 1428 - 1876) Trong thdi ky nay y hoc co truyen co nhang dac diem sau: - To chdc y te daoc chan chinh: Thanh lap Thai y vien d Trung aong, cac to chac y te dia phaong, cac chua chien la noi chda benh cho nhan dan. Dao luat Hong Dac (Le) noi ve phap y. Hinh luat Gia Long co ghi to chac phap y va laong y giam dinh cac tradng hop ngo doc thuoc, lam lan thuoc gay chet ngadi. - Md tradng dao tao can bo (Ta Ddc) - Cac danh y co nhieu tac pham ve phong benh, chaa benh dich (Nguyen Gia Phan thdi Tay Son viet quyen Lieu dich phaong phap toan tap) dac biet co danh y Hai Thaqng Lan Ong (1720 - 1779) da de lai bo sach: "Hai thaong y tong tam linh ap dung sang tao ly luan Trung y vao hoan canh thac tien Viet Nam, de cap toan dien cac van de y hoc nha quan diem phuc vu, dao dac ngadi thay thuoc, ly luan y hoc, chan doan hoc, dieu tri hoc, ve sinh phong dich, dao tao can bo, nghien cdu y hoc, sinh de co ke hoach v.v... 6. Thdi ky Phap do ho: (1879 - 1945). Thac dan Phap chu traong tieu diet nen van hoa nadc ta, loai y hoc co truyen ra khoi to chdc y te bao ho, daa nen y te thac dan xam nhap vao, nhang vdi chinh sach ngu dan cua chung, chi xay dang mot nen y te que quat han che, tap trung mot vai tinh thanh, chu yeu phuc vu cho cac giai cap thong tri. 8 Dai da so nhan dan van chufa benh, tin nhiem y hoc co truyen. Am miAi chia re lam mat tinh chat dan toe Viet Nam cua thac dau Phap da anh hadng sau sac den viec doan ket, nhufng ngadi lam cong tac y te y hoc co truyen, y hoc hien dai ngay nay. 7. Thdi ky nadc Viet Nam dan chu cong hoa Cach mang Thang Tam thanh cong, Nha nadc Viet Nam Dan chu Cong hoa daoc thanh lap, md ra ky nguyen mdi trong lich suf dan toe ra, nhang bon de quoc Phap, My tiep tuc xam laqc nao'c ta. Trong dieu kien vUa khang chien chong xam laoc, vaa xay dang dat nadc, nen y te Viet Nam trong do co y hoc co truyen trai qua 3 thdi ky. a) Thdi ky chong thac dan Phap xam laoc (1945 - 1954): chu yeu dong vien cac thay thuoc, laong y, daoc si tham gia khang chien, bao ve sac khoe cho can bo chien si va nhan dan ta. De giai quyet van de thieu thon do dich phong toa, viec tim kiem cac nguon daoc lieu thay the daoc phat trien, nhat la d Nam Bo da sdm de ra van de ket hop y hoc co truyen vdi y hoc hien dai, suf dung thuoc nam de phong, chda benh cho nhan dan, can bo, quan doi. b) Thdi ky hoa binh lap lai: Ho Chu tich la ngadi trade hon ai het quan tam den van de ket hop y hoc co truyen vdi y hoc hien dai. Trong bde tha gufi cho dai hoi nganh y te ngay (27 - 2 - 1955), Ngadi viet: "Trong nhdng nam bi no le, thi y hoc cua ta cung nha cac nganh khac da bi kim ham. Nay chung ta da doc lap, ta do, can bo can giup dong bao, giup Nha nadc xay dang mot nen y te thich hop vdi nhu cau cua nhan dan ta. Y hoc cung phai daa tren nguyen t&c khoa hoc, dan toe, dai chung". Ngadi lai chi rd "Ong cha ta ngay trade co nhieu kinh nghiem quy bau ve cach chda bang thuoc ta, thuoc b&c. De md rong pham vi y hoc, cac co cac chu cung nen chu trong nghien cdu, phoi hop thuoc Dong va thuoc Tay". Nghi quyet Dai hoi Dang lan thd III nam 1960 va chi thi 101 TTg cua Thu tadng Chinh phu ngay 15 - 3 - 1961 vach ro toan bo phaong phap chu traong ket hop y hoc co truyen vdi y hoc hien dai cua Dang va Chinh phu nha: "Phoi hop chat che y hoc co truyen vdi y hoc hien dai trong cong tac y te tren cac mat phong benh, chda benh, san xuat thuoc men, dao tao can bo, nghien cUu khoa hoc". (Trich van kien dai hoi Dang) "Tren co sd khoa hoc, thda ke va phat huy tot nhdng kinh nghiem cua y hoc co truyen ket hop Dong y, Tay y nham tang cadng kha nang phong benh, chda benh cho nhan dan tien len xay dang mot nen y hoc Viet Nam xa hoi chu nghia (Trich chi thi 101 T. T.g cua Thu tadng Chinh phu). 9 Daa tren nhang van kien tren, nganh y te da co nhQng bien chuyen bade dau nha: - Dat van de ket hop y hoc co truyen va y hoc hien dai la mot trong cac quan diem cach mang de xay dang nganh. - Xay dang Vien Y hoc co truyen de nghien cufu thaa ke y hoc co truyen va ket hop y hoc co truyen vdi y hoc hien dai. - Daa mon hoc y hoc co truyen thanh mon chinh khoa tai cac Tradng dai hoc, trung hoc, so hoc cua nganh. Thanh lap cac bo mon y hoc co truyen tai cac tradng tren de giang day y hoc co truyen. - Thanh lap cac benh vien y hoc co truyen d cac tinh, cac khoa y hoc co truyen d cac benh vien tinh, huyen, de thaa ke va ket hop y hoc co truyen vdi y hoc hien dai dieu tri. - Pho cap thuoc Nam, cham cdu xoa bop trong toan nganh nhat la d cac tuyen co sd. c) Thdi ky khang chien chong xam laoc cua de quoc My: nadc Cong hoa xa hoi chii nghia Viet Nam. Dadi sanh sang cua Nghi quyet Dai hoi Dang lan thd III nam 1960 va Nghi quyet Dai hoi Dang lan tha IV nam 1976. Toan nganh y te bang moi bien phap can thiet de phuc vu cho chien dau, san xuat tren co sd phat huy cac thanh qua da dat daoc, trong thdi ky hoa binh xay dang Nganh Y te, y hoc co truyen vdi thuoc Nam, cham cdu da co nhieu dong gop dang ke. Trong thdi ky nay, Nha nadc kiem diem lai tinh hinh ket hop y hoc co truyen vdi cong tac dong daoc da ra chi thi 21/CP ve viec ket hop y hoc co truyen vdi y hoc hien dai, chi thi 210 ve van de daoc lieu, gan day Nha nadc lai co nghi quyet 200/CP va 266/CP. Nam 1975, cuoc chien tranh bao ve to quoc da gianh th&ng lgri huy hoang: nadc nha hoan toan doc lap, thong nhat. Ca nadc ta bade vao thdi ky xay dang chu nghia xa hoi. Bo Y te dang co nhang chu traong bien phap tich cac, co hieu lac hon de day manh viec ket hop y hoc co truyen vdi y hoc hien dai, xay dang nen y hoc Viet Nam de thac hien Nghi quyet Dai hoi Dang lan tha IV va lan tha V. II. TAI SAO PHAI KET HOP Y HQC CO TRUYEN V(3l Y HOC HIEN DAI TRONG VIEC XAY DlfNG NGANH Y TE VIET NAM 1. Ket hop y hoc co truyen vdi y hoc hien dai la mot cuoc cach mang trong y hoc de xay dang mot nen y hoc Viet Nam XHCN co day du tinh chat khoa hoc, dan toe va dai chung. Y hoc ngay nay la do nhang thanh qua ve bao ve sufc khoe cua nhan dan toan the gidi, nhang thanh tifu khoa hoc tao ra. Tren the gidi cung 10 nhu trong nadc ta thac te co hai nen y hoc: y hoc hien dai va y hoc co truyen cung ton tai. Moi nen y hoc deu co liu diem va nhiioc diem cua no, neu ket hop thanh mot nen y hoc hoan chinh se mang tinh chat hon han ve khoa hoc no se la mot nen y hoc tien bo nhat. Nen y te Viet Nam XHCN ket hop y hoc co truyen va y hoc hien dai vdi nguon daoc lieu phong phu trong nadc, nhufng kinh nghiem phong benh va chufa benh cua ong cha ta, d mot nadc nhiet ddi co nhufng dieu kien thien nhien rieng biet cua no, mang nhieu mau S£tc dan toe nhat. Nen y te Viet Nam XHCN ket hop y hoc co truyen vdi y hoc hien dai co tinh chat dai chung vi no phuc vu cho toan the nhan dan Viet Nam, daoc quan chung ifa thich, dong vien daoc toan the can bo y te, lirong y va nhan dan cung dong gop y kien, kinh nghiem quy bau de xay dang nganh. 2. Ket hop y hoc co truyen vdi y hoc hien dai, doan ket va thong nhat daoc toan bo can bo y te Viet Nam, dong vien thtia ke daoc cac kinh nghiem tot trong nhan dan, phuc vu cho cong cuoc xay dang chu nghia xa hoi va bao ve To quoc. To chdc y te Nha nadc ta hien nay co mot doi ngu can bo dong dao thuoc nhieu chuyen khoa khac nhau tU Trung irong den dia phaong. Mat khac con nhufng ngadi lam cong tac y hoc co truyen chuyen nghiep tdi con so' hon mot van ngadi co mot to chac quan chung bao gom hoi Y hoc co truyen Trung aong, cac tinh hoi, cac phong chan tri y hoc co truyen, cac to chan tri phuc vu giai quyet benh cho benh nhan bang nufa tong so' benh nhan do y te Nha nadc dam nhiem. Thong nhat daoc dpi ngu can bo y te Nha nadc, cac laong y chuyen nghiep, ban chuyen nghiep lai, thi mang ladi y te vdi lac lapng dong dao nha vay se tang cadng kha nang phuc vu rat nhieu cho cong cuoc xay dang, bao ve dat nadc. Hien nay d mien xuoi, mien nui con rat nhieu nhang bai thuoc hay, nhang vi thuoc qui, nhang kinh nghiem chaa benh rat co hieu lac can gap rut sau tam, thaa ke phat huy neu khong se mai mot di, do la mot dieu thiet thoi rat ldn cho cong tac y te, chi co ket hop chat che hai nen y hoc thanh mot nln y hoc xa hoi chu nghia mdi thac hien tot van de nay. 3. Ket hop y hoc co truyen vdi y hoc hien dai mang tinh chat ta lac canh sinh, co tinh chat kinh te ldn trong viec can kiem xay dang dat nadc. 11 Kha nang ve daoc lieu d nadc ta rat ldn: co nhieu loai thuoc quy, va nhieu cay thuoc chda benh; nadc ra d mien nhiet ddri, co nhieu dieu kien khai thac, trong trot thuoc. Ket hop y hoc co truyen vdi y hoe hien dai se day manh cong tac daoc lieu, cong tac san xuat cay thuoc, thuoc dung trong nadc daoc nhieu, nhanh, tot, re, dong gop vao viec xuat khau, han che viec nhap nhufng thuoc nadc ngoai... III. NHtfNG BIEN PHAP KET H0P Y HOC CO TRUYEN V(3l Y HOC HIEN DAI TRONG VIEC XAY DlfNG NGANH Y TE Can cuf vao tha cua Ho Chu tich, Nghi quyet Dai hoi Dang lan thuf IV, lan thuf V, lan thd VI cac chi thi 101 T.Tg, 21 - CP, 210, 266 - CP cua Thu tadng Chinh phu, cac Thong ta cua Bo y te, cong tac ket hop y hoc co truyen vdi y hoc hien dai de xay dang nganh y te co nhang bien phap ldn sau day: 1. Ve mat nhan thdc ta tadng Phai lam cho moi ngadi, nhat la can bo y te thay ro sa can thiet, co loi ich trong viec ket hop y hoc co truyen vdi y hoc hien dai. Tren co sd do khac phuc cac ta tadng sai lam. - Khong tin tadng d dadng loi ket hop y hoc co truyen, y hoc hien dai cua Dang, Nha nadc. - Ta tadng coi thadng thuoc y hoc co truyen va cac phaong phap chaa benh cua y hoc co truyen, coi nhe thuoc nam, coi trong thuoc nhap d nadc ngoai trong can bo y te va laong y. - Coi nhe gia tri cua y hoc co truyen do ta tadng hoai nghi cua mot so can bo vi chaa dapc biet, chaa daoc hoc, dapc lam, v.v... cac phaong phap chda benh cua y hoc co truyen. 2. Gap rut ke thaa nhdng kinh nghiem chda benh cua y hoc co truyen. Nhang kinh nghiem chaa benh, nhdng cay thuoc quy con n&m rat nhieu trong nhan dan, nhat la d vimg cac dan toe it ngadi. Nhdng kinh nghiem nay xaa nay dapc truyen theo tinh chat gia truyen (cha truyen con noi). Nhang vi laong y co tai, co nhieu uy tin, co kinh nghiem chda benh cho nhan dan, hien nay tuoi da cao, sdc da yeu, can gap rut ke thda nhang tai san quy bau do, va la mot dieu hoan toan co the lam tot trong che do xa hoi ta hien nay. 12 3. Day manh cong tac nghien cufu y hoc co truyen Y hoc co truyen co nhufng s&c thai doc dao, hoan chinh bao gom tU ly luan, chan doan, chufa benh, cach dung thuoc, nhang do dieu kien lich sd no thac te chi la mot nen y hoc lam sang va kinh nghiem. Vi vay can dem nhufng thanh tau khoa hoc ky thuat hien dai de nghien cufu ban chat cua no nha sinh hoa, vi sinh hoc, dong vi phong xa, xet nghiem chan doan, X quang, v.v... Can phai co ke hoach hoan chinh, lam tang bade bao gom nhieu mat. - Nghien cufu lich suf nln y hoc co truyen nadc nha, cac tac pham cua cac danh y trong nadc. - Nghien cufu ly luan co ban cua y hoc co truyen - Nghien cufu cong tac dieu tri benh bang ket hop y hoc co truyen vdi y hoc hien dai 4. Day manh cong tac dao tao can bo. Can gap rut dao tao dapc mot dpi ngu can bo dam nhiem dapc cac mat cong tac nha: - Giang day y hoc co truyen - Ket hop y hoc co truyen vdi y hoc hien dai trong viec chaa benh phong benh. - Pho cap cho can bo y te trong toan nganh co mot kien thac thac hanh y hoc co truyen nhat la thuoc nam va cham cau, dac biet la cac can bo y te co sd: so trung, cao cap ta Trung aong den co sd - Doi vdi can bo dapc, can day manh giao due mon dapc lieu, bao che thuoc y hoc co truyen. Cong tac dao tao can bo biet ket hop y hoc co truyen vdi y hoc hien dai trong san xuat thuoc va chaa benh la vo cung quan trong, chi khi nao dpi ngu nay dong dao, lam nong cot thi cong tac ket hop y hoc co truyen vdi y hoc hien dai mdi co chuyen bien manh me. 5. Xay dang chinh sach toan dien ve y hoc co truyen. Chinh sach y hoc co truyen dam bao cho viec thac hien dadng loi ket hop y hoc co truyen vdi y hoc hien dai thu dapc th&ng lpi no bao gom nhieu mat, nhang dac biet ngay nay la: - Chinh sach dai ngo, hadng thu theo tai nang, cong hien cua cac vi laong y. 13 - Chinh sach khen thadng, khuyen khlch phat minh, sang kien nhat la doi vdi nhufng ngadi da dong gop nhufng kinh nghiem chufa benh, nhufng cay thuoc quy, v.v... Tao dieu kien cho cac laong y dapc hanh nghe phuc vu nhan dan, tot nhat la difa vao cac to chufc y te Nha nadc, cac hop tac xa, cac to chan tri y hoc co truyen. 6. Kien toan cac to chdc ket hop y hoc co truyen vdi y hoc hien dai tU Trung aong den dia phaong. - Kien toan to chac chi dao ket hop y hoc co truyen vdi y hoc hien dai tren Bo y te, cac ty y te (Vu Y hoc co truyen, phong y hoc co truyen). - Day manh hoat dong cua cac to chdc hoi y hoc co truyen, cac tinh hoi huyen, chi hoi, de dong vien toan bo quan chung lam y hoc co truyen dong gop vao viec bao ve sdc khoe nhan dan, thaa ke sau tam y hoc co truyen, v.v... - Xay dang cac Vien nghien cdu y hoc co truyen, cac benh vien y hoc co truyen, cac khoa y hoc co truyen thanh nhang trung tam chi dao viec ke thaa nghien cdu y hoc co truyen d Trung aong va dia phaong. 7. Giai quyet tot van de dapc lieu. Van de dapc lieu hien nay la mot trong nhang van de quyet dinh cho viec thac hien y hoc co truyen, y hoc hien dai dat dapc ket qua, phat trien thanh qua bao gom nhang cong tac sau day: - Dieu tra sif co mat va tra lapng cay thuoc thien nhien d nadc ta, lap ban do dapc lieu. - Nghien cdu di thac cac cay thuoc d nadc ngoai vao nadc ta. - Khoanh vung trong trot cay thuoc trong nadc, cay thuoc da di thac san xuat dapc lieu. - Khong ngang cai tien cac dang thuoc y hoc co truyen, de sd dung bao quan dapc de dang, dam bao chat lapng tot. - Co gia ca khuyen khich cho nhdng ngadi trong, san xuat dapc lieu. - Khuyen khich, tuyen truyen va sd dung thuoc y hoc co truyen, v.v... IV. KET LUAN Van de ket hop y hoc co truyen vdi y hoc hien dai la mot quan diem cua Dang trong nganh y te, mot quan diem sang suot de xay dang nen y hoc Viet Nam xa hoi chu nghia mang day du tinh khoa hoc, dan toe va 14 dai chung co hieu ltfc, trong viec bao ve sufc khoe cho nhan dan de xay dyng chu nghia xa hoi va bao ve to quoc. Bkng dtfcmg loi quan stf macxit van dung vao cuoc chien tranh cua nhan dan; Dang ta da thanh cong rUc rd danh bai bon xam lirpc Phap, My nhat dinh se xay dang thanh cong nen y te Viet Nam xa hoi chu nghia, chi can moi ngtfdi quan triet quan diem va ra sric thifc hien nghiem chinh, sang tao moi bien phap ma Chinh phu, Bo Y te da de ra. 15 PHAN II KHAI NIEM VE LY LUAN Y HOC CO TRUYEN TRIET HOC PHUONG DONG tfNG DUNG TRONG Y HOC I. HOC THUYET AM DUONG 1. DAI Cl/dNG Gan 3.000 nam nay, ngifcri xifa da thay sif vat luon luon co sir mau thuSn nhufng thong nhat vdi nhau, khong ngifng van dong de phat sinh phat trien va tieu vong, goi la Hoc thuyet am difong. Trong y hoc co truyen thuyet am difong quan triet tif dau den cuo'i, tif don gian den phijfc tap trong suo't qua trinh sinh ly, benh ly, chan doan va dieu tri. 2. CAC QUY LUAT Cd BAN CUA HOC THUYET Am DUdNG a. Am difong doi lap va ho can - Doi lap: la suf mau thuln giCfa hai mat nhif ngay va dem, mfdc va lifa hifng phan va ufc che... - Ho can: la sif nifong tufa vao nhau cua hai mat nhif co so' am phai co so' difong, co dong hoa mdi co di hoa, v.v... b. Am difong tieu trifdng va binh hanh - Tieu trifomg: tieu la sif mat di, trifdng la sif trifdng thanh noi len qua trinh van dong khong ngifng cua sif vat. - Binh hanh: la sif thang bang giifa hai mat doi lap. Bon mat tren cua sif vat noi len cac quy luat: mau thuan nhang thong nhat, sif van dong khong ngifng nifong tifa nhifng che ifdc lan nhau trong qua trinh phat sinh, phat trien, tieu vong cua sif vat. Tif cac quy luat tren, ngifori ta con suy ra mot so' van de cu the: trong am co difong, trong difong co am; ban chat va hien tifpng; sif tifong doi cua hai mat am difong de van dung trong tif nhien va y hoc cho ro rang hon. Ngifcfi xifa da tifpng trifng Hoc thuyet am difong bang mot hinh tron co difdng cong chia dien tich lam hai phan bang nhau: mot phan la am, mot 16 phan la di/ong. Cf moi phan co mot nhan: phan difong co nhan am, phan am co nhan diiong. 3. LfNG DUNG: a. Trong thien nhien: Am Dat M at Nifcifc Dirdi Trong Lanh Yen So am v.v... trang . tinh Dirang Troi M at trcfi Lufa Tren Ngoai Nong Hoat dong So diiong v.v... b. Trong co che con ngifcfi: ve sinh ly Am Tang Kinh am Huyet Bung Han tfc che Di hoa Hu Dirong Phu Kinh diiong Khi Liing Nhiet Hung phan D6ng hoa ThiTc - Ve qua trinh phat sinh benh tat, chan doan va chufa benh,phong benh. Benh tat phat sinh do suf mat thang bang ve am duWng, bieu hien hoac thien ve dirong (difong th&ng) hoac thien ve am (am th&ng) hoac kem ve phan difong (diiong hiT) hoac kem ve phan am (am hu). Dieu tri benh la dieu hoa lai am daong, tuy theo cac tinh trang benh ly tren ma dung cac phiftmg phap chufa benh thich hop. Trong chan doan cac benh tat ngiidi ta dung cac ciiong linh ldn nhir trong va ngoai de dinh ro vi tri cua benh: hir va thiTc de xac dinh tinh trang cua co the va benh tat, han nhiet de noi len trang thai cua benh tat; xu the chung cua benh tat hoac thien ve phan am, hoac thien ve phan diiong (am va difong la hai cuong linh tong quat nhat). - Ve suf dung thuoc: ngtTc/i ta chia thuoc lam hai loai + Thuoc co tinh chat mat va lanh dung de chufa benh nhiet (nong). + Thuoc co tinh chat am va nong dung de chufa benh han (lanh). II. HOC THUYET NGU HANH 1. DINH NGHIA Hoc thuyet ngu hanh la Hoc thuyet am duong lien he mot cach cu the hon trong viec quan sat quy nap, sir lien quan cua cac sp vat trong thien nhien T2- STYHCT 17 Trong y hoc, vi ngifdi xifa cho con ngifdi la mot vu tru nho, nen dung Hoc thuyet ngu hanh de quan sat, quy nap va stf taong quan trong cac hoat dong sinh ly, benh ly; ngoai ra con dung de tim tac dung thuoc de ap dung cac cong tac bao che thuoc. 2. NOI DUNG CUA HOC THUYET NGU HANH a. Ngu hanh la gi ? Ngiidi xifa cho rang trong thien nhien co 5 loai vat chat chlnh.kim: kim loai; moc: go; thuy: ntfdc; hoa: lufa; tho: dat. Moi hien tifpng trong tif nhien difpc quy nap va xep theo 5 loai vat chat tren goi la ngu hanh. b. Quy nap trong thien nhien va co the con ngifdi (xem bang difdi) hanh Hien tiiong Moc Hoa Tho Kim 1 Thuy ;Vat chat Go, cay coi Lufa Dat | Kim loai Nifcfc Mau sSc (ngu sac) Xanh Do Vang Trang Den Vi (ngu vi) Chua DSng Ngot LCay Man Thdi tiet Xuan Ha Cuoi ha Thu Dong Phuong Dong Nam Trung UOng Tay Bac Tang Can Tam Ty Phe Than Phu Ddm Tieu tri/6ng Vj Dai trUcfng Bang quang Ngu quan M at LiTofi M ieng Mui Tai Bieu hien ben ngoai Can Mach Thit Da long Xuong, tuy Tinh chi Gian Mifng Lo nghi Buon Sg _ c. Cac quy luat hoat dong cua ngu hanh Trong dieu kien binh thifdng, vat chat co lien quan mat thiet vdi nhau thuc day nhau bien chuyen khong ngifng bang cach tifong sinh (hanh nay sinh hanh kia, thuc day hanh kia) hoac che ufc Mn nhau de giuf difpc moi lien he am difong bang cach khac nhau (hanh nay che ifdc, han che hanh kia). - Quy luat tifong sinh: Go (moc) dot chay sinh ra lufa (hoa); lufa thieu moi vat thanh tro bui trd thanh dat (tho); trong long dat sinh ra kim loai (kim) the ran chac; the ran chac sinh the long ntfdc (thuy); co nadc sinh ra cay coi (moc). 18 Vi du: trong con ngufdi, can sinh tam, tam sinh ty, ty sinh phe, phe sinh than, than sinh can. Quy luat tifong khac: Moc khac tho nhif re an sau vao long dat; tho khac thuy nhif dap de, dap dat tri thuy ngan song; thuy khac hoa de chifa chay; hoa khac kim de nau kim loai; kim khac moc nhif dung dung cu kim loai de chat, cifa xe go. Vi du: trong con ngifdi, can khac ty, ty khac than, than khac tam, tam khac phe, phe khdc can. - Quy luat tifong sinh va tifong khac cua ngu hanh difpc tifpng trifng bang hinh (1). Trong dieu kien bat thifdng va dieu kien benh ly co nhieu phu tang qua manh hay qua yeu xay ra hien tifong khac qua manh (tifong thifa) hay cho'ng lai cai khac minh (tifong vu) y hoc co truyen dung quy luat tifong thifa hay tifong vu de giai thich mot so' co che benh sinh va ap dung dieu tri. Tin du ve tuang thUa: binh thifdng thi can moc khac ty tho, nhifng neu can qua manh khac ty yeu gay nen hien tifpng dau da day, khi chifa benh phai dung phifong phap binh can (ha hifng phan cua can) va kien ty (nang cao sif hoat dong cua ty). Moc (can) Hinh 1: Thi du ve tuong vu: Binh thifdng thi ty tho khdc than thuy, trong benh phu do thieu dinh difong vi ty tho bi lan nen tieu hoa kem gay nen hien tifpng phu, uf nifdc (thuy vu tho) vi vay khi dieu tri ngifdi phu dinh difdng phai kien ty (nang cao ty tieu hoa tot) va lpi nieu (ha than thuy) de lam mat phu. 19 3. LfNG DUNG TRONG Y HOC a. Be xac dinh vi tri phat sinh ra mot chUng benh thuoc tang phu nao roi dua ra phuong phap dieu tri cho thlch hop. Co the do 5 vi tri sau: - Ban than tang ay bi benh: chinh ta - Do tang trUdc no sinh ra: hu ta - Do tang sau no dua den: thuc ta Dia ly: khi hau, hoan canh tu nhien, trong san xuat d moi dia phirong la dieu kien anh hudng den moi trUdng song con ngifdi. b. Hoan canh xa hoi: trong dieu kien xa hoi co giai cap, hoac co tan da cua xa hoi co giai cap, gay nen ve hoat dong tam ly xa hoi, lam anh hudng den tir tudng, tinh cam con ngifdi. c. Con ngudi can luon luon thlch ufng vdi hoan canh tu nhien va xa hoi: hoan canh xa hoi va thien nhien la nhufng yeu to can thiet cho sU song cua con ngudi, nhung mat khac la nhufng dieu kien gay ra benh tat. Con ngudi muon sinh ton va phat trien can thlch nghi vdi hoan canh nhu han che, khac phuc, cai tao hoan canh. Muon thlch nghi vdi hoan canh thien nhien, con ngudi can co sUc khoe tot, phai phong benh, sinh hoat dieu do, an uong day du. Mat khac phai cai tao xa hoi, xay dung tinh than, tu tudng lanh manh, luon luon lac quan tin tudng de vUOn len lam chu thien nhien, lam chu xa hoi. 4. tfN G D UNG TH U Y E T T H IE N N H A N H 0 P N H A T V A O Y HOC a. La noi dung phuong phap phong benh cua y hoc co truyen: - Phong benh tlch cUc: + Cai tao thien nhien, bat thien nhien phuc vu ddi song + Chu dong ren luyen sufc khoe - The due the thao: khi cong dudng sinh, v.v... + Cai tao tap quan cu. + Ren luyen y chi, tu tudng; chong due vong ca nhan - Bao ve thu dong: + An tot, mac am, giU ve sinh ca nhan va hoan canh + Chong thu dU + Dieu do ve sinh hoat: an uong, lao dong, nghi ngoi, tinh due, v.v... b. Nguyen nhan gay benh, vai tro chu yeu cua co the trong viec phat sinh ra benh tat: 20 - Nguyen nhan gay benh: + Hoan canh thien nhien: khi hau, dia ly la nguyen nhan gay ra cac benh ngoai cam (benh do ben ngoai gay ra); y hoc co truyen goi la ta khi, gom co 6 thd: phong, han, thuf, thap, tao, hoa. + Hoan canh xa hoi tao ra nhufng anh hirdng, tam ly xa hoi, gay ra cac benh noi khoa gom 7 thuf tinh chi: vui, gian, buon, lo, nghi, kinh, sp. - Vai tro c0 the la quyet dinh trong viec phat sinh ra benh tat: + Hoan canh thien nhien, xa hoi luon luon ton tai tac dong vao con ngiTdi, tuy rat quan trong nhufng la phu. + Vai tro quyet dinh sinh ra benh tat la do suf thay doi noi tai cua con ngirdi ma y hoc co truyen goi la noi nhan, hay la chinh khi cua con ngirdi. Chinh khi con ngifdi gom cac mat: am, difong, khi, huyet, sif hoat dong quan binh cua cac tang phu, tinh than, tan dich, v.v... c. Noi dung cua phirong phap dieu tri toan dien cua y hoc co truyen Phai nang cao chinh khi con ngifdi la chinh bang cac phifong phap: - Phong benh trong dieu tri: khi cong, tap luyen, dirdng sinh - Tam ly lieu phap - An uong boi dufdng - Dung thuoc, cham cdu, xoa bop, v.v... - Khi dung thuoc bao gid cung chu trong nang cac mat yeu cua co the (bo hir) roi mdi den cac thuoc tan cong va cac tac nhan gay benh. Tir ba hoc thuyet tren (am dirong, ngu hanh, thien nhan hop nhat) y hoc co truyen di den mot quan niem toan dien, thong nhat (chinh the) trong phirong phap phong benh, chan doan, dieu tri benh tat. Ngirdi thay thuoc phai thay con ngifdi d the thong nhat toan ven giufa cac chdc phan, gida tinh than, vat chat, gida ca nhan, hoan canh xung quanh de di tdi cac van de: - Phong benh de song lau - Chda ngufdi co benh chd khong phai chda benh - Nang cao chinh khi con ngifdi la chinh de thSng benh tat v.v... 21 III. TANG PHU KINH LAC Can cuf vao hoat dong cua co the con ngirdi luc binh thifdng, luc co benh ngirdi ta quy nap thanh nhdng nhom chufc nang khac nhau roi dat ten cho cac co quan trong co the goi la tang tifpng (hien tifpng cac tang). Nhom chufc nang co nhiem vu chuyen hoa goi la cac tang. Nhom chufc nang co nhiem vu thu nap, chufa dpng, chuyen van goi la cac phu. Ngoai ra con cac hoat dong khac nhif khi, huyet, tinh than, tuf cung, he thong kinh lac. Noi dung gom: - Cac tang; tam, can, ty, phe, than - Cac phu: tieu trifcmg, ddm, vi, dai trifong, bang quang, tam tieu - Hoat dong khac: khi, huyet, tinh than - Kinh lac 1. CAC TANG 1.1. Tam: Bufng dau cac tang, phu trach cac hoat dong ve than kinh (tif duy, sif sang suot, tri nhd) khi co benh thifdng hay hoi hop, sp hai buon phien hay quen, v.v... Quan he vdi huyet mach; khi co benh co hien tifpng thieu mau toe kho mach yeu, da xanh, lifdi nhat v.v... Thong ra lifdi, khi co benh neu co sot cao (tam nhiet) lifdi do, neu thieu mau (tam huyet hif) lifdi nhat mau. Nhif vay tam bao gom mot sd hoat dong ve tam than, tuan hoan, huyet mach. Khi co benh thifdng co cac hoi chdng sau: - Tam difong hif: kinh sp, hoi hop, hay quen,tif ra mo hoi, sp lanh, chan tay lanh - Tam am hif: hay mo mong, hoi hop, hay sp - Tam nhiet: mat do, mieng khat, hong kho, lifdi do, noi lam nham - Tam huyet hif: thieu mau, da xanh, niem mac nhat, lifdi nhat... Vi tang tam la tang dufng dau moi tang nen co tang phu bao ve no goi la tam bao lac, cac bieu hien benh ly nhif tang tam. 1.2. Can: - Can thifdng chia 2 loai: 22 Can khi: bieu hien tinh trang hung phan than kinh: de xuc dong, hay cau gat, nhUc dau chong mat Can huyet: phu trach cac hoat dong kinh nguyet (nU) va sU nuoi dudng cac can (co, than kinh). - Quan he vdi can bao gom cac hoat dong than kinh ngoai bien, gan, day chang. Khi co benh thudng run ray chan tay, teo co, cufng khdp, van dong di lai kho khan. Bieu hien ra 0 mat: co hai tinh trang benh ly + Hu: quang ga, giam thi luc + Thuc: viem ket mac, mat sUng nong do 1.3. Than Than hoa hay than duong: Co nhUng bieu hien ve hung phan than kinh. Neu than duong hu co cac trieu chufng: chan tay lanh, sp lanh, ia chay keo dai, mach yeu, di tinh, hoat tinh, liet duong .v.v... - Than tang tinh, chu ve sU phat due, than hu thudng tre con cham phat trien tri tue, cham biet di, cham moc rang, ngudi ldn thudng hoat dong sinh due giam, dau lung, di tinh, liet duong. - Quan he vdi xuong tuy, bieu hien u tai, dau that lung, dau nhUc xuong. Tren lam sang hay co nhUng hoi chufng sau: - Than am hu: hong kho, dau hong, rang dau, lung lay, tai u, hoa mat kho ngu, nhufc xUOng, ra mo hoi trom, thudng la bieu hien qua trinh Uc che giam hoac trieu chdng do roi loan than kinh thuc vat (roi loan giao cam do lao, chat tao keo...). - Than duong hu: dau lung, lanh cot song, chan tay lanh, hoat tinh, liet duong, ia chay, dai nhieu lan, thudng bieu hien qua trinh hung phan than kinh giam. 1.4. Ty Van chuyen va tieu hoa cac thufc an, uong tao ra huyet va khi; chi phoi co' bap, tay, chan, moi mieng Benh cua ty co cac bieu hien: - Ngudi gay sUc yeu, chong mat, tho doc, an kem khong tieu, tay chan teo nheo - Hoac dau bung, roi loan tieu hoa, dai tien khi long khi tao, mUc do nang hon co the day trUdng bung, phu thung. - Xuat huyet, rong kinh 23 1.5. Phe Co quan chu yeu ve ho hap (khi hoa) nguon goc sinh khi cua co the lien quan tdi tam va mach trong chdc nang van hanh huyet khi". Da, long, mui, hong lien he mat thiet, bieu hien tinh trang chufc nang cua phe. Benh phe co cac bieu hien: - Tieng noi nho yeu, thof doc (thd nhanh nong) phe hu co luc nhu het hoi, ddt doan khong thd dupe, khong chiu duoc ret lanh; mdc do nang hon thi hen suyen, thd kho, khong the n&m ma thd, va mo hoi khdp ngudi, mo hoi ra ca khi ngu (tu han, dao han) sot ham hap ve chieu, ho co ddm dac, co the ho ra mau (khai huyet) hai go ma do. - Thudng hay bi cam sot, ho co ddm loang, sp ret lanh, sUng hong, so mui (chay nude mui) khan giong, mat tieng. - Co the sot cao, dau tUc ngUc, ho, kho thd, khac ra ddm lan mu, mui hoi thoi... 2. CAC PHU 2.1. Ddm: Bai tiet ra chat mat: co mot chdc nang tinh than la chu ve sU quyet doan, long dung cam. 2.2. Vi: Chda dung, nghien nat thdc an. Thudng co bieu hien benh ly d rang mieng: sau rang, hoi mieng, loet mieng do vi nhiet gay nen. 2.3. Tieu triicfng: Nhan thdc an tU vi dua xuong: hap thu cac do tinh khiet vao co the bien thanh tan dich, huyet de (nuoi) dinh duong cac tang phu; dua chat can ba (phan nude tieu) xuong dai trudng, bang quang. 2.4. Dai tritdng: Chda dung, bai tiet cac chat can ba 2.5. Bang quang: Chda dung va bai tiet nude tieu 2.6. Tam tieu: Nhom chdc nang noi len quan he gida cac tang phu tren va dudi vdi nhau. Goi la sU khi hoa tam tieu chia lam 3 phan. - Thupng tieu: td mieng den tam vi, ma cac tang tam va phe la dai dien - Trung tieu: td tam vi den mon vi ma ty, vi la dai dien - Ha tieu: td mon vi den hau mon ma cac tang than va can la dai dien 24 3. CAC HOAT DONG KHAC 3.1. Khi: La dong luc thuc day moi hoat dong cua co the con ngudi, bien hoa khong ngUng, di khSp noi, d cac bo phan nhu Phe khi, Ty khi, Than khi v.v... Nguon goc la do: - Than khi: do bam sinh cha me dua tdi con goi la khi tien thien. - Phe khi: do ho hap khi trdi - Ty khi: do tinh hoa dinh dudng cua do an dem lai, con goi la khi cua hau thien Ngudi ta cho khi do do an mang lai la chu yeu, cho nen khi noi den khi thudng hay can cU vao ty khi. Tren lam sang thudng bieu hien cac hoi chUng sau: + Khi hu: ngudi met moi, noi nho, thd ng&n gap, hay ra mo hoi, an kem, cham tieu, ngUdi gay thit nheo, v.v... + Khi tre: co that cac tang phu, co co: p hoi, day hoi non mufa, kho thd, nac, v.v... 3.2. Huyet: La vat chat hUu hinh nuoi duong cac tang phu. Nguon goc: do dinh duong cua do an mang vao vi vay ngudi ta cho khi la soai cua huyet, co sU lien quan mat thiet giUa khi va huyet. Tren lam sang co tinh trang huyet hu, gay chufng thieu mau da xanh, chong mat, roi loan hoat dong kinh nguyet, v.v... 3.3. Tinh than: - Tinh do tinh hoa do an dinh duong dem tdi, dupe tang trU d than, la co sd vat chat cua hoat dong tinh than. - Than la hoat dong tinh than cua co the, sU sang suo't de danh gia sdc khoe ve tien lupng benh tat. Thudng hay dung chung chU tinh than, y muon noi bao gom sU manh khoe ve the chat va sU sang suot ve tinh than. Ngoai ra con cac hoat dong khac nhu tan, dich, tuf cung, v.v... 4. KINH LAC Kinh la dudng thang (doc co the) hay dudng chinh, lac la dudng ngang noi cac dudng chinh vdi nhau. 25 He kinh lac gom cac dudng kinh noi lien td trong tang phu ra ngoai, cac dudng ngang (lac) noi cac dudng kinh chinh vdi nhau tao thanh mot mang ludi ch&ng chit kh&p co the de dinh dudng toan bo co the, lam cho co the thlch Ung vdi hoan canh ben ngoai. Trong dudng kinh co khi huyet van hanh, tren dudng kinh co cac huyet. CAU TAO CUA HE KINH LAC 4.1. Cac ditdng kinh: Gom 12 dudng kinh chinh, 8 dudng kinh phu a. Mudi hai dudng kinh chinh: gom cac dudng kinh xuat phat tU 6 tang la cac kinh am. Cac dudng kinh xuat phat tU 6 phu la cac dudng kinh duong. 3 kinh am Phe kinh Tam bao kinh 6 kinh d tay 6 kinh d chan 3 kinh duong 3 kinh am 3 kinh duong Tam kinh Dai trUdng kinh Tam tieu kinh Tieu trUdng kinh Can kinh Ty kinh Than kinh Ddm kinh Vi kinh Bang quang kinh b. Tam dudng kinh phu: khong xuat phat td tang phu ma ra, ma la cac dudng dac biet bo sung cho 12 dudng kinh chinh. Trong 8 kinh phu, co 2 kinh quan trong nhat la Nham mach (di theo dudng giUa trudc co the de dieu hoa cac kinh am td cac tang ra). Doc mach (di doc theo cot song lung de chi phoi cac kinh duong xuat phat td cac phu ra) Tam kinh phu gom: Nham Duong kieu Doc Am kieu Xung Duong duy Ddi Am duy 26 4.2. Co 15 lac: Moi mot dudng kinh trong 12 dudng kinh chinh va 2 duong kinh phu (Nhan - Doc) co mot dudng ngang vdi 2 kinh bieu ly vdi nhau gom 14 lac, mot trung tam lien lac la huyet Dai bao thuoc kinh ty (vi tri lien sudn 6 dudng nach giUa). Tong cong la 15 lac. 4.3. Co 12 viing da: Do 12 dudng kinh chinh toa ra chi phoi d be mat da 4.4. Cac huyet: Gom 365 huyet n&m tren 14 kinh mach. Neu ke ca 2 ben la 670 huyet va 200 huyet ngoai dudng kinh. Chung ta chi hoc 70 - 90 huyet thudng dung de chan doan, tien hanh chUa benh bang cham cUu. IV. NGUYEN NHAN GAY BENH Y hoc co truyen chia nguyen nhan gay benh thanh may loai sau day: - Hoan canh thien nhien do khi hau, dia ly anh hudng den con ngudi do sau thuf khi (luc dam): phong, han, thuf, thap, tao, hoa la nguyen nhan ben ngoai. - Hoan canh xa hoi gay nen nhUng roi loan ve tam ly xa hoi, do bay thuf tinh chi (that tinh): vui, gian, buon, lo, nghi, kinh, sp la nguyen nhan ben trong. - Cac nguyen nhan khac: sang chan, tinh due, lao dong, an uong, trung thu cdn... 1. NGUYEN NHAN BEN NGOAl - Do luc khi: phong, han, thuf, thap, tao, hoa gay ra, khi tro thanh nguyen nhan gay benh goi la luc dam. - Gay ra nhUng benh ngoai cam (benh do ben ngoai dua tdi) nhu benh nhiem khuan, viem khdp, truyen nhiem... Luon luon quan he chat che vdi thdi tiet + Phong: mua xuan + Han: mua dong + Thuf: mua he + Tao: mua thu - Sau thU khi hay phoi hop vdi nhau ma phong hay xuat hien hon ca, lam tinh trang benh ly co tinh chat da dang. 27 1.1. Phong: Gio, la chu khi ve mua xuan, nhung vi mua nao cQng co gio nen hay phoi hop vdi cac thuf khi khac. + Dac tinh: hay xuat hien theo mua - Xuat hien dot ngot, mat di khong de lai dau vet - Hay di chuyen, hay gay co giat, rung dong - Gay ngda, gay sot, sp gio, mach phu + Hay phoi hop vdi cac thuf khi khac thanh cac nguyen nhan gay benh. a. Phong han: - Cam mao do lanh: ngat mui, sp lanh, sp gio, mach phu. - Dau day than kinh ngoai bien, liet day VII do lanh, dau lien sUdn - Phat ban di ufng, viem mui di ufng do lanh - Dau khdp, sifng khdp b. Phong nhiet: - Cam mao co sot, hoac thdi ky dau cua cac benh truyen nhiem: sot, sp nong, ludi do, mui kho, mach nhanh - Nhiem khuan than kinh - Thap khdp cap - Viem mang tiep hop cap theo mua, do virut c. Phong thap: thudng do cac trieu chufng dau minh, cuf dong nang ne, dau cac khdp: - Dau khdp va dau day than kinh ngoai bien - Phu di ring, eczema, v.v... - Can phan biet vdi chufng noi phong (ben trong) sot cao co giat (nhiet cifc sinh phong) - Liet nufa ngifdi do cao huyet ap (huyet hif sinh phong) 1.2. Han: Lanh, chu khi ve mua dong: a. Dac tinlv. hay lam tdc lai, khong ra mo hoi. - It di chuyen, gay dau tai ch6 - Chudm nong dd dau... - Khi gay benh hay tac dong vao Kinh lac: gay dau day than kinh, dau khdp. 28 Tang phu: vao phe gay ho hen; vao ty vi: lam non mufa dau da day, co that ruot, ia chay v.v... b. Phoi hop vdi cac khi khac: - Phong han: da trinh bay d phan phong - Han thap: gay di ia chay do lanh, khong tieu, dau bung, day 1.3. ThiC: Nang, chi khi ve mua he a. Dac tinh: hay gay nhufng chUng: sot cao, co ra mo hoi hoac khong ra mo hoi Chia lam 2 loai: thuf nhiet hay duong thuf gom • Nhe (thuong thuf): sot ve mua he • Nang (trung thuf): say nang, hon me, mat do, khong ra mo hoi b. Thii tliap: hay am thuf gay ia chay mua he do tam lanh, an do lanh ly, ia chay nhiem khuan. 1.4. Thap: Am thap do do am trong khong khi, sitong mu, lam viec dvidi rntdc. a. Dac tinh: minh may nang ne, cuf dong kho khan - Hay gap phu, bi tieu tien, ra mo hoi. - Hoang dan, - Co kem theo nhUng trieu chUng ve tieu hoa: nhat mieng, khong muon an, cham tieu, ia chay. b. Hay gay benh khi phoi hop vdi cac khi khac: - Thap nhiet: gay nhUng benh nhilm khuan dudng tieu hoa, tiet nieu, sinh due (ly, ia chay, nhilm khuan, hoang dam nhiem khuan, viem than, viem bang quang, viem loet co tuf cung...) - Phong thap, han thap, thuf thap (nhu da trinh bay d tren) 1.5. Tao: Do kho trong khong khi, hay xuat hien ve mua thu Dac tinh: hay gay sot, mat nude - Gay ra nhUng benh truyen nhiem - Thudng phoi hop vdi nhiet gay ra benh truyen nhiem (tao nhiet) nhu sot xuat huyet, v.v... 1.6. Hod nhiet: Dac tinh gay sot cao khat nude, gay chay mau 29 - Hay gay cac benh nhiet doc, nhiem khuan nhu: mun, nhot, nhiem khuan huyet, benh truyen nhilm, v.v... Thap nhiet, phong nhiet, thuf nhiet da trinh bay 0 phan tren. - Can phan biet vdi cac chufng nhiet d ben trong: do am hu sinh noi nhiet: ro'i loan than kinh thuc vat, hoi chUng colagenose, hoi chUng do Uc che than kinh giam. 2. NGUYEN NHAN BEN TRONG - Do bay thuf tinh chi (that tinh) gay ra nhdng roi loan ve tam ly, tinh cam: vui (hy), gian (no), buon (bi), lo (Uu), nghi (tu), kinh (kinh), khung (sp). - La nguyen nhan gay benh noi thuong hay xuat hien d cac tang phu nhu dau da day, suy nhupc than kinh, cao huyet ap v.v... 2.1. Vui: Luc binh thudng vui thi hoa hoan thu thai. Vui qua hai tam gay nen nhUng bieu hien that thudng nhu: cUdi noi huyen thuyen khong chu dinh nhu trong benh tam than. 2.2. Gian: Lam mat trang thai binh thudng cua Can gay ra cac benh - Can hoa vUOng: hay cau gdt, nhUc dau, kho ngu (cao huyet ap, suy nhupc than kinh the hung phan tang). - Can khi uat: gay nen cac benh roi loan kinh nguyet thong kinh, hysteria, tam can suy nhupc. - Can khac ty: loet da day hanh ta trang, ia chay do than kinh 2.3. Buon: Lam anh hudng den noi tang: tinh trang tinh than: buon rau, phien nao dau kho lam anh hudng den tam can, ty (suy nghi nhieu hai ty). o 2.4. Lo: Gay nen tinh chi tram lang, uat ufc, lam anh hudng tdi phe, ty gay an uong khong tot. 2.5. Nghi: Tap trung tinh than suy nghi, ket lai hai ty gay an uong khong tot, khong ngon, anh hudng den tam lam mat ngu. 2.6. Kinh: NhUng su viec de doa den tinh mang ma khong biet trUdc, gay cang thang than kinh, anh hudng tdi tam than. 2.7. Khung: Sp hai nhUng sU viec de doa den ddi song anh hudng den khi huyet cua can, tam, than. Bay thU tinh chi tren thuc chat la nhUng roi loan ve tam ly xa hoi hay gay ra nhUng benh roi loan chufc phan than kinh trung uong, benh tinh 30 than, mot so benh noi khoa khac co nguyen nhan vo nao noi tang (da day, cao huyet ap, suy nhupc than kinh). 3. Cac nguyen nhan khac Sang chan (nga, dam chem, tai nan) trung thu can, an uong, lao dong qua do, tinh due, v.v... la nhufng nguyen nhan lam anh hudng den sufc khoe (gio'ng cac tai lieu ve y hoc hien dai da ghi) V. PHl/GfNG PHAP CHAN DOAN TRONG Y HOC CO TRUYEN Phuong phap chan doan y hoc co truyen nham khai thac trieu chufng cua benh roi can cuf vao nhUng cUOng linh chung nhat, quy nap thanh nhUng hoi chUng benh tat cua tang phu, kinh lac, v.v... Vi vay noi dung cua phuong phap chan doan gom: - Bon phuong phap de ngudi thay thuoc dung khai thac trieu chUng (goi tdt la tU chan). - Tam cUOng linh de chan doan vi tri, tinh trang, xu the chung nhat cua benh tat (goi tdt la bat cUOng). - Cac hoi chufng tren cua luc phu, ngu tang, khi huyet, kinh lac, v.v... Trong chuong nay chi noi den tuf chan, bat cUOng con hoi chUng benh tat se neu d phan dieu tri. 1. Bon phtfo'ng phap chan doan (tuf chan) A. N H IN (Vong chan) • Than: trang thai tinh than bieu hien net mat, con mat, moi cuf chi hanh dong tu the co nghia la toan bo su bieu hien ben ngoai cua hoat dong ben trong co the. Chu yeu xem con mat, dong tac bat thudng, noi nang lan Ion, me man, v.v... Thudng buc doc khong yen la nhiet, u uat la benh noi thuong, hoang hot do tam huyet hu, met moi do khi hu, tram lang thuoc phan am, hung phan thuoc phan duong. • Sac: sdc sang, tUo'i bong la benh mdi mac, sac tdi slm la benh lau ngay. Sac vang thuoc benh d ty, co thap ben trong nhu hoang dan; sac do la co nhiet; sdc trang thuoc han; sdc xanh la thieu mau hoac dang co con dau. • Hinh thai: chi sU beo hay gay, thit rdn chdc hay mem nheo. Tay chan duoi thang hay co qudp. Ngudi beo hay mdc benh liet do cao huyet ap, ngudi gay thit mem la benh d ty. 31 • Xem mat: mat sifng do la phong nhiet, mat vang do hoang dan. Mat nhin nghieng hay true thi la sap sinh co giat. Mat khong nham dirge la do trung phong kinh lac (liet day VII). • Xem mieng moi: mau hong nhuan la binh thudng, siTng do hay nuft ne la thuoc nhiet, xanh den thuoc han, trang nhot la huyet hu. Chay mau cam co sot thuoc nhiet, hoi thd nong ra mui thuoc phe nhiet Chay nude trong la phong han, nude mui due la phong nhiet. • Xem tay chan: chan tay co duoi kho khan, dau cac khdp hoac sUng do la do thap khdp; chan tay mem nhun khong cuf dong, khong dau la do bai liet. • Xem ludi: (thiet chan): ludi chiem mot vi tri quan trong trong phuong phap vong chan, lien quan true tiep den tang phu kinh lac, tan dich, huyet. Chia ra 2 loai: reu ludi va chat ludi. - Reu ludi: Ldp reu dong tren ludi, bieu hien vi tri nong sau cua benh tat, tinh trang tieu hoa cua vi. + Reu trang: phan nhieu benh con d ngoai (bieu) trang tron do ngoai cam phong han, nhdn dinh do tha'p. + Reu vang: benh ben trong, co nhiet: vang kho nUt ne la tan dich bi ton thuong ben trong, thudng co tao bon. + Reu den: bieu hien tinh trang cUc nhiet d ben trong neu kem them kho la sot cao lau ngay, lam tan dich ton thuong nang ne. - Chat ludi: chi ban chat cua ludi gom mau sac hinh the, hoat dong de xem xet tinh trang cac tang, nhat la tam. + Mau sac: sac do la do co nhiet ben trong, phan biet do vUa, do dam de noi den mUc do cua nhiet. + Sac nhat do huyet hu (thieu mau) + Ludi Udt: tan dich con, ludi kho tan dich thieu + Ludi lech: do trung phong, ludi run kho noi la do tam ty kem + Ludi tim, tham, toi la do uf huyet B. N G H E (Van chan) De thu thap cac trieu chufng do tai nghe, mui ngufi: • Am thanh: tieng noi nho, theu thao, ngai noi thuoc chufng hu, noi to noi sang thuoc thuc nhiet. Noi mot minh: tam than bi thuong ton. 32 - Hai thd: Thd manh, tieng ho vang thuoc chufng thac Thd yeu, suyin do chufng ha - Ho co ddm hoac khong co ddm, ddm long do han, ddm dac xanh do nhiet, khong ddm thuoc benh d phe, co ddm nhieu thuoc benh d ty. Mdi ho, khan tieng thuoc thac, ho lau khan tieng thuoc ha. - Non mufa: Non mufa nadc trong, ddm dai, mach yeu, sp lanh thuoc vi han. Non mufa ra ddm dac, nude vang chua, dang, mach nhanh thuoc vi nhiet. • Khi vi: ngufi, mui hoi, chua, thoi cua mieng, ddm mui, phan, nadc tieu khi ha... de giup chan doan benh thuoc han, nhiet, ha, thac. C. HOI BENH (Van chan) • Hoi ve lich suf benh: que quan, tap quan, qua trinh benh ly, qua trinh chda benh, v.v... • Han nhiet - Nhiet + Sot co mo hoi hoac khong, nhufc dau, sp lanh, dau minh, mach khong nhanh la ngoai cam phong han (thuoc bieu). + Sot sp nong, khat nadc, ra nhieu mo hoi, ladi do, mach di manh, vat va, noi sang, hon me, tao bon (benh da vao trong). + Luc nong, luc ret, ngUc sudn day tufc, buon non, mieng dang la benh d gida bieu va ly (ban bieu ban ly). + Sot lien mien hay ham hap sot, go ma do, ra mo hoi trom, nhufc trong xaong, long ban tay nong la am ha hoa vupng thuoc nhiet (ha nhiet). - Han + Sp lanh, chan tay lanh, long lanh, met mdi la duong hu + Dau bung lien mien, sp lanh, chan tay lanh, mach yeu, cham tieu, ia chay keo dai la ty duong hu han. • Mo hoi: ngoai cam phong han co mo hoi la bieu hu, khong co mo hoi la bieu thuc. Ra mo hoi trom la am hu. Tu ra mo hoi la duong hu (khi hu) • Hoi ve dau, minh T3- STYHCT 33 Dau dau: tuy vi tri dau do nguyen nhan khac nhau (dua theo dudng di cua kinh lac) gay ra: Dau dau sau gay thuoc kinh Bang quang Dau dau vung trUdc tran thuoc kinh Vi Dau 1/2 dau thuoc kinh Ddm Dau or dinh dau thuoc kinh Can Dau d quanh dau, toan dau nhu bo chat thuoc kinh Ty. Dau that thuorng kem theo hoa mat chong mat la do noi thuong, dau kem theo nong ret la do ngoai cam. Minh: can ctf vao vi tri dau de tim benh or cac tang phu Tinh chat dau: Dau lien mien do han Dau di chuyen do phong Dau e am, te, van dong kho khan do thap Dau dU doi mot cho la do uf huyet, v.v... Dai tieu tien Dai tien + Tao: Tao co sot do thuc nhiet Tao bon neu da xanh, thieu mau la do huyet hu, Neu sot ham hap, nhUc xuong ra mo hoi trom, do am hu + Tao bon: do co nheo cham tieu, ngudi gia, phu nU de nhieu lan, do khi hu, ty hu + Ia chay: keo dai, an uong kem, phan song do ty hu. Hau mon nong rat, mot ran, do thap nhiet. Tieu tien: + Vang do: thap nhiet + Trang trong, di luon, dai son: do khi hu + Dai ra mau, dau soi tiet nieu: do thap nhiet + Dai dam: do than hu An uong: khong muon an, an vao khong tieu, day bung; ty hu An do mat, uong nude nhieu: do nhiet Thich an do nong: thuoc han NgUc bung: Tuy theo vi tri noi dau de tim ton thuong cua phu tang Mdi phat dau, an vao bung day trUdng, dau dU doi mot cho, sd n&n khong chiu dupe thuoc thuc chufng. Dau lau ngay, an vao de chiu, dau lien mien, thlch xoa bop thuoc hu chufng. Chudm nong dd dau la do han • Tai u, tai diec: Tu nhien diec thuoc thuc. Lau ngay diec dan dan thuoc hu U tai hoa mat, chong mat co the suy nhupc, thieu mau thudng do than hu • Kinh nguyet: Phai hoi benh nhan them ve kinh nguyet, bach ddi (kill hu). thai nghen, san hau v.v... Kinh nguyet: hoi ve chu ky, lupng kinh, mau s&c, mui vi, thong kinh khong. Kinh sau ky, s3c nhat, lupng It, moi lung thuoc hu han Bach ddi (khi hu): Mau trdng, ngudi met moi do co nang. Mau vang, mui hoi do thap nhiet: (do nhiem khuan) D. X E M M A C H SC? N A N (Thiet chan) • Xem mach: muc dich la de biet tinh trang hu thuc cua khi huyet, benh tat or cac tang phu Noi xem mach: tai dong mach quay d tay, dong mach dui, dong mach chay sau, dong mach mu chan nhung thong thudng ngudi ta dung dong mach quay goi la thon khau. Phuong phap xem mach: benh nhan de ngufa ban tay, thay thuoc dat 3 ngon tro, giUa va nhln vao mach. Ngon giUa dat tuong duong vdi mom chan xUo'ng quay keo vao mach quay. Co 2 cach xem: xem chung tinh trang cua mach (tong khan). Cach nay dupe dung thong thudng, xem ttfng bo vi (don khan) de biet tinh trang tdng tang phu, dung de di sau hon vao chan doan. Cach chia bo vi nhu sau: mach m6i ben chia lam 3 phan tuong duong vdi moi ngon tay, tren goi la thon, giUa quan, dudi xlch. So do cac tang phu chia nhu sau: Thon Tam Phe Thon Quan Can Ty Quan Xlch Than - Than + Xlch Hinh 2 MUc do: - An nhe da thay mach dap (thuong an): mach phu - An vUa phai xem mach (trung an) - An mach sat xuong thay mach dap (ha an): mach tram Khi xem mach ngudi thay thuoc phai binh tinh, nhe nhang tap trung tu tudng, chu y cam giac dau ngon tay. Benh nhan chua van dong, chua an uong, khong uong rUpu, neu di td xa den hay len thang gac phai nghi ngoi mot thdi gian de cho nhip mach, hoi thd trd lai binh thudng. Hien tuong cua mach: - Mach binh thudng: mach dap td ton, khong noi (phu), khong chim (tram) khong ldn, khong be, khong nhanh, khong cham. - Cac yeu td khi hau, thdi tiet, ngudi gia, phu nU, tre con, ngudi beo, ngudi gay deu co anh hudng den mach. Sau loai mach chu yeu - Mach phu: an nhe da thay mach dap + Mach phu an manh vln thay dap la thuc chufng thudng do bieu, do phong + Mach phu ma an manh thay dap yeu di la hu chufng thudng do huyet hu mat mau 36 - Mach tram: an manh mdi thay mach dap. Binh thifdng ngudi beo thifdng mach tram, khi co bieu hien benh d ben trong (ly) + Tram co luc: thuc chufng + Tram khong co luc: hu chufng - Mach sac: mach nhanh tren 90 lan/phut, thudng bieu hien chufng nhiet, chUng thuc. + Phu sac co luc: thuc chUng, nhiet chUng + Phu sac vo luc: thieu mau, chay mau ben trong - Mach tri: mach cham dudi 60 lan/phut. Thudng bieu hien hu chufng han chUng. - Mach hoat: mach dap tron, di lai d§ dang nhu hat chau lan. Thudng do thuc chufng (phu nU co mang) - Mach sap: mach di kho khan, thudng bieu hien thieu mau, uf huyet, khi ngUng tre. Mot so mach hay gap - Mach huyen: mach di cang nhu day dan thudng bieu hien benh d can: cao huyet ap, suy nhupc than kinh the hung phan tang... - Mach nhu: mach di mem yeu, thudng thuoc hu chufng benh d ty, co thap - Mach hong: mach dap manh to, bieu hien nhiet chdng - Mach te: mach nho, bieu hien huyet hu - Mach nhupc: mach di yeu nho, do khi huyet hu - Mach hoan: mach binh thudng ve so' lan, deu dan, thudng bieu hien tren ngudi binh thudng hoac benh nhe. Su phoi hop cac loai mach: thudng It khi co mot loai mach don doc ma thudng co sU phoi hop vdi nhau goi la kiem mach, vi cac trieu chufng lam sang nhieu tang phu co benh, nhieu benh cung di§n ra mot luc nhu mach phu sac, tram tri, tram te, huyen te, nhu hoan, v.v... • Sd n&n: Sd xem da kho hay nhuan, co mo hoi hay khong, phu do viem nhiem v. v... - Sd xem chan tay am hay lanh cong. Mu ban chan nong la benh ngoai cam, long ban tay nong la benh noi thuong. - Kham bung sd nan biet cac tang phu co benh. - Kham theo dudng kinh lac de biet benh thuoc tang nao, dudng kinh nao ... 37 2. TAM Cl/CfNG LINH DE CHAN DOAN 2.1. Dinh nghia: Trade tinh trang phufc tap cua cac trieu chutag sinh benh ngudi thay thuoc can phai dua vao tam ctfong linh chung nhat de danh gia vi tri tinh trang, hinh thai va nhdng xu the chung cua benh tat, giup cho viec chan doan nguyen nhan benh, de ra phuong phap chufa benh chinh xac. Mach hong Hinh 3 38 Tam cuong linh gom co: ngoai, trong (bieu ly); hu, thuc; han, nhiet; am va duong. 2.2. Bieu va ly: Tim vi tri nong sau cua benh tat de ngudi thay thuoc danh gia tien lupng, de ra phuong phap dieu tri thlch hop. • Bieu: benh of ben ngoai, cac trieu chUng thudng bieu hien ra: - Kinh lac, gan xUOng nhu thap khdp, dau day than kinh ngoai bien. - Benh nhiem khuan dr giai doan viem long khdi phat chua co nhufng bien loan co nang tram trong nhu mat nude, nhiem doc than kinh, trang thai, roi loan than kinh, tinh than. - Thuofng hay quan he vdi cac cuong linh khac nhu bieu han (kem them so lanh), bieu nhiet (sp nong sot cao), bieu hu (co mo hoi), bieu thuc (khong co mo hoi). • Ly: benh d ben trong co the, hay xuat hien khi benh d: - Cac tang goi la benh noi thuong nhu dau da day, cao huyet ap, benh tinh than, benh ve cau tao mau v.v... - Cac benh nhiem khuan va truyen nhiem d giai doan toan phat co kem theo mot so' bien loan ve chUc nang nhu mat nude, roi loan dien giai, roi loan tinh than vdi cac trieu chufng cu the nhu vat va, khat nude, ra mo hoi nhieu, noi sang, hon me, tao. - Benh d ben trong co the co the phoi hop vdi cac cUOng linh khac nhu: ly han (sp lanh, chan tay lanh, mach tram nhupc, v.v...), ly nhiet (sot cao, vat va, khat nude, mach hong dai), ly hu (sp lanh, an kem, ia chay, cham tieu, v.v...), ly thuc (tao bon, bung day trUdng, vat va phat cuong). • Bieu ket hop vdi ly: co nhUng tinh trang bieu hien d ben ngoai nhung nguyen nhan d ben trong nhu mun nhot, ban chan, di ufng tuy bieu hien ben ngoai la ngufa, phat ban nhung do tinh trang huyet nhiet ben trong gay ra. - Co nhUng benh nhu cam mao, cac trieu chufng d bieu van con (sp lanh, mach phu) nhung da co cac trieu chufng d ben trong nhu tao bon, khat nude thi phai can cuf vao tinh trang benh la chinh de co bien phap dieu tri cho thlch hop - GiUa bieu va ly (ban bieu ban ly) thudng co cac trieu chufng luc nong luc ret ngUc sUdn day tufc, mieng dang hoa mM khong the dung phuong phap giai bieu don thuan (nhu cho ra mo hoi) hoac 39 khong the dung phuong phap thanh ly nhu: khong dung phuong phap thanh nhiet dupe ma phai dung phuong phap hoa giai. 2.3. Han nhiet: Cac bieu hien trang thai khac nhau cua benh tat, de khi suf dung thuoc, cham cufu cho thlch hop vdi tinh trang cua benh ly nhu han thi dung cdu, nhiet thi cham. Han dung thuoc nong am, nhiet dung thuoc mat lanh. • Tren lam sang benh cung mot tang nhung co nhUng tinh trang khac nhau nhu benh loet da day ta trang neu thuoc nhiet co trieu chdng dau thanh con, khat nude, p chua, reu ludi vang, tao bon, mach huyen; neu thuoc han co trieu chUng dau lien mien, chan tay lanh, mach tram nhupc. • Khi xet nhUng bieu hien ve han nhiet can chu y den cac mat - Khat hay khong khat - Dai tien tao hay binh thudng, nude tieu do hay trong - Tay chan lanh hay nong - Mach phu sac hay tram tri • Tren lam sang co nhUng bieu hien ban chat khong phu hop vdi hien tupng, khong phan biet ro thi dieu tri khong chinh xac nhu: (chan han gia nhiet): benh nhiem khuan, nhiem doc gay truy mach ngoai bien lam chan tay lanh nhung nhiet do d hau mon rat cao (Bang ben). 2.4. Hit thitc: Noi len tinh trang cua ngudi benh (chinh khi), tac nhan gay benh (ta khi) thuc chat la sdc de khang cua benh nhan, hu la chinh khi yeu, thuc la ta khi manh, de nham muc dich de ra cac nguyen tac chUa benh phu hop nhu: hu thi bo, thuc thi ta. - Tren lam sang co nhUng bieu hien hu va thuc don thuan, co khi hu thuc l&n Ion (sdc khoe yeu kem theo benh mdi m&c). - NhUng bieu hien chinh cua hu va thuc - Trong nhUng hoi chdng lam sang can chu y: + Ve hu: khi hu, huyet hu, am hu, duong hu + Ve thuc: khi tre, huyet d Cac phan nay trong phan thuoc va phan dieu tri se noi ro 40 ^ " '\ H a n nhiet Tuf chan Bang. Han - nhiet Han N hiet Nhin Sac mat trang. Reu ltfdi trang mong, chat liidi nhat Sac m at do. Reu ludi day, vang, den, chat ludi do Nghe It noi Hay noi, mieng hoi Hoi benh Khong khat, thich am, tieu tien trong dai, ia long Khat, thich m at, ti§u tien do, dai dat, tao bon M ach, xuc chan Tram te nhuoc, tay chan lanh M ach phu, sac co luc, tay chan nong Bang. Hu - thuc Hu Thuc Nhin Gay yeu, da xanh nhat, bo phd, nam im, it hoat dong Nghe Tho yeu, van dong thd gap tieng noi nho. Phan nude tieu khong co mui dac biet Hoi NgUcfi met moi, dau am i thich xoa chddm, an uong vao do dau Khoe m anh nhanh nhen hong hao Thd to, ho to tieng, o hang non mufa. Phan thdi, midc tieu khai, sot, me sang Dau dtf dpi, khong thich xoa chudm, an uong vao dau tang Xem mach -------------------------------- M ach khong co luc, te, vi, nhu nhiioc M ach co liic, hong, hoat, phu 2.5. Am diicfng: La hai cuong linh tong quat nhat (tong cuong) de danh gia xu the chung nhat cua benh tat vi nhufng trieu chdng cua bieu ly, han nhiet, hu" thuc luon l&n Ion vdi nhau. Bieu hien lam sang cua benh tat co the thien ve am (am chdng) co the phan am kem (am hu), phan duong kem (duong hu) - Am chdng va duong chdng: Am chdng thudng co bieu hien cua hu han Duong chdng thudng co bieu hien cua thuc nhiet. 41 Am chufng Diidng chufng NgiJdi lanh, chan tay lanh, met moi, thd nho, thich am, khong khat, tieu tien trong, dai tien long. Mach tram nhtfpc Chan tay du6i thang, thd manh, hay noi, khat, dai tien tao, nude tieu vang, ngirdi am, tay chan nong. M ach phu sac Am hu va duong hu: Am ha hay xuat hien chufng noi nhiet. Duong hu hay xuat hien chdng ngoai han Am hu Duong hu Sot ham hap nhufc trong xuong, ho khan kho mieng, hong rao, hai go ma do, ra mo hoi trom, long ban tay nong, kho ngu, ludi do, mach nho nhanh (te sac). Ket luan ve bat cUang So lanh, chan tay lanh, an khong tieu, tieu tien nhieu lan, di tinh, liet duong, ia chay, reu ludi tr&ng nhat, mach yeu, vo life. - Phai danh gia xu the chung nhat, khong nen can cd vao mot trieu chdng ma phai can cd vao ca mot hoi chdng. - Phai tim dung ban chat cua tinh trang benh co khi ban chat phu hop vdi hien tupng. - Khi van dung thuc te thudng co sU phoi hop cac cuong linh vdi nhau nhu hu han, thuc nhiet. Nhung kho khan ho'n la hu nhiet, thuc chat la hien tupng am hu. VI. NGUYEN TAC DIEU TRj VA CAC PHl/ClNG PHAP DIEU TRj BANG THUOC (BAT PHAP) 1. NGUYEN TAC DIEU TRI Dung cac vi thuoc hoac cac thu thuat dieu tri de giup cho sdc de khang cua ngudi benh lap lai thang bkng cac qua trinh sinh ly dang bi roi loan, khoi phuc dupe sdc khoe trd ve binh thudng la muc dich cua viec chUa benh. Vi sU bien hoa cua benh tat rat phde tap, phep chUa cung nhieu loai (bao gom ca nhUng phuong phap khong dung thuoc nhu cham cdu, yoga, xoa bop... va cac phuong phap dung thuoc) nen nguyen tdc co ban la "bien chdng luan tri" tdc la phai tap hop day du cac trieu chdng cua benh roi can cd vao phep bien chdng ma phan tich, quy nap tim ra nguyen nhan benh de dieu tri nguyen nhan nao la chinh, trieu chdng gi la phu, hoi chdng nao la that , chdng nao la "gia" (hien tupng be ngoai) de n&m vUng tinh chat cua chdng trang, roi sau mdi xd ly, de ra nguyen tSc, chon phuong phap, bai thuoc, vi thuoc, hay huyet vi thich dang. 42 Be dat den muc dich bi§n chdng luan tri dupe chuan xac, can chu y mot so nguyen tac dieu tri sau: 1.1. Chita benh phai nam vUng tieu, ban, hoan, cap: Phan ro tieu ban: tdc la phan ro: goc (ban) hay ngon (tieu), nhe hay nang, chinh hay phu, cung chinh la phan biet xem the benh cap tinh, nguy kich can xd ly gap (cap) hay la benh dien bien til td, man tinh (hoan). Y nghia cua khai niem tieu, ban bao gom kha rong rai: Thi du ve benh tat thi: nguyen nhan la ban,trieu chdng la tieu, benh phat trudc la ban, phat sau la tieu, benh d noi tang la ban, benh d ngoai phan bieu la tieu. Chda benh can phai tim cho ra va nam dupe nguyen nhan cua benh (tri benh cau ky ban) de nham vao nguon goc ma chda mdi co the khoi benh. Vi du: Chdng "am hu phat nhiet" (thieu, kiet tan dich ma phat sot) thi phat sot la "tieu" ma am hu la "ban" nen phuong phap dieu tri phai nham vao goc benh la bo am tiep nude, them chat dich thi co the ha sot dupe. Trong thuc te lam sang can phai bien chdng linh hoat cai nao cap thi phai dieu tri trUdc. Bo do ma co nguyen tac "cap thi tri tieu, hoan thi tri ban". Neu ca tieu va ban deu cap thi "tieu ban dong tri": (dong thdi cung chda ca tieu va ban). 1.2. Chita benh phai tuy giai doan benh (set, trung, mat) va bo td, thich help: Vi du: viec chda benh cum, viem phoi... thi giai doan dau, luc mdi mac thudng phai giai bieu lam cho ra mo hoi, d giai doan toan phat co sU dau tranh quyet liet giUa nhan to gay benh va sdc chong dd cua ngudi benh thi thudng phai ket hop ta vdi bo (de nang cao sdc chdng dd cua co the) va d trang thai "hd' thi phai van dung phep bo the de co the mau hoi phuc. 1.3. Chita benh phai nam duCOc ’’chinh tri” va "phdn tri’’ - "Chinh tri” la phuong phap dung cac vi thuoc ngupc lai vdi tinh chat cua benh tinh ma chda. Vi du: Bung vi thuoc Han (mat lanh) de chda chdng Nhiet (sot...) dung phep Ta (cong) de chda chdng Thuc, dung phep Bo de chda chdng Hu... cd theo mat chinh cua benh ma dieu tri. - "Phan tri" hay "Long tri" la thuan theo trieu chdng gia be ngoai (gia tupng) ma chda. Phep dieu tri nay dupe van dong trong cac trUdng hop mau thuln gida ban chat va hien tupng nhu: Ban chat benh la han nhUng hien tupng gia, be ngoai la nhiet (chan han gia nhiet) nhu vay, 43 phep dieu tri la tuy thay cac trieu chufng be ngoai la nhiet, sot nhung van dung thuoc nong am de chufa vao ban chat thuc sU cua benh. 1.4. Ngoai ra, chvCa benh con can phai chu y toan dien den: Dieu kien thofi tiet, moi trUdng, khi hau, dia phuong, tuoi tac, trai gai, tam tu, tinh cam cua ngudi benh de viec dieu tri dupe thlch dang, toan dien. 2. CAC PHl/CfNG PHAP DIEU TRI UONG TRONG Co tam phuong phdp la: Han (lam ra mo hoi). On (lam cho am). Tho (gay non). Thanh (lam cho mat). Ha (lam nhuan trang, sd). Tieu (lam cho tan). Hoa (dieu hoa). Bo (boi duong co the). 2.1. Phep han (lam ra mo hoi) Dupe dung de chUa benh ngoai cam thofi ky dau, dau, sdi chua moc, mun nhot mdi phat. Dieu can chu y la phep phat han chi dung khi co day du cac trieu chufng cua "bieu chufng" neu benh da vao sau tang phu ben trong (ly chufng) thi khong dupe dung nUa. VI du: - Doi vdi chUng bieu han (mdi cam phong han): co trieu chdng sp lanh, sot, khong khat, reu ludi trdng tron, nhde dau, dau khap minh, khong co mo hoi, thd nhanh, mach phu khan thi dung cac vi thuoc, bai thuoc cay am de giai bieu lam ra mo hoi nhu Ma hoang, Que chi, To td, Kinh gidi, Gdng, Hanh... VI du bai Ma hoang thang (Ma hoang, Que chi, Hanh nhan, Cam thao). - Doi vdi chdng bieu nhiet (mdi cam phong nhiet): co trieu chdng sot cao, It sp lanh, khat nude, chat ludi hong, reu ludi mong, vang, mach phu sac thi phep chda la dung thuoc cay mat de giai cam lam cho ra mo hoi nhu cac vi Bac ha, Beo, Tla to, Hoa cuc, Cu san day... VI du bai thuoc Ngan kieu tan gia giam (Kim ngan hoa, Lien kieu, Bac ha, Cat canh, La tre, Do den, Re say...). - Vdi benh phu than cap thdi ky dau co the dung bai thuoc lam cho ra mo hoi trong do co cac vi Ma hoang, Thach cao, Cam thao, Gdng tuoi. - Vdi chdng dau thdi ky dau, dung bai thuoc co vi San day, Thang ma. - Vdi benh sdi chua moc, dung bai thuoc co vi Bac ha, San day, Phong phong, Kinh gidi, La tre, Cat canh, Cam thao... 44 Ngirdi ta cung thudng dung phep xong ra mo hoi de giai cam (loai cam it ra mo hoi). Chu y: - Khong dung phep han (lam ra mo hoi) trong cac trUdng hop ia chay mat nude, non ra mau, ho ra mau, co the qua suy nhupc (du co bieu chufng cung khong duoc dung). - Can than trong trong mua he vdi ngudi benh da nong bdc ra mo hoi nhieu roi. - Van dung phep han, khong nen cho ra qua nhieu mo hoi de phong chUng mat nUdc. 2.2. Phep tho (gay non) Lam cho non, tong bo chat doc con d trong da day. TrUdc day, ngudi ta thudng dung cac vi: Qua de (num dua), Phen chua, Phen xanh, Sam tu... cho uong hoac ngoay vao hong lam cho ngudi benh non ra chat doc hoac thUc an khong tieu. Chu y: khong dung phep tho9 trong cac trUdng hop co the ngudi benh qua yeu, phu nU cd thai, ngudi benh cd tien suf non ra mau, suy tim. 2.3. Phep ha (tay, nhuan trang) Phep ha la phuong phap dung cac vi thuoc klch thich lam cho nhuan trang, hoac gay ia long de tong cac chat can ba: tich tu, tao ket trong ruot ra va de chUa mot so' trUdng hop tao bon cd sot, m ot so' trUdng hop phu than cap, mot so' chufng U huyet, dam tre cua dong y. Cd 2 phep ha la: On ha (dung bai thuoc cd vi thuoc ha cd tinh chat nong nhu Ba dau...) va han ha (dung bai thuoc cd vi thuoc ha tinh lanh nhu Dai hoang, Mang tieu, Phan ta diep). Khi can ha manh, thi dung cac vi Dai hoang, Ba dau, Phac tieu, Vo dai, Chut chit. Khi can ha td td hay nhuan trang thi dung cac vi Mat ong, VUng den. Can lUu y la phep ha manh dung trong trUdng hop ngudi benh con khoe manh, thuc chUng, con phep nhuan trang de dung trong trUdng hop suy nhupc, gia yeu. Cliu y: khong dung phep ha trong cac trUdng hop + Benh con d phan bieu, mdi cam, hoac ban bieu ban ly. 45 + Neu khong du cac trieu chufng tao, ket, day thi khong dung phep ha + Phu nU dang co thai, dang hanh kinh, mdi de. 2.4. Phep hod (dieu hoa) - Dieu hoa giufa cac phan trong, ngoai co the. Phep hoa thudng dupe ap dung de hoa giai bieu ly: khi benh ta d giUa khoang nufa con d phan bieu, nufa da vao phan ly. - Dieu hoa can vi: dieu hoa sU nong lanh tren dudi. Vi du ngudi ra dung bai thuoc co vi Sai ho, Hoang cam, Cam thao, Ban ha, Gdng tuoi, Dai tao... de chUa hoi chUng "Thieu duong" (luc nong, luc ret, ngUc sUdn day, tUc, hay buon non, mieng dang). Ngudi ta thudng dung bai thuoc co Duong quy, Bach thupc, Sai ho, Bach truat, Phuc linh, GUng tuoi, Dai tao... de dieu tri hoi chufng "Can khi uat" kinh nguyet khong deu d phu nU hoac trUdc hanh kinh cd sot, sp lanh, vung ha vi day tUc. Chu y: Khong dung phep hoa trong cac trUdng hop: - Benh ta dang con d phan bieu (mdi cam) - Hoac da vao sau tang phu (phan ly) - Hoac trUdng hop sot cao, me man, tao bon, khat nude 2.5. Phep thanh (lam cho mat) Phep thanh la mot phuong phap dung nhUng vi thuoc mat lanh (han luong) de ha con sot, thanh nhiet nhu: Hat danh danh, Thach cao, Kim ngan hoa, Sai dat, Nhan tran, Thd phuc linh, Hat muong, Bo cong anh, Ha kho thao, Rau sam... Vi du: de dieu tri hoi chUng phat sot khong sp lanh ma lai sp nong, mo hoi ra, khat nude, reu ludi vang kho, thi phai dung bai thuoc cd nhUng vi cay mat de thanh nhiet, sinh tan dich, nhu Thach cao, Tri mau, Ha kho thao. - Neu sot: khat nUdc, reu ludi vang day, lai them tao bon thi dung cac vi thuoc dSng lanh de ha sot nhu Hoang lien, Hoang cam, Hoang ba, Kho sam. - Neu co sot cao vat va, me sang co xuat huyet dudi da, chay mau cam thi dung cac vi thuoc man lanh de thanh huyet nhiet, ha sot nhu Te giac, Sinh dia, Huyen sam. Chu y: khong dupe dung phep thanh trong cac trUdng hop: + Benh con d phan bieu, mdi cam sot nhe 46 + The chat qua yeu, sufc chong lanh von kem, ia chay, an kem, phien tao, huyet hu ma phat sot. + Chan han gia nhiet (ban chat la "han" nhung hien tupng be ngoai nhu la "nhiet"). 2.6. Phep on: (lam cho nong am) Phep on la phuong phap dung cac vi thuoc co tinh chat nong, am de chUa cac chUng benh "han", sufc chong do lanh kem, de bo them duong khi, hoi phuc sufc nong cho ngudi benh nhu cac vi: Que, Gting kho, Dai hoi, Tieu hoi, Ngo thu, Thao qua, Ho tieu, Ngai cdu, Phu td... VI du: - Ngudi ta dung bai thuoc co nhUng vi GUng kho, Phu td, Cam thao... de cap cUu cac trUdng hop la chay, non, hay chan tay lanh ng&t, truy mach (goi la hoi duong cUu nghich). - Hoac dung bai thuoc co nhUng vi Sa nhan, Moc huong, Gdng, Bach truat, Cam thao... de chUa cac trUdng hop dau bung, day bung, cham tieu do lanh. Cliu y: khong dung phep on trong cac trUdng hop: - Ho ra mau, non ra mau, dai ra mau, ia ra mau. - Ia chay co sot, tinh trang mat nude. - "Chan nhiet gia han" (ban chat la nhiet nhung hien tupng be ngoai la han) 2.7. Phep tieu: (lam tieu tan cac do an tlch tre, tieu dorm...). Thudng dung cac vi thuoc co tinh chat tieu tlch lam cho khi lUu thong nhu: Hau phac, Vo quyt, Chi thuc... de lam cho nhUng tlch tre tieu di, phep tieu thud'ng dung cho benh man tinh (khac vdi phep ha co tinh cong trac manh liet hon de chUa chufng cap tinh va thuc chUng). VI du: De dieu tri chUng: thdc an dinh tre bung day trUdng cang, tdc, kho chiu, p hoi, p chua, chan an thi dung bai thuoc co nhUng vi: Son tra, Than khuc, Vo quyt, Hat cu cai, Mach nha, Phuc linh, Ban ha. De dieu tri chUng phu thung (nhat la phu nhieu nufa dudi co the) thd gap, thi dung bai thuoc co cac vi: Vo qua cau, Vo cay dau, Vo phuc linh, Vo cu gdng, Vo quyt de tieu phu. Cliu y: Khong dung phep tieu cho chufng "ty hu" (trUdng bung ma ia chay) hoac "ty hu" sinh phu thung. 47 Can than trong vdi ngadi benh co the suy nhupc; neu can phoi hop phep tieu vdi phep bo. 2.8. Phep bo (boi dudng co the) Bo co nghia la bo sung vao ch6 hu yeu, boi dudng co the lam cho mau chong hoi phuc, nang cao sdc de khang. NgUdi ta thudng dung nhUng vi thuoc chda nhieu chat dinh dudng de bu vao cho thieu cua co the nhu: Nhung huou nai, Cao dong vat, Rau thai, SUa, Quy ban, Sam, Thuc dia, Qua to hong, Ha thu o, Hoai son, Duong quy, Bach truat, Cau tlch, Dau den. Ngudi ta thudng chia lam 4 loai bo la: bo khi, bo huyet, bo am, bo duong. Hai loai bo am, bo duong la nham bo vao nguon goc "tien thien". Lay than am, than duong lam chu. Hai loai bo khi, bo huyet, nham vao nguon goc "hau thien" lay ty vi lam chu. Ngoai ra con can phan biet xem tang phu nao hu yeu de bo true tiep vao tang phu do. Va lai can biet mdc do hu nhupc, sdc hap thu cua co the de con bo manh hay bo td td. VI du: De dieu tri hoi chdng co the suy nhupc, bai hoai, hut hoi, met moi, khong muon cd dong, tu do mo hoi, sa true trang, sa td cung... thi phai dung bai thuoc co nhUng vi bo khi nhu Dang sam, Bach truat, Cam thao, Hoang ky, Thang ma... - De dieu tri chUng thieu mau phai dung bai thuoc co nhdng vi bo huyet nhu Duong quy, Thuc dia, Rau thai, Bach thuoc... - De dieu tri hoi chUng "Am hu": gay hoc hac, da kho, di tinh, do mo hoi trom thudng dung cac bai thuoc bo than am co cac vi nhu Cau ky td, Quy ban, Thien mon dong, Thuc dia, Dau den... - De dieu tri hoi chdng "Duong hu" nhu liet duong, ngudi gia yeu, chan tay lanh, dai dat, ia long do lanh thudng dung cdc bai thuoc co nhdng vi: Do trong, Tuc doan, Tac ke, Hat to hong, Loc nhung, Phu td, Nhuc que... de bo trp duong. Chu y: - Khi benh mdi cam, tac nhan gay benh con nhieu ma co the con khoe chd nen voi dung phep bo, phai trd tac nhan gay benh trUdc roi sau se bo mdi co cong hieu. - Trd trUdng hop ngudi benh qua suy nhupc, mac du tac nhan gay benh van con, van co the ket hop ca "cong" va "bo". 48 Tren day gidi thieu tifng phuong phap dieu tri nhung vi benh tinh thudng phdc tap, it khi dan thuan nen trong thac te lam sang thudng phai phoi hop nhieu phep, vi du: Phoi hop phep han vdi phep ha; phep on vdi phep thanh; phep tieu vdi phep bo. 3. PHl/dNG p h Ap c h Ca n g o Ai Phep chda ngoai la phep chda bang thuoc, hay bang tay hoac phoi hop vdi mot y cu nao do thudng de chda nhdng tat benh ngoai khoa, ngoai da, cho bi dau... nhung cung dung ca cho cac benh tat noi khoa. NhUng phuong phap chda ngoai thudng dung trong noi khoa: - Phuong phap xong: dung khoi, hoi va nhiet (de chda cam, nhot Id, dau khdp...) - Phuong phap tam, ngam trong dung dich thuoc (chda ghe Id, te thap...) - Phuong phap boi, dap: thudng dung cac vi thuoc tuoi, da nat hoac thuoc bot kho hoa rUOu, mat. - Dan cao thudng de chda nhot, te thap... - Chudm thudng dung vai boc thuoc da xao nong de chudm - Thoi, khi dung dung dich hoac bot thuoc vao khi dao. - Ngam, sdc mieng dich thuoc. - Dung hinh thdc thoi, dan "nhet" vao cac 16: tai, mui, am dao, hau mon. - Thoa xat thudng dung rUpu gdng, dau cao thoa xat - Xoa phan, - Lam phong da - Ngoay hong lam non - Thong dao dung dung dich thuoc thut vao hau mon chda phan tao VII. PHONG BENH CUA Y HQC CO TRUYEN 1. DAI ClJdNG d nUdc ra mot sd danh y co tieng da de cap den van de ve sinh The ky XIV Tue Tinh: Trong tap Hong nghia gidc tu y thu Tue Tinh da viet: Be tinh dudng khi ton than. Thanh tam, qua due, thu chan, luyen hinh. Hai cau tho tren la khai quat hoa phep dudng sinh cua y hoc co truyen The ky XVI Hoang Don Hoa: Thuyet thanh tam, tinh cong va dao dan (cuonHoat nhan toat yeu) T4- STYHCT 4 9 The ky XVIII Dao Cong Chinh viet: Bao sinh dien tho toan yeu: neu phuong phap dudng sinh. The ky XVIII Hai Thupng Lan Ong viet tap Ve sinh yeu quyet. 2. PHONG BENH KHI CHUA CO BENH 2.1. Tu dudng ve tinh than: Gian hai can, miTng qua hai tam, lo nghi hai ty. Moi benh do khi gay nen: gian: khi boc; vui mUng: khi hoan; buon: khi tieu; sp set: khi ham; kinh khung: khi loan; suy nghi: khi ket. Khi kiet thi tinh than bi huy hoai Muon benh khong phat, khong lao luc qua do, lay diem tinh thoai mai vui tuoi. Do la lieu thuoc song. 2.2. DUdng sinh: Bo gian dU de nuoi dudng tinh, It lo nghi de nuoi dudng than, bdt noi de nuoi dudng khi, chan long ham muon de nuoi dudng tam. Nhin lau thi hai tam ton huyet; ngoi lau hai ty, ton co nhuc; dufng lau hai than ton xUOng; nim lau hai khi ton phe. - Muon nuoi duong than the phai luon luon nuoi duong ty - Muon nuoi duong ty vi phai nuoi duong tam trUdc. - Muon nuoi duong tam phai nuoi dudng than trUdc - Muon nuoi duong than phai nuoi duong khi trUdc - Muon nuoi dudng khi phai nuoi dudng tinh trUdc - Muon nuoi duong tinh phai nuoi dudng chi trUdc - Muon nuoi duong chi phai nuoi duong than trUdc 2.3. Thich ting vdi khi hau bon mua: Ngudi dori xUa biet dudng sinh theo qui luat am duong, biet phep nuoi dudng than, tinh, an uong dieu do, sinh hoat chUng muc, khong lam lung bira bai, met nhoc. Vi vay hinh the va tinh than deu manh khoe, hudng het khoang trdi sinh tram nam. - Ba thang mua xuan ngu day sdm di bach bo, xoa toe buong minh - Ba thang mua he day sdm cho khi thu thai - Ba thang mua dong ngu sdm day muon - Mua thu mua dong nuoi dudng am khi - Mua xuan mua he nuoi dudng tinh than 2.4. An uong nghi ngefi co dieu do, co chitng mtfc a. An uong: - Nong: hai trUdng vi 50 - Nhieu bo ngot: sinh nhot - Man: mach ngifng tre - Dang: da de kho, long toe rung - Cay nhieu: gan co co cufng - Chua: co bap nhan nheo - Ngot: sung dau va toe rung b. Suy nghi va lao dong: Lao dong viTa phai lam cho than the cUorng trang. Neu qua than hinh hao ton. - Nhin lau hai huyet - Nam lau hai khi - Ngoi lau hai thit - Dufng lau hai xuong - Di lau hai gan 2.5. Ren luyen than the Khi huyet dieu hoa gan xuong thu loi - Sau khi an di bach bo tCr tCr, xoa vung sUcm bung, thai duong - Ngufa mat len trofi ha hoi ba lan de lam de tieu - An uong rUpu say khong nen nam ngay - An no hai khi, ty, rang, mach 2.6. Tranh cac benh truyen nhiem (on dich) Lam cho than hinh cUofng trang, chi khi manh, ta khi khong xam nhap duqc. Cach ly ngUfri benh: dung thuoc ngan ngiTa. VI du: Quan chung 20g sac uong phong cum: Hoac huong + Quan chung: phong va dieu tri thd ta Cay long nao triT muoi - la xoan hun muoi Phen chua loc nude - Bach bo trif chay ran 2.7. Ve sinh phu nU va tre em - Ve sinh trong khi hanh kinh: giU am, kieng tam giat, kieng an cac chat song lanh, giam lao dong nang,tinh than thoai mai, kieng giao hop. 51 - Ve sinh thai nghen: thai nghen lam thay doi toan bo sinh 11 co the do vay tinh than phai dieu hoa, lao dong nhe nhang, that lung vUa phai, ngu day du, khong dung thuoc btia bai, khong di xa vac nang. - Sau khi sinh: chinh khi yeu, ta khi de xam pham vao co the. + Thang 1 - 2 nen d trong nha tranh gio, mac am de phong ngoai cam + Dinh dudng tot, kieng chat song, lanh, cufng lam ton hai ty vi. + Hoat dong tinh than trong thofi ky hau san phai dieu hoa chong that tinh - Tre em: giuf ve sinh co vai tro quan trong vi trif benh tien thien. Neu cham soc tot thi rat han che dupe benh tat "cay co goc, tudng co mong, goc chac thi canh la tuoi tot". Cho an co gib giac, dieu do, mac quan ao vUa phai, am, khong cho bu khi mdi giao hop, gian dU, say rUpu Ve sinh num vu cho tot de phong tSc tia sUa va viem tuyen vu 3. PHONG BENH KHI DA MAC BENH (BENH CAP TINH) 3.1. Benh phat trien theo ba quy luat chinh nhti sau: - Bieu - Ly: Thai duong - duong minh - thieu duong - thai am - thieu am - quyet tam - Ve - khi - dinh - huyet Vi vay: dieu tri khi benh con d phan bieu, phan duong la tot nhat, benh man tinh khi benh da vao den: tam, can, ty, phe, than phai dieu tri a ly va dung phuong phap hoa la chu yeu. 3.2. Cham soc, ho ly trong qua trinh dieu tri co vai tro rat quan trong: - An uong: tuy benh ma cho an: nong, mat, lanh, am - Cham soc d: noi thoang, mat ve mua he - Han am: chudm nong am va ngupc lai - Thuoc men: han uong nong, nhiet uong nguoi - Benh than thi cho uong thuoc nong hoi man vao buoi tdi. vui. cAc h lA m benh An y hoc cd tr u yen Ghi chep lam benh an la ghi chep cac trieu chdng, phan tlch, chan doan, xuf ly nhUng trieu chUng benh tinh do mot cach day du thanh mot 52 tu lieu thuc tiin, sinh dong de lUu lai, no rat quan trong trong viec nghien cufu khoa hoc ve benh tat, dieu tri, tong ket kinh nghiem phat trien y hoc.... Ngoai phan hoi, kham chung theo benh an cua y hoc hien dai (nhif ten tuoi, nghe nhiep, chufc vu, dia chi, ngay gift vao vien, ra vien, benh sd...) ta can chu y kham xet, khai thac cac thong tin ve benh tat theo cach xem xet cua y hoc co truyen nhu: Tim hieu xem quan he giufa thdi tiet vdi benh tat: benh xuat hien or loai hinh thdi tiet nao ? Dia phirong tho nghi nao, vi nhu benh xuat hien khi co dpt gio mua dong bac, trong cac dpt thdi tiet nong am, lanh kho... hay nong kho ? Van dung tuf chan thi: - Nhin xem ngudi benh tinh than tinh tao, nhanh nhen hay Id dd ? Gay hay beo ? Mau sac da trang hong, tuoi nhuan hay sam den, kho heo ? Chat ludi do tuoi hay nhpt, beu ? Reu ludi tr&ng mong hay vang kho... ? - Nghe xem am thanh (ngudi benh) tram, to hay nho ? Ngufi xem mui hoi thd ra cua benh nhan nhu the nao? - Hoi xem benh nhan thich an, uong nong hay lanh ? Tieu tien trong dai hay do, xon ? Dai tien tao hay long ? Tinh chat cua mo hoi, chat non, kinh nguyet... nhu the nao ? - Bat mach sd nan xem: mach phu hay tram ? Nhanh hay cham ? Sd n&n ngUc, bung, tay, chan... thay the nao ? Co phu de lai dau an lom... ? Sau do, phan tlch, tong hpp lai ve chan doan theo bat cuong thi thuoc the han hay nhiet ? Hu hay thuc ? Bieu hay ly ? Cam phong han hay phong nhiet ? Hay do nguyen nhan noi thuong ?... Ve phep dieu tri: benh tinh nhu vay thi de ra phuong phap chUa nhu the nao? ChUa trieu chUng trUdc hay nham ngay vao goc benh (tieu, ban), dung phuong phap dieu tri gi ? (Lam cho ra mo hoi (han), lam cho mat (thanh) ? Hay lam cho am (on) ? Co ket hpp vdi phuong phap bo ? Va bo phan gi, tang phu gi ? Suf dung bai thuoc gi ? Don huyet cham cufu gom nhUng huyet nao ? Thu thuat ra sao ? Trong bai thuoc co nhUng vi thuoc nao ? Cach bao che cac vi do ra sao ? Uong vao luc nao ? Vi thuoc nao la chinh, vi thuoc nao ho tro them ? Cham soc che do an uong the nao ? Tien lupng benh se dien bien ra sao ? Tom lai: td budc dau benh an cho den khi xem xet de ghi mot don thuoc, mot don huyet dieu tri cho ngudi benh la ca mot qua trinh tu duy bien chufng (bien chdng luan tri), phan tlch tong hpp cac trieu chufng vdi mot quan diem, phuong phap chinh the, bien chufng de di den chan doan xac dinh roi lap, chon ra mot phuong phap dieu tri, td chufc ra mot bai 53 thuoc thich hpp roi lua chon cac vi thuoc, cac huyet dieu tri thich hpp. Do la ca mot qua trinh tu duy logic: tif "ly", "phap" den phuong dupe . Dit&i day la mot mau benh an y hoc cd truyen phan kham ve y hoc co truyen - Van (hoi ve Ua thich nong lanh, khau vi, mo hoi, dai, ia, kinh nguyet...) - Vong (xem than, sac, hinh thai, chat ludi, reu ludi...) - Van (nghe, ngufi, xem am thanh, khi vi chat thai tiet) - Thiet (bat mach, sc1n&n ngUc, bung, chan tay...) - Chan doan (tang phu, bat cuong, nguyen nhan...) - Luc vao: - Luc ra: - Phep chUa (du kien phuong phap dieu tri, bai thuoc, huyet vi, an uong, tap luyen, ket hpp y hoc hien dai...) - Bo sung, dieu chinh trong qua trinh dieu tri - Ket qua dieu tri: a) Khoi; b) Do nhieu; c) Do it; d) Khong ket qua - Tong ket (so" lupng thuoc, dpt cham cUu, thdi gian dieu tri) - Rut kinh nghiem - Che do xuat vien Chu nhiem khoa duyet Thay thuoc diiu tri IX. CONG TAC DIEU Dl/ONG CUA Y HOC C0 TRUYEN Cong tac dieu dudng cua y hoc cd truyen dong mot phan quan trong vao ket qua tri lieu. Nhan viec dieu duong ket hpp vdi thay thuoc ve mat y thuat, con co nhiem vu chu y tdi sinh hoat, hoat dong tinh than, an uong, ve sinh ca nhan, ve sinh hoan canh cua ngudi benh. NhUng viec do nhan vien dieu dudng dua vao nhUng nguyen tdc nhat dinh ket hpp vdi thuc tien ma dan do ngudi benh thi hanh. Y thuat ket hpp vdi dieu duong mdi tang cUdng ket qua va rut ng&n thdi gian chUa benh. Y hoc cd truyen trUdc day khong co nhan vien dieu dudng chuyen nghiep, thay thuoc phai nim vUng cong tac dieu dudng de dan do ngudi benh thi hanh. Cac sach ve kinh dien cua y hoc cd truyen day ve cong tac dieu dudng nhu sach To Van noi "Benh d tang can cam ra gio, benh tang 54 tam cam an thufc an cay nong, mac qua am". Tren co sd ay, thay thuoc cac ddi sau, tlch luy kinh nghiem cong tac dieu dudng thanh nhUng phuong phap dieu dudng tot. Noi dung chu yeu cua cong tac dieu dudng y hoc co truyen nhu sau: 1. VE TINH THAN Y hoc cd truyen luon de cao tac dung tinh than trong viec bao ve sdc khoe chong benh tat, cho nen cong tac dieu dudng cung nhan manh moi quan he chat che cua viec cham soc tinh than ngudi benh vdi viec tri lieu. Muon tang cudng ket qua tri lieu, ngudi dieu dudng phai chu y lam cho ngudi benh thoai mai khoan khoai, tranh nhUng kich thich xay ra nhu gian dU, lo lang... Ngudi benh co cac trieu chUng, nguyen nhan d cac khu vUc khac nhau, gidi tinh, tuoi tac, hoan canh khac nhau. Tinh than cua ngUdi benh rat de thay doi that thudng do anh hudng cua benh tat cho nen nhan vien dieu dudng phai tinh te tim hieu tam trang, tuy theo hoan canh tinh hinh benh tat ma tien hanh giai thich va thuyet phuc. Doi vdi nhUng ngudi khong chiu lam theo ldi ran cua thay thuoc phai lay sU co hai cua sdc khoe de tien hanh dau tranh vdi ban than ma nghe ldi thay thuoc. Doi vdi nhUng ngudi tinh than hay uat dc, benh kinh nien ma phat sinh hay buon rau, lo sp, phai thudng xuyen an ui, dong vien de gay cho ho quyet tam phan dau chong benh tat, giU tam tinh lac quan vui ve. GiU cho tinh than ngudi benh luon vui ve de tranh cac kich thlch xau la dieu trong yeu: cho nen nhan vien dieu dudng phai thong cam vdi n6i dau kho cua ngudi benh, dong tinh tam trang, co thai do hoa nha, thuong men de ngudi benh thay am ap nhu d gia dinh, nhan vien dieu dudng phai dua theo nguyen tac tri lieu hoac an dudng ma giup dd ngudi benh nhUng phuong tien sinh hoat tdt nhat ma hoan canh cho phep. Khi benh tinh chuyen xau nhat thiet khong de benh nhan biet de ho nghi ngpi anh hudng den benh. Benh nhan tuf vong cung khong the tuy tien noi trong buong benh de tinh than cua nhUng ngudi benh khac khong cang thing sp hai. NgUdi nha benh nhan den tham hoi phai tiep don, gidi thieu tinh hinh benh nhan, lam the nao cho ngudi den tham hoi khong lo lang. Dong thdi dan ngudi nha giU trat tu trong phong benh, co thai do ung dung, binh tinh, nhat thiet tranh thai do kinh ngac, sp hai thuong cam, Uu sau, tranh noi nhUng chuyen dau buon lam cho ngudi benh xuc dong. Cho nen sach ngoai khoa tinh nghia dan ngudi den tham benh nhan rang: "Ddng lam benh nhan hai, lo buon, khong nen ngoi lau, noi nhieu lam ngudi benh met moi". 55 Cac sach vd xUa con ghi chep: "Tri benh trUdc het tri than . Dieu do ngudi lam cong tac dieu duong cung nhu cac thay thuoc, can chu y nhd ky de san soc tinh than ngudi benh dupe tot. 2. VE KHI HAU Chinh khi ngudi benh kem kha nang thich dng vdi dieu kien khi hau cung anh hudng. Vi vay nhan vien dieu dudng can chu y den khi hau ma san soc benh nhan cho thich hop. Trdi ret phong benh phai am ap, kin gio, nhung v&n thoang du khong khi can thiet, dan ngudi benh an mac du am. Trdi nong nuc can giU phong benh mat me, thoang khi. Trong thdi gian khi hau bien doi that thudng phai theo doi sat tinh hinh thdi tiet nong lanh tdng buoi (sdm, chieu, toi, dem). Phai dua vao tinh hinh benh tat ma tien hanh cong tac dieu dudng khac nhau. - Ngudi khi huyet hu, duong khi bat tuc, hay so lanh, phai chu trong giU cho ngudi am ap - Ngudi benh ngoai cam phat sot bieu ta chua giai nen tranh phong (gio), neu bieu ta giai roi ma sot cao, nen ha thap nhiet do trong phong lam cho khong khi phong benh lUu thong nhung khong nen de gio thdi true tiep vao ngudi benh. - Tre em len sdi, dUng de nhilm lanh, nhiem nong - Ngudi trung thd nen dat vao cho thoang mat de mau tinh, v.v... 3. ve An u on g Ngudi benh vi khi con tuong ddi tdt mau khoi, vi khi suy yeu, benh lau khoi. Vi vay trong cong tac ho ly, an uong cua ngudi benh rat la quan trong. Trong viec an uong, ngudi benh can chu y may mat: day du chat dinh dudng, thufc an nen dung hay tranh, an uong dieu do. Trong qua trinh phat benh, vi chinh khi phai chdng benh ta bi hao ton nen trong khi dung thuoc phoi hpp vdi dinh dudng de bo sung chinh khi. Nhat la sau benh nang mdi khoi, sUc khoe chua binh phuc, ta khi da het nhung chinh khi chua phuc hoi nen phai chu y an uong day du chat dinh dudng mdi lai sUc. Sach Hai Thupng Lan Ong noi: "Trong khi chUa benh phai chu y van de dinh dudng, khong phai chi dua vao thuoc". Song viec an uong cua ngudi benh, mot mat can chu y den van de dinh dudng, mot mat can chu y den mot van de nUa la nen an thdc an gi, tranh thdc an gi, kieng thdc an gi va quan he giUa thdc an vdi thuoc ra sao ? nhu bi ung thu, dinh nhot nen kieng thUc an tanh, benh thuy thung kieng thdc an man (muoi). Benh hoang dan (vang da) ia chay, kiet ly nen kieng dau md. Ty vi hu han nen kieng thUc an song lanh. Am hu hoa 56 vupng nen kieng thufc &n cay nong... Uong Kinh gidi kieng an ca tanh; Nhan sam ky rau cai cu... Co nang tieu hoa ngudi benh thuofng giam sut, cho nen an uong can co dieu do neu khong benh se lau khoi, hoac sinh ra benh khac: nhieu benh thdi ky hoi phuc la an khoe, nhung can chu y tiet che, cho ngudi benh an it mot, an lam nhieu bUa, neu khong benh co the tai phat. Ngudi benh kinh nien, chinh khi suy ton, can het sufc chu y den van de dinh dudng. Neu ngudi benh khong muon an, tim moi cach cho ngudi benh them an, de cung cap cho co the ngudi benh day du chat dinh dudng, giup cho chinh khi manh len, chinh khi manh len benh mdi mau khoi. 4. VE SINH HOAT Can chu y ve ve sinh trong phong benh. Cac do dung nen thudng xuyen lau chui sach se. Quan ao, chan dem benh nhan dung nen giat luon cho sach se, kho rao. Cac thuf cua ngudi benh bai tiet (ddm, rai, nude tieu, phan) can don sach. Nen thudng xuyen md cufa phong thoang khi, khong khi lUu thong nhung can chu y dUng de gio thoi thang vao ngudi benh. Trong va ngoai phong benh nen giU gin yen tinh trong phong benh trif nhan vien dieu dudng, khong nen cho nhieu ngudi la den choi lau. Khong de ngudi nha vao tham nhieu qua hoac ngoi noi chuyen dai lam benh nhan met moi. Hoat dong va nghi ngoi cua ngudi benh nen qui dinh theo tinh chat va tinh hinh benh. Benh cap tinh va qua suy nhupc can an tinh nghi ngoi. Ngudi benh kinh nien nen hoat dong thlch dang theo sU chi bao cua thay thuoc, nhan vien dieu dudng nhu tap the due mem deo, tap thai cue quyen de khi huyet lUu thong, co the mau hoi phuc. Ngudi benh nam lau khi huyet suy nhupc, da thit di bi Id loet, cho nen nhan vien dieu dudng nen thudng xuyen chu trong giup dd benh nhan thay doi vi tri, tu the, hoat dong thlch dang. 5. VE VIEC CHO UONG THUOC Cho ngudi benh uong thuoc can co thdi gian nhat dinh, co benh uong trUdc khi an, co benh uong sau khi an, hoac uong luc sang sdm, luc di ngu hoac mot ngay uong lam nhieu lan. Neu uong khong dung luc se anh hudng den ket qua chUa benh. Nhu thuoc sot ret phai uong trUdc luc len con sot thuoc tri mat ngu nen uong ngay trUdc luc di ngu. Ve phuong phap uong thuoc, thuoc s&c noi chung la uong am song can cuf vao nhu cau tri lieu, co khi uong nguoi, co khi uong nong, co khi mot ngay uong nhieu lan, luc sang sdm, luc ngu. Thuoc tan han nen uong nong, thuoc thanh nhiet nen uong nguoi, sau khi uong thuoc giai bieu xong nen d&p chan kin, hoac uong nude soi, an 57 chao nong de mo hoi ra, uong thuoc de non ma khong non dupe, co the moc hong de non ra. Nhan vien dieu dudng con phai theo doi sau khi uong thuoc, nhu sau khi uong thuoc giai bieu xong ma mo hoi ra khong duft thi phai xem xet co phai vong duong khong. Mot so vi thuoc manh co doc, uong xong ngudi benh thay buc doc hoac choang vang, tim dap manh thi phai xem xet co phai hu thoat khong. Neu thay co phan ufng nhan vien dieu dudng phai lap tdc bao cao ngay vdi thay thuoc de co cach doi pho thlch dang khoi phat sinh hau qua xau. Muon lam tot cong tac dieu duong nhan vien dieu duong chlng nhUng phai n&m vUng tinh than ngudi benh, yeu thuong ngUdi benh nhu ngudi nha ma con phai n&m vUng benh tat de ket hop vdi bien chufng luan tri lam cho sU cham soc ngay cang co tac dung trUc tiep tdi co the ngudi benh. Benh tat dien bien khong ngUng, tinh than cung luon thay doi, neu nhan vien dieu dudng cham soc chung chung, khong sat vdi yeu cau va tam ly ngudi benh, tac dung se bi han che. Cang ket hpp chat che vdi quan niem chinh the va bien chUng luan tri, cong tac dieu dudng cang gop phan nang cao ket qua tri lieu. Vi vay nhan vien ho ly, mot mat phai thi hanh nghiem tuc ldi dan cua thay thuoc, mot mat phai dem lai nguon an ui dong vien, niem lac quan tin tudng cua ngudi benh va tao cho ho nhUng phuong tien sinh hoat thuan tien nhat ma thuc te cho phep. Nhu the cong tac dieu dudng la cai cau noi lien thay thuoc vdi ngudi benh tao thanh mot quan he tri lieu hoan chinh, toan dien. 58 PHAN III CAC PHl/CfNG PHAP CHLfA BENH KHONG DUNG THUOC I. PHl/dNG p h A p c h A m cufu Cham la dung kim cham vao huyet, cufu la dung sdc nong cdu tren huyet de gay kich thich dat tdi su phan dng cua co the nham muc dich chda benh. Muon dat ket qua chda benh tot, can phai n&m vdng va thuc hanh toan bo phuong phap cham cdu, nhung dac biet la mot so diem sau: - Chi dinh va chong chi dinh trong cham cdu - Ky thuat cham kim - Thu thuat d&c khi, bo ta khi cham 1. PHl/CfNG PHAP CHAM 1.1. Dung cu de cham a. Kim lam bang thep khong ri - Hao cham: kim dai ng&n khac nhau td 1 - 7cm, than tron, kim can phai sac, thang: khi cun phai mau, khi cong phai vuot thang. - Kim tam lang: mui nhon, co 3 canh, dung de cham nan mau - Kim mai hoa (con goi la bi phu cham): dung 7 kim nho buoc thanh bo cam len can go, de gd nhe len mat da b. Bong con 70°, hop dung kim sach 1.2. Chi dinh va chong chi dinh khi cham a. Clii dinh: mot so" benh c0 nang va trieu chdng - Than kinh: nhdc dau, mat ngu, co giat dau day than kinh ngoai bien (dau day toa, liet day VII...) - Tuan hoan: tim dap nhanh, cao huyet ap... - Tieu hoa: con dau da day, non mda, tao, ia long... -Tiet nieu: bi dai, dai dam - Sinh due: rong kinh, rong huyet, thong kinh, di tinh... 59 - Mot sd benh do viem nhilm: viem mang tiep hpp, viem tuyen vu, ch&p... b. Cliong chi dinli: khong nen giU de cham cufu don thuan cac benh thuoc dien cap cufu. - Cac con dau bung can theo doi ve ngoai khoa - NgUdri sufc khoe yeu, thieu mau, ngUori mdc benh tim, trang thai tinh than khong on dinh. - Co the khong or trang thai binh thudmg: vUa lao dong met nhoc, di met, doi - Cam cham vao cac huyet or vi tri ron, dau vu. Khong dupe cham sau vao cac huyet: Phong phu: giufa xUOng cham - Cl A mon: Ci - C2 Liem tuyen: sun giap Cac huyet vung ngUc 1.3. Tit the, goc cham, do sau cua kim a. Tit the: - Thay thuoc phai dr tu the thuan loi nhat - Benh nhan phai dr tu the thoai mai, chiu dung dupe lau. Thuorng co may tu the: + Ngoi: (ngoi ngufa tUa ghe, ngoi cui nghieng, ngoi chdng ckm, ngoi cui sap, ngoi duoi tay, ngoi co khuyu tay) khi cham cac huyet or vung dau, cd, gay, vai, canh tay. + Nam ngufa: khi cham dr mat bung, mat trudc dui, chan, mat trong canh tay. + Nam nghieng: khi cham phia ngoai, mat ngoai tay, chan + Nam sap: khi cham or gay, lung, mat sau dui b. Goc cham: la goc tao bori kim va mat da Goc cham 15° goi la cham xien: dung vdi cac huyet or vung da sat xuong nhu dau, mat, cac khdp... Goc cham 45 - 60 goi la cham ngang: dung cho cac huyet dr vung co trung binh nhu ngUc bung... Goc cham 75 - 90 goi la cham thang: dung cho cac huyet dr vung nhieu co nhu dui, lung, mong 60 c. Do sau cua kim: tuy theo tuoi, tre em, ngudi gia khong nen cham sau, cac vi tri co nhieu hay it co, benh nhan beo hay gay, cac tang phu d dudi ma quyet dinh. 1.4. Nh&ng hien tuftng bat thiCcfng xay ra khi cham va cach gidi quyet a. Soc: do benh nhan sp, yeu sufc khoe, trang thai co the khong binh thudmg (doi hoac vUa an no, vUa lao dong nang, met moi...) - Hien tupng: tai da, do mo hoi, mach nhanh, tim dap yeu... - Xuf tri: rut kim ngay, d&p am, giai thich cho benh nhan, tiem thuoc trp tim neu can - Be phong: + Phai chon benh nhan trUdc khi cham, loai mot sd chdng chi dinh + Khi cham lan dau phai giai thich dong vien benh nhan va cham it huyet, cham nhe nhang. b. Chay mau: do choc kim vao tinh mach, rut kim ra gay chay mau - Lay ngay bong an chat noi chay mau, mau se cam - Neu bi tu mau: dung ngon tay day nhe noi mieng bong, cho tu mau se tan dan. c. Gay kim: do kim cong, kim ri va thu thuat qua manh. Thudng gay dr cd can kim - Xuf tri: dung cap kep kim ra, khong de benh nhan giay giua khi gay kim - Be phong: trUdc khi cham phai vuot kim cho thang, loai bo kim ri, khong cham hut can kim, benh nhan thd deu khong gay phan Ung co cufng co dot ngot. Khong cham kim khi benh nhan phan ufng co cdng co, thu thuat cham nhe nhang. 1.5. Thu thuat cham kim a. Luyen tap cham kim thanh thao TrUdc khi cham phai tu luyen tap luc cua cac ngon tay tif tren xuong dudi va cach cham cho thanh thao, tranh gay dau cho benh nhan va de nang cao hieu qua chUa benh. Phai tap cham nhieu lan: - Vao mot mieng xa phong - Vao tui vai co nhet bong chat 61 b. Cac giai doan tien hanh cham kim - Chon huyet: xac dinh vi tri huyet, dung ngon tay tro an vao vung huyet de tim cam giac cua benh nhan (dau, tufc). - Sat trung vung da bang con 70° Cham qua da: can cham nhanh qua da de tranh dau vi duoi da co nhieu dau mut than kinh cam giac. - Cham vao thit: nong sau tuy vung, dung cac phuong phap de dat tdi dac khi. Sau do tuy tinh trang benh nhan dung phuong phap bo ta de nang cao them ket qua cham. - Thu phap phai chdc chan, ddt khoat, nhe nhang. Thudng co may dong tac lam cang mat da: + Dau ngon cai tay trai an vao huyet, tay phai cham kim + Dau ngon cai va ngon tro tay trai cang mat da vung huyet, tay phai cham kim + Dung ngon cai va ngon tro tay trai veo da, tay phai cham kim 1.6. Van de dac khi khi cham Dac khi la van de trong yeu khi cham. No danh gia khi cham dat ket qua chUa benh tot hay khong tot. a. NliUng hien titong xay ra khi cliam ddc khi: - Benh nhan co cam giac te, dau, chudng nang, giat d vung huyet. Cam giac te, dau chay doc len tren hoac xuong dudi huyet cham - Kim bi mut chat - Vung da tren hoac dudi huyet cham do biTng hoac tai nhpt b. Co che Theo y hoc co truyen: hien tupng tren xay ra do cham kim dung huyet, kinh khi keo den day du (neu la hu chdng), hoac ta khi theo kim ra ngoai (neu la thuc chdng), vi khi co benh kinh khi bi tdc lai, hay cham cdu lam cho dudng kinh thong suot nhu binh thudng. Hien tupng mut kim do ta khi manh qua gay nen khi cham dung huyet ta khi theo kim ra ngoai. Theo hoc thuyet than kinh: ddc khi la mot phan Ung cua co the khi cac xung dong cua kich thich da dat tdi ngudng kich thich nao do. Hien tupng te doc theo dudng kinh len tren hoac xuong dudi huyet cham thudng xay ra d tay chan phu hpp vdi dudng di cua day than kinh cam giac hoac tren mot co dai. Hien tupng mut kim xay ra khi cham vao vung co dang co cdng do tinh trang benh ly hoac la phan xa bao ve cua co the 62 khi vung ccr do bi kich thich. Phan xa van mach khi co thdt lam da tai nhot, khi gian mach lam da do. c. De dat tdi dac khi khi cham, can: - Tim cho dung huyet: dung vi tri, co cam giac tufc khi an manh vao huyet - Xoay chuyen kim: ve phia phai hay trai den khi thay cac hien tupng tren - Nhac kim len xuong: tdi khi co cac phan dng cua benh nhan Neu cham va ap dung cac thu thuat ma khong thay dac khi can tim nguyen nhan: - Kim co cham dung huyet khong - Benh nhan d trang thai sufc khoe qua yeu, trong tinh trang Uc che (hu chUng) can ddi cham ra cUu, tdi khi sUc khoe dupe hoi phuc thi cham mdi co hien tupng ddc khi. 1.7. Thu thuat bo td khi cham Sau khi cham da ddc khi thu thuat bo ta dupe ap dung tuy trang thai cua benh nhan de nang cao them hieu luc cua cham. a. Tliii thuat bo td xuat phat tu: nguyen tdc: hu thi bo, thuc thi ta - Hu: Chinh khi co the suy nhupc, sufc de khang giam sut, benh lau ngay, ngudi gay yeu, da xanh, sp lanh, chan tay lanh. Dung phuong phap bo de nang cao chinh khi, don khi va khong lam mat them chinh khi. - Thuc: ta khi thuc, tac nhan gay benh va mufc phan Ung cua co the manh, benh mdi mac, sot, mach nhanh, sung nong do dau... Dung phuong phap ta de dua khi ra ngoai vi ta khi lam dudng kinh bi tdc. b. Theo hoc thuyet than kinh: bo hay ta la dung cudng do khac nhau cua kich thich dupe ap dung tuy theo the tang cua benh nhan. Neu benh nhan d trang thai hu chufng tdc la than kinh d trang thai Uc che, dung phuong phap bo, cudng do kich thich nhe de gay hung phan than kinh. Neu benh nhan d trang thai thuc chdng tdc la than kinh d trang thai hung phan, dung phuong phap ta, cudng do manh va lien tuc de gay ufc che than kinh. c. Cac phuong phdp bo td - Ve cudng do (phuong phap don gian, hay dung va co hieu luc nhat): + Cham ddc khi de nguyen la bo. + Cham kim ddc khi ve kim nhieu lan la ta 63 - Ve thdi gian: + Luu kim lau la bo (de don khi tdi) + Rut kim nhanh la ta (ta khi di voi vang) - Ve tiep nhap: + Cham tif tif la bo (de don khi tdi) + Cham nhanh la ta (ta khi di voi vang) - Ve dong md: + Rut kim bit lo cham la bo (de khoi mat khi) + Rut kim khong bit lo la ta (de ta khi thoat ra) 2. PHUdNG PHAP CtfU - Cilu true tiep: bang ngai hoac dieu ngai dot true tiep tren da - CUu gian tiep: dung moi ngai dot qua mieng gdng, toi, muoi, hoac ho tren da. Hien nay con dung phuong phap cufu bang dien: lam nong kim khi cham, lam nong nhUng mieng kim loai de tren huyet 9, ^ x O day chi gidi thieu cach cUu gian tiep. 2.1. Nguyen lieu va dung cu can thiet - Dung cu: dao, khay, hop petri dung ngai, hop petri dung gdng da thai. - Vat lieu: ngai nhung (la ngai cufu phoi kho tan nho bo xo, cuong la). Cuon ngai nhung thanh dieu nhu dieu thuoc la. Diem, que huong. Gdng gia tuoi thai lat day 2 - 4mm 2.2. Chi dinh va chong chi dinh Chi dinh va chong chi dinh giong khi cham nhung theo cac nguyen tic sau: - Hu han thi cdu, thuc nhiet thi cham (Hu han: benh nhan d trang thai yeu, sp lanh, tay chan lanh). Benh lau ngay cdu tot hon cham. - Cam cdu trong cac trUdng hpp thuc nhiet: sot cao, mach nhanh vi cdu gian tiep la mot kich thich nhe lam tang hung phan d benh nhan. Khong cdu khi benh nhan co cao huyet ap. - Khong nen cdu d mat, vung co nhieu gan (nhu cd tay) de phong bi bong thanh seo xau, co rut gan co. 64 2.3. Thdi gian va mite do nong: a. Mile do nong: khi benh nhan thay nong thi lot them mieng gdng khac. Khi ho dieu ngai benh nhan nong dua dieu ngai ra xa mat da. Tranh dong vien chiu nong den mile toi da vi se gay bong. b. Thai gian: doi vdi ngudi ldn mdi huyet chi nen cufu 3 moi, ho dieu ngai do 15 phut. Ngudi gia, tre em thdi gian cufu it hon. 2.4. Tai nan va cach gidi quyet a. Bong: do bi nong qua, thudng bong do I, chu y tranh nhilm khuan b. Chay: do benh nhan giay giua khi bi bong lam dd mdi ngai chay chan, chay quan ao. c. De phong: tranh dong vien benh nhan chiu nong, khi nong lot them gdng, khong cUu nhieu huyet tren mdi ngudi va cufu nhieu ngudi mot luc. Khong dupe rdi bo benh nhan khi cufu. 2.5. Thu thuat ciCu a. Cach che moi ngai, dieu ngai - Lay it ngai nhung de tren mieng gdng lay dau ngon cai, tro vao giUa an manh thanh hinh thap, to bang hat ngo hoac dau ngon ut. - Cuon ngai thanh dieu bang giay nhu cuon thuoc la, dudng kinh khoang 1cm b. D ot: dat mdi ngai len mieng gdng. Cham dau chay que huong len dinh mdi ngai, thdi cho bat lufa. Dat len huyet. - Ngai chay, khi nong lot mieng gdng khac. Khi chay het mdi ngai gat tan vao khay, lam lai mdi khac tren mieng gdng va tiep tuc nhu tren. - Dot chay dieu ngai ho sat da, khi benh nhan keu nong nhac ra xa rdi lai dua vao gan. 3. PHOI HOP G I0A CHAM VA CLfU Tren mot benh nhan co the dung phuong phap cham hoac phuong phap cdu, co khi ket hpp vda cham vda cufu. Thudng dung hai phuong phap: 3.1. Cd huyet cham, cd huyet ciiu: Can cd vao nguyen tac chda benh co ngon va goc (tri benh co tieu ban) ngon thi cham, goc thi cdu. Mot sd benh nhan han gia nhiet (thuc chat la han, hien tupng la nhiet) Thi du: Chda chdng nhde dau do thieu mau T5- STYHCT 65 - Cham huyet vung dau chufa nhufc dau (ngon) - Cufu cach du, cao hoang chufa thieu mau (goc) 3.2. On cham Dung kim cham, tren can kim gdn mot moi ngai nho va dot chay, ap dung cho cac benh co thien hudng han nhung chUa ro ret. ii. cd c h e t A c d u n g c u a PHifdNG p h A p c h Qa b e n h bA n g c h a m cufu Cham cUu la mot phuong phap chUa benh co nhieu ket qua, pham vi Ung dung rong rai, ngay mot phat trien dudi nhUng hinh thUc vo cung phong phu Da tU lau, ly luan ve co che tac dung cua phuong phap cham cdu di/a tren nhUng nguyen ly cac hoc thuyet co ban cua YHCT (am duong, ngu hanh, tang tupng, kinh lac, thien nhan hpp nhat...). Trong nhUng nam gan day, d rat nhieu nude, phuong phap chUa benh bang cach tac dong len "huyet" da dupe quan tam dac biet, va viec tim hieu co che tac dung cua no tren co sd khoa hoc da va dang gay nen nhUng tranh luan vo cung soi noi. Qua cac cong trinh nghien cdu tren lam sang va thuc nghiem that kho ma noi mot cach chinh xac khoa hoc ve co che tac dung cua phuong phap chUa benh bang cach cham cUu. Co rat nhieu gia thuyet ve c0 che tac dung cua cham cdu dupe ban den. - Co che the dich Miarbe (Phap) Tokieda (Nhat) - Co che thay ddi qua trinh dien sinh vat Delafuje, Niboyet (Phap) Patsibiakin (Lien Xo) Okamoto (Nhat). - Co che thay ddi cac chat trung gian hoa hoc dac biet la Histamin cua Martiny (Phap). - Co che than kinh phan xa: Chu Lien (Trung Quoc), Vigralic (Lien Xo), Felix Mann (Anh), Kassin (Lien Xo), J. Bossy (Phap) - Co che than kinh the dich noi tiet dac biet la Endorphin (giai thudng Nobel ve y hoc 1977): Bruce Pomeranz (Canada). 1. COt CHE CUA CHAM CtfU THEO Y HOC CO TRUYEN 1.1. Sit mat thang bdng ve dm diCamg phat sinh ra benh tdt Am duong la thuoc tinh cua moi su vat trong vu tru. Hai mat am duong luon co quan he ddi lap (mau thuan) nhung luon thong nhat vdi 66 nhau. Am duong trong co the bao gift cung thang bdng (binh hanh), nuong tua vao nhau (ho can) de hoat dong giup cho co the luon thich ting vdi hoan canh xa hoi thien nhien. Benh phat sinh la do sU mat can bang cua am duong. Su mat can bang do gay nen bdi cac tac nhan gay benh ben ngoai (ta khi cua luc dam), hoac the trang suy yeu, sUc de khang giam (chinh khi hu), hoac do su bien doi bat thudng ve mat tinh cam, tinh than (noi nhan), hoac cung co khi do nhUng nguyen nhan khac nhu the chat cua ngudi benh qua kem, sU an uong, nghi ngoi, sinh hoat khong dieu do... Tren lam sang, benh li bieu hien hoac han hoac nhiet, hoac hu hoac thuc (hu han thuoc ve am, thuc nhiet thuoc ve duong) nhieu khi rat phdc tap, cac dau hieu han nhiet rat kho phan biet (kiem chufng)... Nguyen tac dieu tri chung la lap lai moi can bang cua am duong. Cu the trong dieu tri bdng cham cufu, muon dudi ta khi, nang cao chinh chi phai tuy thuoc vao vi tri nong sau cua benh, trang thai han nhiet, hu thuc cua ngudi benh de van dung thich dang dung cham hay cdu, dung thu thuat ta hay bo. 1.2. Benh tat phat sinh ra lam rdi loan hoat dong hinh thitcfng cua he kinh lac: He kinh lac bao gom nhUng dudng kinh (thang) va nhdng dudng lac (dudng ngang) noi lien cac tang phu ra ngoai da va td chi, khdp, ngu quan va noi lien cac tang phu kinh lac vdi nhau. He thong kinh lac chdng chit khdp trong co the, thong suot d moi cho, (tren, dudi, trong, ngoai) lam co the tao thanh mot khoi thong nhat, thich nghi dupe vdi hoan canh tu nhien va xa hoi. Trong kinh lac co kinh khi (The Energy of life) van hanh (1) de dieu hoa khi huyet lam co the luon manh khoe, chong dupe cac tac nhan gay benh. He kinh lac cung la noi bieu hien cac trang thai benh ly cua co the, dong thdi cung la noi tiep nhan cac hinh thdc kich thich (cham cdu, xoa'bop, bam huyet, giac...) thong qua cac "huyet" de chda benh. Benh tat sinh ra do nguyen nhan ben ngoai (ngoai nhan) hoac nguyen nhan ben trong (noi nhan) dua den sU be tdc van hanh kinh khi trong dudng kinh. Neu ta khi thuc phai loai bo ta khi ra ngoai (dung phuong phap ta), neu do chinh khi hu phai bdi bo cho chinh khi day du (dung phuong phap bo). Mdi dudng kinh mang ten mot tang hoac mot phu nhat dinh khi tang phu co benh thudng co nhdng bieu hien thay ddi benh ly tren cac dudng kinh mang ten no hoac tren cac dudng kinh co moi quan he bieu ly vdi 67 no. Cham cufu tac dong vao cac huyet tren cac kinh mach do de dieu chinh cac roi loan chufc nang (be tdc) cua kinh mach. Tren co sd hoc thuyet kinh lac, tuy theo nguyen nhan gay benh, tinh trang cua co the, ngudi ta chu trong dac biet den cac van de sau: - Cham phai dac khi - Hu thi bo, thuc thi ta - Dua vao su lien quan giUa tang phu va dudng kinh, phoi hpp suf dung cac huyet tai chd vdi cac huyet d xa... 2. Ccf che tac dung cua cham cufu theo hoc thuyet than kinh - noi tiet - the dich 2.1. Mgt so van de cua hoat dong than kinh co lien quan tdi viec gidi thich cd che tdc dung cua cham ciCu. a. Cham ciiu la mot kich thich gay ra mot cung phdn xa mdi Cham la mot kich thich co gidi, cufu la mot kich thich ve nhiet gay nen kich thich tai da, co. - Tai noi cham, cufu co nhUng bien ddi: to chufc tai noi cham bi ton thuong se tiet ra Histamin, Acetylcholin, Cathecolamin... nhiet do or da thay ddi, bach cau tap trung, phu ne tai cho, cac phan xa dot true lam co gian mach mau, v.v... - Tat ca nhUng bien doi tren tao thanh mot kich thich chung cua cham cufu. Cac luong xung dong cua cac kich thich dupe truyen vao tuy len nao, td nao xung dong chuyen tdi cac co quan dap Ung hinh thanh mot cung phan xa mdi b. Hien tuong chiem Uu the cua Utomski - Theo nguyen ly cua hien tupng chiem Uu the cua Utomski thi trong cung mot thdi gian, d mot noi nao do cua he than kinh trung uong (vo nao) neu co 2 luong xung dong cua 2 kich thich khac nhau dupe dua tdi, kich thich nao co cudng do manh hon va lien tuc hon se co tac dung keo cac xung dong cua kich thich kia tdi no va kim ham, tien tdi dap tat kich thich kia. - Nhu tren da trinh bay cham cufu se gay ra mot cung phan xa mdi. Neu cudng do kich thich du ldn se Uc che dupe hung phan do ton thuong benh ly gay ra, tien tdi lam mat hoac pha vd cung phan xa benh ly. Tren lam sang, ngudi ra thay hieu qua nhanh chong cua cham cdu (dac biet la dung cham dien trong viec lam giam con dau cua mot so benh cap tinh nhu con dau da day, giun chui ong mat, dau cac day than kinh ngoai bien, gay xuong, viem khdp cap, dau rang v.v... va tac dung lam het 68 cam giac lanh, scf lanh cua phuofng phap cufu trong dieu tri cap cufu, cac truang hofp truy tim mach v.v...). Khi cham cufu de dam bao ket qua dieu tri, cac kich thich tac dong len huyet phai dat den ngUting (seul d’excitation) con goi la "dac khi", phai thanh thao cac thu thuat "bo, ta". c. Su phdn chia tiet doan than kinh va sU lien quan gitia cac tang phu doi vdi cac vung co the do tiet doan chi phoi. Co 31 doi day than kinh tuy song, moi doi day chia lam 2 nganh trUo'c va sau chi phoi van dong va cam giac mot vung co' the goi la mot tiet doan. Su cau tao than kinh nay goi la sU cau tao tiet doan. Vi du: vung da of cac tiet doan ngUc D5, D6, Dg va tiet doan cd C2, C3, C4, C5 tUcrng ting vdi da day. Khi noi tang co benh, ngutii ta thay co sU tang cUting cam giac vung da cung tiet doan vdi no nhu cam giac dang thay ddi dien sinh vat, v.v... Hien tuong nay xay ra do nhufng sai than kinh cam giac bi kich thich, xung dong dan truyen vao cac te bao cam giac sting sau tuy song, gay ra nhufng su thay doi ve cam giac or vung da. Mat khac nhufng kich thich giao cam lam co mach, sU cung cap mau of vung da it di va lam dien tror of da giam xuong gay ra nhufng thay doi dien sinh vat. Tren cor sof nay Zakharin (Lien Xo) va Head (Anh) da thiet lap dupe mot gian dd ve sU lien quan gitia vung da va noi tang, va day cung la nguyen ly che tao cac may do dien tror vung da va may do kinh lac, v.v... Neu noi rang co ton thuong, dung cham ctiu hay cac phuofng phap vat ly tri lieu khac tac dong vao cac vung da tren cting mot tiet doan vtii noi tang se chufa dUo'c cac benh or noi tang. Bang doi chieu su lien quan gitia cac noi tang va tiet doan than kinh. Noi tang Tiet doan Tim Di - D3 (D4 - D6) Phoi D2 - D3 (D4 - D6) Thiic quan D7 - Ds Da day D5 - Dg (C2 - C5) Ruot Dg - D 12 Triic trang S2 - S4 Gan, mat D7 - Dg Than, nieu quan Dio - D 12, Li - L2 Bang quang D 11 - D 12, Li, Si - S4 Tien liet tuyen Dio - D 11, L5 - Si - S2 - S3 Tuf cung Dio - Li, L2, Si - S4 Tuyen vu D 4 - D 5 69 C : Cd, D : Lung, L: That lung, S: Cung d. Nguyen ly ve ca nang sinh ly linh hoat ciia lie than kinh cua Widekaki Theo nguyen ly nay trong trUdng hcfp than kinh d trang thai yen tinh mot kich thich nhe thudng hay gay ra mot phan ting hung phan nhe, kich thich manh thudng hay gay ra mot phan ufng hung phan manh. Nhung neu than kinh d trang thai bi hung phan do kich thich benh ly thi mot kich thich manh chang nhUng khong gay ra phan Ung hung phan manh ma con lam cho hoat dong than kinh chuyen sang qua trinh tic che nen co tac dang dieu tri. e. Ly thuyet dau cua Melzak va Wall (ci2a kiem soat - 1965): Trong trang thai binh thudng cac cam thu ban the di vao sting sau tuy song, d cac ldp thti 3, thti 4 (gom cac te bao cua cac chat keo va cac te bao chuyen tiep) lam cam giac dau (hoac khong dau) dupe dan truyen. Te bao nhu canh ctia kiem soat, quyet dinh cho cam giac nao di qua. O trang thai binh thudng luon co nhting xung dong nhting xung dong nay phat huy tic che, qua te bao chuyen tiep va di len tren vdi kich thich vtia phai xung dong dupe tang cudng den lam hung phan te bao chat tao keo lam khti cUc dan truyen va di len. Tren co sd ly thuyet cua kiem soat cua Melzak va Wall nam 1974 Sheoly che tao dupe mot may luon kich thich vao cot sau cua tuy song de lam giam dau trong cac benh Ung thu. h. Vai trd the dicli, noi tiet va cac chat trung gian than kinh: TU nam 1973 nhieu thuc nghiem da chting minh dupe trong cham ctiu va dinh cao cua no la cham te, ngoai vai tro cua than kinh ra con co vai tro cua the dich. Co the la: Acetyl cholin, cac chat Monomin (Cathecolamin 5 Hydroxyptamin) cac chat Beptida cac chat Monoacite Morphinelike (quan trong la Endorphin), chat gay dau P (Subtinoe P) Morphinelike - Nhting nam 1976 Guillemin (NgUdi My goc Phap) Chor Haoli (ngudi My goc Trung Quoc) da phan tich dupe tuyen yen cua lac da, lpn, ctiu... chat Morphinelike. - Cung nam 1976 Mayer va cong su da chting minh tac dung cua cham te bi huy do tiem vao dong vat thuc nghiem chat Naloxon (chat ddi lap vdi Morphin, (3 Endorphin). - Bruce Pomeranz (TrUdng dai hoc Toronto Canada) nam 1976 da thanh cong trong mot sd thuc nghiem ve cham te: + Tiem Naloxon vao meo dupe cham te thay sp phong dien cua cac te bao d ldp sting sau tuy song, meo khong bi tic che ntia. + Cat bo tuyen yen meo roi cham te, khong thu dupe ket qua te. 70 + Ngudi ta da xac dinh duoc cong thdc hoa hoc cua chat Morphinlike la nhting chat tiet cua nao chu yeu do hau yen tiet ra, ngoai ra con tim thay or tren mot hoac nhieu co quan khac. No la mot Polypeptid gom 91 axit amin va duoc chia lam 3 doan: doan a, doan p va doan y endorphin trong do doan p co cac axit amin tti sd 61 den sd 91 co tac dung morphin nhieu nhat, manh gap 200 lan morphin. 2.2. Cof che tdc dung cua cham ctiu Vogralic, Kassin (Lien Xo); Chu Li§n (va nhieu tac gia Trung Quoc). Vu Xuan Lang, Le Khanh Dong (Viet Nam); Mai Van Nghe, Jean - Bossy (Phap), v. v... Can cuf vao vi tri tac dung cua noi cham cUu de ra 3 loai phan Ung cua co the tren co sd nay de giai thlch co che tac dung va hudng dan phuong phap hoc tap va suf dung cham cdu cho de dang. a. Phdn ting tai clio: cham hay cdu vao huyet la mot kich thlch gay mot cung phan xa mdi cd tac dung Uc che va pha vd cung phan xa benh ly nhu lam giam co'n dau, giai phong sU co cd... - NhUng phan xa dot true cua he than kinh thuc vat lam anh hudng den sU van mach, nhiet, sU tap trung bach cau, v.v... lam thay ddi tinh chat cua ton thuong, giam xung huyet, bdt nong, giam dau. - Phan dng tai cho co y nghia thuc tidn lam sang kha ldn la co sd cua phuong phap dieu tri tai cho hay xung quanh noi cd thuong ton ma cham cUu dung cac huyet goi la a thi huyet (thong diem, thien Ung huyet). b. Phdn ting tiet doan: khi noi tang cd ton thuong benh ly thi cd nhUng thay doi cam giac vung da d cung mot tiet doan vdi no, nguoc lai nhUng kich thlch tU vung da cua mot tiet doan nao dd se cd anh hudng den noi tang cung tren tiet doan dd (xem so do Zakhazin - Head). Viec sd dung cac huyet co lien quan vdi cac noi tang cung tiet doan se gay ra mot phan dng tiet doan. NhUng xung hudng tam se truyen nhip vao sdng sau tuy song, qua sdng trUdc bat dau cung phan xa li tam: mot la theo cac soi van dong trd ve bo phan co cua tiet doan duoc cham, hai la theo cac soi thuc vat den mach mdu va den cac co quan, noi tang tuong ufng, lam dieu hoa moi co nang sinh ly nhu phan tiet, dinh dudng v.v... Viec sd dung phan dng tiet doan co nhieu y nghia thuc tidn ldn vi no co the giup cho ngudi cham cdu chon nhUng vung va huyet d mot tiet doan than kinh tuong dng vdi co quan, noi tang bi benh. Viec thanh lap cong thdc cham cdu dieu tri mot sd benh thuoc tdng vung duoc tien loi va dd dng dung hon. Mat khac theo quan niem cua phan dng tiet doan giup ngudi hoc va dng dung cham cdu hieu va giai thlch duoc phuong phap dung cac du huyet (d lung) mot huyet (d ngUc bung) va cac huyet d xa 71 (tay, chan), dac biet la dung cac huyet sat cot song (Hoa Ba giap tlch) va cac boi du huyet trong cham te de phau thuat. c. Phdn ling toan than: tuy nhien thuyet phan ufng tiet doan khong the giai thich duoc tac dung cua cac huyet 6 xa tiet doan co lien quan den benh li. Cac nha nghien ctiu cham ctiu hien dai cho rang tac dung dieu tri benh cua cham ctiu trong cac trUdng hop ke tren la thong qua tac dung gay ra phan ting toan than. Thuc chat bat ky mot kich thlch nao doi vdi co the cung deu co lien quan toi hoat dong cua vo nao, nghia la co tinh chat toan than. Nhu vay, sU phan chia ra phan ting tai cho, phan ting tiet doan chi co gia tri ve lien quan cuc bo tting phan cua co the thong qua hoat dong cua tuy. Khi noi ttii phan ting toan than, chung ta can nhti lai nguyen ly ve hien tuong chiem Uu the vo nao cua Utomski, ve co nang linh hoat cua he than kinh cua edensky ve cac kich to" (Hormon) va cac chat trung gian hoa hoc than kinh (Histamin, Acetylcholin, Morphinlike...) Diem quan trong cua phan ting toan than la tac dung cua he than kinh trung Uong ttii he than kinh thuc vat, qua do anh hudng den cac co quan noi tang va nhting to chtic cua co the. Khi cham, xung dong than kinh khong ngting duoc dan truyen vao tuy song len nao. Vagralic, Kassin (va nhieu tac gia) nghien ctiu dien nao do trong khi cham thay dien the co nhting bien doi lan toa, toan dien, doi xting toan than thuting thay song delta va theta cham hon nhieu cac song khong deu nhip. Tinh trang tinh than luon luon cang thang gay ra roi loan qua trinh hung phan va tic che cua hoat dong than kinh cao cap. Cham ctiu co tac dung dieu chinh cac roi loan do vi sau mot dot dieu tri trieu chting lam sang tot hon, dien nao do bien doi tot hon. Mot diem quan trong ntia cua phan ting toan than la cac bien doi ve the dich, noi tiet. ThUcmg thuting trong khi cham va sau mot dot dieu tri bang cham ctiu cac the dich nhu Sympatin, Adrenalin, Histamin, Acetylcholin, Morphin - like (dac biet la (3 Endorphin) cung co nhting bien doi, anh hudng den cac he tuan hoan, ho hap, tieu hoa, bai tiet va sU chuyen hoa cac chat. Nhieu tac gia nghien ctiu hoat dong cua he tuyen yen, thuong than sau cham thay ro tuyen yen tao ra mot kich to (Hormonotrope) lam tang hoat dong cua mot so tuyen noi tiet nhu tuyen thuong than, tuyen giap trang, tuyen sinh due... NgUtii ta da chting minh duoc rang: cham lam cho bach cau ai toan giam (70 - 80% cac truting hop), cham lam ldp vo thuong than bai tiet ra kich to Corticosteroid cung tuong tif nhu tiem vao co the 20 72 dan vi ACTH de kich thlch tuyen thuong than bai tiet chat nay. Cham cac huyet Dai chuy (XIII14), Thuy dot (V10) ctiu gitia cac dot song lifng co the lam cho tuyen giap trang tam then ngting hut iod... 2.3. Nhting Uu diem va nhtiefe diem khi van dung hoc thuyet than kinh the dich de giai thich cd che tac dung cua cham ctiu - Co che tac dung cua cham ctiu giai thlch theo hoc thuyet than kinh the dich giup cho qua trinh hoc tap va sti dung cham ctiu de dang, co the van dung de giai thlch duoc hau het cac trUdng hop benh ly co nang duoc chi dinh dieu tri bang phuong phap cham ctiu. Ve mat hoc tap, chia cac huyet theo tting vung tiet doan co the, so luong huyet sti dung chting 80 - 100 huyet thong thudng (ma khong can thiet phai nhd tat ca 365 huyet), giup cac thay thuoc da khoa co co sd co ban de ket hop tot hai nen y hoc trong dieu tri benh. Ve tac dung va van dung cac huyet: trutic het can ndm duoc vi tri cua cac huyet tren vung co the de biet tac dung cua no. Sau do can nSm mot so cong thtic de chtia benh noi tang va cac co quan or tting vung co the: + Huyet 0 vung lung: chtia cac benh ve tuan hoan, ho hap, viem tuyen vu, tdc tia stia, dau than kinh lien sUdn, v.v... + Huyet vung thuong vi that lung: chtia benh ve bo may tieu hoa (viem loet da day, benh gan mat...) + Huyet vung ha vi that lung cung: chtia benh dudng tiet nieu, sinh due + Ve toan than can ndm mot so huyet co tac dung toan than de phoi ho'p dieu tri vo'i cac huyet tting vung - Co che cham ctiu giai thlch theo hoc thuyet than kinh the dich chua giai thlch duoc nhting dieu da neu trong cac sach cham ctiu co dien nhu he kinh lac, phuong phap bo ta... khong giai thlch duoc cac quy luat van dung cac huyet toan than nhat la benh ly cac tang phu, cac quy luat lay huyet theo thdi gian (cham ctiu theo gift, theo mua, v.v...) 3. KET LUAN Van de dieu chinh co nang cua co' the qua cach tac dong len huyet bang cham ctiu da co mot lich sti kha lau doi, song de tim ra nhting van de cu the cua no tren co so khoa hoc, co the noi rang mtii chi duoc bat dau. Nam vting duoc he thong ly luan cua y hoc co truyen ket hop vdi cac kien thtic cua y hoc hien dai, cung vdi viec nghien ctiu va ap dung cham ctiu mot cach rong rai va nghien ctiu cua cac nha khoa hoc trong nude va tren the gidi chdc chdn rdng trong tuong lai khong xa, co che tac dung cua cham ctiu se duoc sang to. 73 III. Vj TRI CAC HUYET THEO VUNG CO THE 1. DAI ClfclNG VE HUYET 1.1. Huyet nam tren cac ditcfng kinh: La noi di lai cua kinh khi, bao dam su tuan hoan va sU lien lac chat che giUa con ngudi va thien nhien, co lien quan ve mat sinh ly va benh ly cua cac tang phu. Khi co benh, tren huyet co nhUng thay doi ve cam giac (dau, tUc, v.v...) va dien sinh vat. Khi dieu tri, can cU vao nhUng thay doi tren, ngudi ta ap dung cham va cUu de dieu hoa cong nang hoat dong cua cac tang phu. Thudng co 295 huyet den 365 huyet tren dudng kinh va khoang 200 huyet ngoai dudng kinh; thong thudng chi hoc tU 80 - 100 huyet hay dung. 1.2. Phitcmg phdp lay huyet - Lay huyet theo vi tri co the Dung cac moc co, xuong, than kinh, vi tri tuong xdng cua co the. Ve trong ngoai, lay theo quy Udc giai phau (tay: ngon cai ra ngoai, ngon ut vao trong; chan: ngon cai vao trong, ngon ut d ngoai) - Don vi do litong: Lay chieu dai theo do'n vi thon cua ngudi benh ap dung chung cho ngudi ldn, tre em cac Ida tuoi Thon la gi ? Co dau ngon cai va ngon giUa thanh mot vong tron, cho tan cung gida hai nep gap dot 2 ngon giUa la thon. Bon khoat ngon tay (be rong cua bon ngon tro, giUa, nhan, ut) la 3 thon 1.3. Trinh tit trinh bay vi tri cac huyet: Cac huyet tU khuyu tay den ban tay, td dau goi den ban chan co tac dung toan than; de van dung d§ dang ta hoc vi tri cac huyet trinh tu nhu sau: huyet vung tay, huyet vung chan, huyet vung dau, mat co, huyet vung ngUc lung, huyet vung thuong vi lung, huyet vung ha vi va that lung cung. 2. HUYET VUNG TAY VA CONG THtfC DIEU TRI 2.1. Chi dinh dieu tri - Tai cho: + Dau cac day than kinh ngoai bien: mu, quay, gida, tru + Dau cac khdp: vai, khuyu, co tay, ban tay - Toan than: ha sot (cac huyet mat ngoai cang tay). Mat ngu, rdi loan than kinh tim, non, mda, ho hen con dau noi tang (cac huyet mat trong ciing tay). 74 2.2. Ky thuat cham ctiu: - Cham nong 2mm cac huyet 5 dau ngon tay - Khong ctiu cac huyet vung co tay 2.3. Cac huyet d vung tay Ten huyet Vi tri va cach lay huyet Tac dung dieu tri Thu thuat Kien ngung (kinh dai trUdng] Khuc tri (kinh dai trUdng) Xlch trach (kinh phe) Khuc trach (kinh tam bao lac) Thieu hai (kinh tam) ! Tieu hai (kinh tieu trUdng) Noi quan (kinh Cho lom dudi mom cung vai giufa noi bdt dau cua co den ta Gap khuyu tay, huyet d tan cung phia ngoai nep gap khuyu tay Tren ranh nhi dau ngoai, ngoai gan co nh: dau, huyet tren dudng ngang nep khuyu Tren nep ldn khuyu tay tren ranh nhi dau trong ben trong gan co nhi dau Gap khuyu tay huyet 0 tan cung diu trong nep gap khuyu tay Tren ranh rong roc canh tay (noi co day than kinh tru di qua) Tir lkn chi co tay do len 2 thon gida gan co gan Dau khdp vai, dau vung ba vai, dau dam roi than kinh canh tay - liet day mu Dau day quay, dau khdp khuyu, liet chi tren, sot viem hong Sot, ho, viem hong, con hen phe quan, dau lien sUdn 1- 2, co giat tre em Dau khdp khuyu, dau day than kinh giufa, sot cao, say song, non mufa Dau khdp khuyu, dai^ day than kinh tru, con dau that ngUc, dau vung trudc tim Dau khdp khuyu, dau day than kinh tru, co giat Dau khdp co tay, dau Cham 1 - 2cm cufu 20 - 30’ Cham 1 - 2 cm cufu 10 - 30’ Cham 6mm den 1 cm Cham 3 - 6mm cufu 5 - 15’ Cham 4 - 5mm cufu 5 - 15’ Cham 4 mm Cham 6mm tam bao lac) Thai uyen tay lotn va gan tay be Tren ldn chi co tay ben than kinh giufa, roi loan than kinh tim, it ngu, dau da day, non mufa Ho, ho ra mau, hen, cufu 5 - 15’ Cham 1 mm (kinh phe) ngoai gan co gan tay ldn viem phe quan, viem den 6mm huyet phia ngoai mach hong, dau lien sudn quay 1 Dai lang (kinh Tren ldn chi cd tay, giufa Roi loan than kinh tim, Cham 3 - 6mm tam bao lac) gan hai co gan tay ldn va gan tay be cao huyet ap, mat ngu, con dau da day, non mufa, dau khdp cd tay, dau day than kinh giufa 75 Than mon (kinh tam) Ngoai quan (kinh tam tieu) Hop coc (kinh dai trUdng) Tren lan chi co tay, cr Dau khdp co tay, dau cho 15m giufa xUOng dauthan kinh tru. Mat ngu va dau duoi xuong tru,roi loan than kinh tim, phia ngoai cho bam cd co giat tre em tru trudc ------------------------------------| ■ Cf cang tay sau, tif co’ Dau khdp khuyu, co tay, tay do len 2 thon, doi nhufc 1/2 dau, cam mao, xUng vdi huyet noi quansot, dau vai gay, viem ben trong tuyen mang tai - Dat dot 2 ngon cai ber^Nhdc dau. u tai, mat kia len ho khau (gida ngu ra mo hoi trom, ngon 1 va 2) ban tay so t cao, cam mao, dau ben nay noi tan cungrang, viem amidan, ho, dau ngon la huyet. 'chay mau cam, dau ImSt, liet day VII ngoai 'bien. Cham 6mm - 1cm Cdu 15’ Cham 1 cm Cdu 15’ ! Cham 1 cm Cdu 10 - 20’ Bat ta (ngoai kinh) Thap tuyen (ngoai kinh) Tan cung cac nep gap cua 2 ngon tay phia mu tay (mdi ban tay 4 huyet, 2 ben la 8 huyet) Cf 10 dau ngon tay, diem giufa cach bd tu do cua mong tay 2mm ve phia gan tay - Viem khdp ban tay - Cuoc - Dau rang Sot cao, hon me, co giat Dung kim tam lang trich nan mau Duong tri (kinh tam tieu) Tren nep lan cd tay ben ngoai gan co duoi chung ✓ -> Dau khdp cd tay, u tai diec tai, cam mao, nhdc 1/2 dau Cham 6mm 2.4. Cong thtic dieu tri • Dau dam roi than kinh canh tay: - Dau day mu: Kien ngung, Khuc tri - Dau day quay: Khuc tri, Xich trach, Hop coc, Thai uyen - Dau day giufa: Khuc trach, Noi quan, Dai lang - Dau day tru: Tieu hai, Thieu hai, Than mon • Dau khdp khuyu tay va co tay: - Khuyu tay: Khuc trach, Xlch trach, Khuc tri, Thieu hai, Tieu hai, Noi quan, Ngoai quan. - Co tay: Noi quan, Ngoai quan, Hop coc, Thai uyen, Dai lang, Duong tri, Than mon. 76 3. HUYET VUNG CHAN VA CONG THl/C DIEU TRI 3.1. Chi dinh dieu tri - Tai cho: dau day than kinh dui, dau day than kinh toa, dau cac khdp hang, dau goi, co chan, ban chan - Toan than: + Benh ve bo may sinh due tiet nieu: dai dam, di tinh, liet duong, kinh nguyet khong deu, rong kinh, thong kinh, bi tieu tien, v.v... (cac huyet mat trong cang chan). + Benh ve bo may tieu hoa: an kem, cham tieu, ia chay, ly, giun chui ong mat, con dau da day, v.v... (huyet mat trudc va sau cang chan) + NhUc dau, mat ngu, cao huyet ap, v.v... 3.2. Vi tri cac huyet thiibng dung: 1 ' Ten huyet Vi tri va cach lay huyet Tac dung dieu tri Thu thuat 1 2 3 4 NSm nghieng co chan Hoan khieu i (kinh ddm) tren, duoi chan dudi, huyei Dau khdp hang, Dau day toa, liet chi dudi Cham 3 - 5cm ThCra phu (kinh d cho lorn dang sau ngoai mau chuyen ldn xiiOng duj tren co mong to Mat sau dui, giufa nep lan Dau day toa, dau lung Cham 2 - 3cm bang quang) mong liet chi dudi Huyet hai (kinh ty) Gap dau goi, td bd tren Dau khdp goi, dau xtiong banh che do len 1 than kinh dui, kinh Cham l,4-2cm cufu 10 - 30’ thon, vao trong 2 thon .. Gap dau goi, tif giufa bd trer nguyet khong deu eczema, me day Li/Ong khau iDau khdp goi, dau Cham 1 - 1,6cm (kinh vi) xuong banh che do len 2 thon, ra ngoai 1 thon than kinh dui, dau da day,viem tuyen vu Cufu 10 - 30’ ■ ' Doc ty (kinh vi) Cho lom dau dudi ngoai xirong banh che Dau khdp goi Cham 5-10mm Uy trung (kinh Diem giufa nep lan tram Dau td that lung trd Cham 1,5cm bang quang) khoeo chan xuong, dau khdp goi Dau than kinh toa, ha sot cdu 15 - 30’ 77 Tuc tam ly (kinh vi) Duong lang tuyen (kinh ddm) Am lang tuy§n (kinh ty) Tam am giao (kinh ty) Thifa son (kinh bang quang) Thai khe (kinh than) Thai xung (kinh can) Thifong khau (kinh ty) Noi dinh (kinh vi) Td Doc ty do xuong 3 thon ngoai mao chay 1 khoat ngon tay tro Cho lom giufa xifong mac va xiiOng chay, huyet 0 tren va 0 ngoai huyet tuc tam ly 1 thon Vuot ngifoc bd trong xifong chay den nganh ngang la huyet (n lm tren co dep) Td loi cao mat ca trong do len 3 thon, tif bcf trong xifong chay do ra sau 1 khoat ngon tay Giufa cang chan sau tren co dep, noi hop lai cua 2 co sinh doi Cach ngang sau mat ca trong xifong chay 1/2 thon Ke ngon 1 - 2 do len 2 thon ve phia mu chan Cho lom dau trifdc difdi mSt ca trong xifong chay Ke ngon chan 2 - 3 do len 1/2 thon ve phia mu chan - Viem khdp goi, dau day toa - Cac benh tieu hoa: cham tieu, 0 hoi, tao bon, ia chay, kiet ly, dau da day. La huyet cifdng trang. Khi cufu, xoa bop co tac dung phong benh (cam mao, v.v...) Dau khdp goi, dau day thin kinh toa, nhufc dau 1/2 ben, dau vai gay, dau lien sifdn cung ben, giun chui ong mat Kem an, non, ia long, di tinh, dai dam, mat ngu Rong kinh, rong huyet, doa say, bi dai, dai dam, di tinh, viem tinh hoan, mat ngu, nhufc dau Dau day toa, chuot rut, tao bon Dau lifng, dau khdp cd chan, sot, cam mao, nhufc dau sau gay Dau viem tinh hoan, nhufc dau vung dinh, cao huyet ap, viem mang tiep hop, kinh nguyet khong deu, rong kinh, dai dam, thong kinh Soi bung, day hoi khong tieu, bi dai tien, tri, ia chay Dau rang ham difdi, liet day VII, chay mau cam, day bung, sot cao, giun chui dng mat Cham 1 - 1,6cm 1 Cham 1cm Cufu 10 - 30’ Cham 1 - 1,6cm Cufu 5 - 15’ Cham 1 Cufu 15’ 1 Cham 2 - 2,5cm Cufu 15 - 30’ Cham 2mm Cufu 15 - 30’ Cham 6mm den 1cm Cufu 5 - 20’ Cham 4mm den 6mm Cdu 5 - 20’ Cham 6mm, Cdu 5 - 20’ Cham sau 6mm 78 Bat phong 8 huyet ngay ke ngon chan cua 2 ban chan Dau cac dot ngon chan cifdc 3.3. Cong thtic dieu tri: - Dau day than kinh dui: Than du (L2 - L3, do ngang 1,5 thon) Huyet hai, Luong khau. - Dau day than kinh toa: Dai trifdng du (L4 - L5 do ngang 1,5 thon) Hoan khieu, Thifa phu, Uy trung, Thifa Son, Con Ion, Giai khe, Difang lang tuyen. - Dau khdp goi: Huyet hai, Luong khau, Doc ty, Tat nhan, Difang lang V 9 tuyen, Tuc tam ly, Uy trung. - Dau khdp cd chan: Tam am giao, Thai khe, Con Ion, Thifong khau, Giai khe 4. HUYET VUNG DAU MAT CO VA CONG THLfC DIEU TRI 4.1. Chi dinh dieu tri - Tai did: cac benh dau day than kinh VII, III, V, nhtic dau, cac benh ve tai mui, xoang. - Toan than: ngat, sot cao co giat, sa trifc trang, cam mao 4.2. Ky thuat cham ctiu - Cac vung da sat xifong (tran, dinh dau) hoac d difdi co cac co quan (mat) cham nong 2mm va cham nghieng kim 15° - Khong nen cufu hoac rat than trong khi cufu, tranh bong thanh seo d mat 4.3. Vi tri tdc dung cac huyet thticfng dung Ten huyet Vi tri va cach lay huyet Tac dung dieu tri Thu thuat An duong (ngoai kinh) Di/ong bach Diem giufa dau trong 2 cung long may Tif diem giufa cung long Viem xoang tran, nhufc dau, viem mang tiep hop, chap leo, viem tuyen le Liet day VII, nhufc dau, Cham 2mm cufu 5 - 15’ Cham 2mm (kinh ddm) viem mang tiep hop, may do len 1 thon, nSm (nghieng) Tinh minh (kinh bang quang) Toan true (kinh bang quang) tren co tran Cho lom, cach goc trong mi mat tren 2mm Cho lom dau trong long may chap leo, viem tuyen le Liet day VII, viem mang tiep hop, chap leo, viem tuyen le Nhufc dau, viem xoang tran, liet day VII, viem mang tiep hop, chap leo cufu 5 - 15’ Cham xien 2mm. Khong cufu Cham nghieng 2 mm 79 Ty true khong I ''NhUc dau, benh ve mat [Cho lom dau ngoai long " - ■ ' | Cham 2mm (kinh tam tieu) Dong tuf lieu (kinh ddm) may Cach khoe mat ngoai 3/10 thon tuong ling mom o mat ngoai liet day VII Liet mat, benh ve mat Cham 4mm Thai duong (ngoai kinh) Nghinh huong (kinh dai trUdng) Cuoi long may hay duoi mat do ra sau 1 thon tren xifong thai duong Tif chan canh mui do ra ngoai 2/10 thon NhUc dau, dau rang, viem mang tiep hop Viem mui di Ung, ngat mui, chay nude mui, chay mau cam, liet day VII Cham 4mm | Cham 4mm Nhan trung (mach doc) 1/3 tren ranh nhan trung Ngat, choang, sot cao, co giat, hon me, liet day VII Cham 2mm Dia thuong (kinh vi) Ngoai khoe mieng 4/10 thon Liet day VILdau rang Cham 2mm ThUa tuong (mach nham) Giap xa (kinh vi) Thinh cung Cho lom dudi moi difdi tren cam Tif goc xifong ham difdi do ra 1 thon, tif Dia thifong do ra sau 2 thon ve phia goc ham (trifdc bd dudi co nhai) Cho lom ngang trifdc giifa Ngat, liet mat, truy mach Liet day VII, dau day V, dau rang, cam Liet day VII, u tai, viem Cham 2mm Cham 2mm Cham 3 - 4 (kinh tieu trUdng) ThUa khap nap tai (nhi binh) Difdi mi mat difdi 7/10 tai giUa, viem tuyen mang tai Viem mang tiep hpp, mm Cham 6mm (kinh vi) E phong thon tifong dng hom difdi o mat Cho lom giifa xifong ham chap leo, liet day VII Liet day VII, u tai, viem Cham 6mm (kinh tam tieu) Bach hoi (mach doc) ’ difdi va xifong chum, an, dai tai xuong ranh tdi dau la huyet d dd Dinh dau, noi gap nhau cua 2 dudng noi 2 dinh tai va dudng giUa sdng mui tuyen mang tai Sa tnlc trang, sa da day, Cham 2mm sa tu cung, nhtic dau, cam cum, ngat mui Cham 1,2 - 1,5cm CUu 10 - 20’ 80 Phong tri (kinh ddm) TU xuong cham - Ci do Dau vai gay, cao huyet nSanS ra 2 thon, huyet dap, benh mat, cam mao, lom ngoai co thang sau cPnhUc dau Uc don chum