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giai thch nguyen nhan cua cac hien tng tam than bat
thng lien quan en cac qua trnh vo thc ma benh nhan
khong nhan biet c.
Benh hoc tam than thc nghiem Tiep can nay
cung tm cach giai thch cac hien tng bat thng cung nh
mo ta chung. Tuy nhien, cac giai thch trong tiep can nay
lien quan en cac qua trnh tam ly co the xac minh c
bang thc nghiem, hn la cac qua trnh vo thc nh trong
benh hoc tam than ong lc. Cac phng phap c dung
e nghien cu cac hien tng bat thng la cac phng
phap cua khoa hoc than kinh, bao gom cac ky thuat chan
oan hnh anh nao va tam ly hoc nhan thc. Mac du
benh hoc tam than thc nghiem lien quan en nguyen nhan
cua cac trieu chng, cac trieu chng nay ch c nghien
cu trong boi canh cua cac hoi chng. V du, v benh hoc
tam than thc nghiem ve lo au a c nghien cu chu
yeu cac benh nhan b roi loan lo au nen no c mo ta
trong chng ve cac roi loan nay.
Khi mo ta cac trieu chng tam than, can phan biet
gia hnh thc va noi dung cua cac trieu chng; s phan
biet nay c minh hoa tot nhat qua cac v du. Mot benh
nhan noi rang, khi mot mnh anh ta nghe nhng tieng noi
goi anh ta la mot ke ong tnh, th hnh thc cua trai nghiem
la mot ao thanh con noi dung lien quan en phat bieu anh
ta la ong tnh. Mot benh nhan th hai nghe nhng tieng noi
noi rang anh ta sap b giet; nh vay hnh thc van la mot
ao thanh nhng noi dung lai khac. Mot benh nhan th ba co
cac y ngh am anh anh ta la ong tnh nhng nhan biet
nhng y ngh nay la khong ung. Trng hp nay co noi
dung tng t nh v du au (lien quan en ong tnh) nhng
hnh thc th khac- mot y ngh am anh. Hnh thc giup cho
viec thiet lap chan oan con noi dung tuy t co vai tro trong
chan oan nhng lai rat quan trong trong x tr. V du, noi dung
cua mot cua mot hoang tng gi y benh nhan co the
tan cong mot mot ke lam hai gia nh.
Cac trieu chng co khi c chia thanh nguyen phat
va th phat nhng cac thuat ng nay co hai ngha khac
nhau. Ngha th nhat lien quan en thi gian, nguyen phat la
xay ra au tien, va th phat la xay ra sau. Ngha th hai
lien quan en tnh nhan qua, nguyen phat la phat sinh trc
tiep t qua trnh benh ly, va th phat la phat sinh nh
mot ap ng vi trieu chng nguyen phat. Hai ngha nay
thng i oi vi nhau v cac trieu chng phat sinh trc tiep
t qua trnh benh ly bao gi cung xuat hien trc. Tuy
nhien, mac du cac trieu chng xay ra sau thng la mot
ap ng vi cac trieu chng au tien, nhng khong phai
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luon luon nh vay v chung cung co the phat sinh trc tiep
t qua trnh benh ly. Thuat ng nguyen phat va th phat
thng c dung nhieu hn trong ngha ve thi gian v cach
dung nay khong can en mot suy luan ve tnh nhan qua.
Tuy nhien, nhieu benh nhan khong the noi cac trieu chng
cua ho xuat hien theo th t nao. Trong nhng trng hp
nay, khi mot trieu chng dng nh la mot ap ng vi
mot trieu chng khac, chang han mot hoang tng b theo
doi bi nhng ke am hai la mot ap ng vi viec nghe
nhng tieng noi ket an mnh, no se c goi la th phat
theo ngha nhan qua.
Ve y ngha cua cac trieu chng rieng le, cac roi loan
tam than thng c chan oan khi co s hien dien cua
mot nhom cac trieu chng a c xac nh ro. Hau nh
moi trieu chng n oc eu co the c trai nghiem bi
mot ngi bnh thng; ngay ca cac ao giac, thng c coi
la ac iem cua roi loan tam than, oi khi cung co the
xuat hien nhat thi nhng ngi khoe manh. Trng hp
ngoai le la mot hoang tng n oc thng c xem la
bang chng cua roi loan tam than neu no la ro ret va
dai dang (roi loan hoang tng). Do o, s hien dien cua
mot trieu chng n oc tuy khong han la bang chng cua
roi loan tam than nhng la mot ch nh can phai kham
xet ky lng nhieu lan e tm them cac trieu chng khac
cua roi loan tam than.
I. CAC ROI LOAN Y THC:
Y thc la s nhan biet ve ban than va moi trng
xung quanh. Cac mc o cua y thc co the thay oi t
hoan toan tnh tao cho en hon me.
Hon me la trang thai nang nhat cua roi loan y thc.
Benh nhan khong co cac bieu hien cua hoat ong tam
than va rat t hoat ong van ong tr ho hap. Benh nhan
khong ap ng ngay ca oi vi cac kch thch manh. Hon
me co the c phan loai tuy theo mc o cua cac ap
ng phan xa con lai va loai hoat ong ien nao.
Y thc u am lien quan en mot trang thai co the
thay oi t mot roi loan va u nhan thay en ngu ga ro
ret trong o benh nhan ap ng khong ay u vi cac
kch thch. Cac kha nang tap trung, chu y va tr nh b giam
cac mc o khac nhau va nh hng lc b roi loan. T
duy ngi benh lon xon, va cac s kien c giai thch mot
cach khong chnh xac.
Sng s Theo ngha c dung trong tam than hoc,
sng s la mot trang thai trong o benh nhan bat ong,
khong noi, va khong ap ng nhng dng nh van con
nhan biet qua oi mat m va doi theo cac vat xung quanh.
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vui chi cua ngi benh. Cac roi loan chu y va tap trung
gom:
Phan tan chu y (distractibility) la trang thai trong o
chu y b loi cuon vao cac kch thch khong quan trong hoac
khong thch hp t ben ngoai.
Mat chu y chon loc la khong chu y en nhng s
kien gay lo au.
Tang canh giac (hypervigilance) la chu y va tap trung
qua mc vao tat ca cac kch thch t ben trong lan ben
ngoai, gap trong cac trang thai hoang tng, hng cam.
III.CAC ROI LOAN KH SAC VA CAM XUC
Trong tam than hoc, khi mo ta cac trang thai xuc cam
(emotions) bieu hien thai o cua con ngi, cac thuat ng
kh sac (mood) va cam xuc (affect) oi khi c s dung vi
y ngha gan giong nh nhau. Tuy nhien, gia hai thuat ng
nay van co s khac biet nhat nh. Kh sac c dung e
ch trang thai chu quan keo dai hoac lan toa trong khi cam
xuc e ch trang thai xay ra tng luc, co the quan sat
c, oi khi bien oi nhanh chong e ap ng vi s a
dang trong t duy va tnh huong.
A. Cac roi loan kh sac
Tram cam (depression) la mot ap ng bnh thng
vi s mat mat hoac bat hanh. Tram cam tr nen bat
thng khi nang ne hn so vi s bat hanh hoac keo dai
qua mc mong i. Kh sac tram cam thng ket hp chat
che vi cac bien oi khac nh anh gia thap ban than, t
cho mnh co nhieu khuyet iem, va suy ngh bi quan. Ngi b
tram cam co bieu hien ac trng vi cac khoe mieng gap
xuong, gia tran co nhng nep nhan thang ng; ho
thng khom lng, cui au, ve mat buon rau, au kho. Van
ong thng b c che nhng cung co the gia tang cac
benh nhan kch ong, lo au. La trieu chng c ban trong cac
giai oan tram cam cua roi loan tram cam va roi loan
lung cc nhng tram cam cung hay gap trong nhieu roi loan
tam than khac nh cac roi loan lo au (roi loan lo au toan
the, hon hp lo au-tram cam, roi loan am anh-cng che),
tam than phan liet, loan than ngan, cac roi loan an uong
Sau uat (melancholia) la trang thai tram cam nang
vi cac ac iem nh mat hng thu trong tat ca cac hoat
ong, mat phan ng vi cac kch thch thng van thng
gay thch thu, tram cam nang hn vao buoi sang, thc giac
sm, chan an hoac sut can ro ret, cam giac toi loi qua
mc hoac khong phu hp.
Hng phan (elation) la cam giac vui sng, khoai cam,
het sc t man hoac lac quan. Hng phan thng ket hp
vi cac bien oi khac nh tang s t tin va thoai mai, tang
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van ong co the xay ra trong tam than phan liet hoac do
tac dung phu cua cac thuoc chong loan than.
Cac phan ng chuyen dang (conversion reactions) la
cac roi loan chc nang, do can nguyen tam ly lien quan
en cac chc nang giac quan hoac van ong. Cac the van
ong hay gap la yeu hoac liet chi, mat ng-mat i, that
ieu hoac mat tieng. Cac phan ng chuyen dang giac quan
gom mu, iec, va mat cam giac.
Cac roi loan kiem soat xung ong
Xung ong uong ru (dipsomania) la cn them
uong mot lng ln cac thc uong co ru, ngi benh
khong cng lai c. Gap chu yeu trong cac giai oan hng
cam va roi loan nhan cach.
Them uong (potomania) la nhu cau thng xuyen
uong mot lng ln nc. Gap trong tam than phan liet
man tnh, roi loan nhan cach va co the nhng benh
nhan ang ieu tr bang cac thuoc chong loan than,
carbamazepine, lithium, hoac cac thuoc khac. Nhng benh
nhan nay thng co t trong nc tieu va nong o sodium
trong huyet thanh thap, trng hp nang co the a en ngo
oc nc (water intoxication) vi cac cn co giat.
Them an (bulimia) la nhng cn an nhieu kem theo
mot cam giac oi d doi. Gap trong chng an nhieu loan
than kinh, tam than phan liet, cac giai oan hng cam, cham
phat trien tam than, sa sut tam than, roi loan nhan cach.
Xung ong an cap (kleptomania) la s that bai tai
dien trong viec chong lai xung ong an cap cac o vat
khong can thiet, hoac cho viec s dung cua ban than,
hoac co gia tr ve tien bac. Cac xung ong nay khong ket
hp vi cac hoang tng hoac ao giac, khong do tc gian
hoac muon tra thu. Hanh ong an cap thng giup lam
giam s cang thang ngi benh. Cac o vat an cap
thng t co gia tr va benh nhan co u kha nang e
mua, sau o chung c tch tr, vt i, hoac tra lai cho chu
nhan. Xung ong nay hay ket hp vi cac roi loan lo au va
roi loan an uong.
Xung ong ot nha (pyromania) lien quan en cac
cn co y ot nha; c thc hien khong phai e kiem tien,
che dau toi pham, tra thu hoac v cac ong c khac; khong
do hau qua cua cac ao giac, hoang tng, hoac roi loan
phan oan (do ngo oc, sa sut tam than, hoac cham phat
trien tam than). Nhng benh nhan nay thng quan tam
en la va viec cha la, thch nhn thay la chay. Ho co
the len ke hoach ot nha trc va khong he quan tam
en hau qua nguy hiem do hanh ong cua ho.
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phc tap. Khi ieu nay xay ra, cac hoang tng c goi la
he thong hoa.
Hoang tng chia se (shared delusions) Thong thng,
nhng ngi xung quanh nhan biet hoang tng la sai va
tranh luan vi benh nhan nham lam cho benh nhan t bo
cac y tng sai lam cua ho. Tuy nhien, oi khi mot ngi
song chung vi benh nhan co hoang tng lai chia se hoang
tng vi ngi nay. Trang thai nay c goi la hoang tng
chia se hoac ien tay oi (folie a deux). Mac du s tin chac
vao hoang tng cua ngi th hai cung manh nh ngi
au khi ca hai con song chung, no thng giam i khi ho
tach ri nhau.
Kh sac hoang tng (delusional mood) Khi trai nghiem
mot hoang tng, benh nhan se co ap ng ve cam xuc.
V du, khi ngh rang co nhieu ngi ang tm cach am hai
mnh th benh nhan thng lo s. Nhng co khi roi loan cam
xuc lai xuat hien trc hoang tng. Chang han ban au
benh nhan cam thay lo s nhng khong biet tai sao, tm cach
giai thch, va roi tin chac rang co ngi ang tm cach hai
mnh . Khi hoang tng theo sau, no dng nh e giai thch
cam xuc cua ngi benh.Hien tng nay c goi la kh
sac hoang tng.
Tri giac hoang tng (delusional perception) Thuat ng
nay c dung khi hoang tng ot ngot xuat hien do ngi
benh vo c gan mot y ngha khac thng vao mot s vat
ma ho tri giac c.V du, v tr cua mot bc th e lai tren
ban lam viec co the c benh nhan giai thch ay la dau
hieu mnh sap b chet. Trai nghiem nay c goi la tri giac
hoang tng.
Tr nh hoang tng (delusional memory) Trong trieu
chng nay, mot y ngha mi a c gan cho cac s kien
trong qua kh. V du, mot benh nhan ngh rang ang co mot
am mu au oc mnh, va khi nh lai la mnh a b oi sau
mot ba an cach ay kha lau trc khi hoang tng hien
nay bat au, va benh nhan ket luan rang mnh a b au
oc trong lan o. Trai nghiem nay can c phan biet vi
hoang tng a xuat hien t trc. Thuat ng tr nh hoang
tng khong xac ang v khong phai tr nh b roi loan ma
chnh la do y ngha hoang tng c gan vao cac s kien
qua kh.
Hoang tng ky quai (bizarre delusions) Cac hoang
tng c coi la ky quai neu chung vo ly mot cach ro
ret, khong the hieu c va khong xuat phat t cac trai
nghiem cuoc song thng ngay. V du, mot benh nhan tin
rang mot ngi la a lay i het cac noi tang cua mnh va
thay the chung bang cac noi tang cua mot ngi khac ma
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khong e lai mot vet thng koac mot vet seo nao; mot
benh nhan khac tin rang mot ke xam nhap t vu tru a
cam cac ien cc vao nao e theo doi cac y ngh cua
mnh. Cac hoang tng thuoc cac trieu chng hang au cua
Schneider trong chan oan tam than phan liet nh t duy b
anh cap, t duy b ap at, t duy b boc lo, t duy b phat
thanh eu c xem la ky quai. Mac du cac hoang tng
ky quai c coi la ac trng cua benh tam than phan liet,
tnh chat ky quai co the kho anh gia do can phai xet
en cac khac biet ve van hoa.
Hoang tng khong ky quai (nonbizarre delusions) la
hoang tng lien quan en cac tnh huong co the xay ra
trong i song thc nh b theo doi, b au oc, c yeu,
hoac b phan boi bi v hoac chong mnh Hoang tng
khong ky quai la bieu hien chu yeu cua roi loan hoang
tng, va viec xac nh cac hoang tng co ky quai hay
khong la ac biet quan trong trong chan oan phan biet
gia roi loan hoang tng va tam than phan liet.
Hoang tng phu hp vi kh sac (mood-congruent
delusion) la hoang tng co noi dung phu hp vi kh sac, v
du mot benh nhan tram cam tin rang mnh phai chu trach
nhiem ve s huy diet cua the gii.
Hoang tng khong phu hp vi kh sac (moodincongruent delusion) la hoang tng co noi dung trung tnh
hoac khong phu hp vi kh sac, v du mot benh nhan tram
cam co cac hoang tng ve t duy b ap at hoac t duy b
phat thanh.
Cac chu e cua hoang tng
Hoang tng b hai (persecutory delusions) Ngi benh
khang nh co nhieu ngi hoac to chc nao o ang tm
cach mu hai, au oc, quay roi, lng gat, hoac vu khong,
lam mat thanh danh cua ho. Hoang tng b hai hay gap nhng
t co gia tr chan oan v co the gap trong nhieu benh loan
than nh tam than phan liet, roi loan hoang tng, loan than
thc the, roi loan kh sac Benh nhan co hoang tng b hai
thng co thai o gian d, thu han va co the dung bao
lc chong lai nhng ngi ho tin la ang lam hai ho.
Hoang tng lien he (delusions of reference) Ngi benh
cho rang moi o vat, s kien hoac hanh vi cua nhng ngi
xung quanh eu co mot y ngha ac biet vi mnh. V du, khi
thay hai ngi noi chuyen vi nhau th benh nhan cho rang
ho ang ban tan ve mnh. Mot bai bao hoac mot nhan xet
tren truyen hnh cung c benh nhan cho la am ch mnh
hoac truyen at mot thong iep en cho mnh.
Hoang tng b chi phoi (delusions of control) Ngi
benh cho rang co mot sc manh nao o t ben ngoai chi
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chng y khoa eu ngc lai. Cac hoang tng nay hay gap
ngi cao tuoi, phan anh s quan tam nhieu ve sc khoe
la tuoi nay. Hoang tng nghi benh thng lien quan en
benh ung th hoac benh da lieu, hoac hnh dang cua cac
phan c the, ac biet la mui. Nhng benh nhan co cac
hoang tng thuoc loai sau cung nay oi khi oi c phau
thuat tao hnh. Hoang tng nghi benh gap trong cac roi loan
tram cam va tam than phan liet.
Hoang tng h vo (nihilistic deusions) Ngi benh tin
rang mot ngi hoac mot vat nao o a ngng hoac sap
ngng ton tai, s nghiep cua mnh tieu tan va the gii sap
b huy diet. Hoang tng h vo ac biet hay ket hp vi
cac trang thai tram cam cc nang. oi khi, hoang tng h
vo lien quan en cac chc nang cua c the nh tim phoi
ngng hoat ong, ruot gan thoi ra Khi hoang tng nay
xay ra trong mot roi loan tram cam nang th c goi la hoi
chng Cotard.
Hoang tng t cao (delusion of grandeur) Ngi benh t
cho mnh la mot nhan vat quan trong, giau sang, co nhieu
quyen lc va tai nang ac biet. Gap chu yeu trong cac giai
oan hng cam va oi khi trong tam than phan liet.
Hoang tng c yeu (erotomania) Hiem gap, xay ra
n nhieu hn nam. Ngi benh cho rang co mot ngi
ang yeu mnh tha thiet, ngi nay thng la mot nhan vat
noi tieng hoac cap tren ni ho ang lam viec. Gap trong roi
loan hoang tng, tam than phan liet.
Hoang tng nhan nham (delusional misinterpretation)
Gom hoang tng Capgras va hoang tng Fregoli. Hoang tng
Capgras hiem gap, n nhieu hn nam, trong o benh nhan
cho rang ngi than cua mnh a b thay the bi mot ke
gia dang giong het e lng gat mnh nen co the tan cong
ngi than nay. Trong hoang tng Fregoli, ngi benh cho
rang nhng ngi khac nhau ma ho gap that ra ch la mot
ngi duy nhat, thng la ke benh nhan tin la muon am
hai mnh, a cai trang thanh. Cac hoang tng nay co the
gap trong tam than phan liet va cac benh thc the nao.
3. Am anh va cng che (obsessions and compulsions)
a. Am anh la cac y ngh, xung ong, hoac hnh
anh khong c mong muon, xuat hien dai dang tren ngi
benh vi tnh chat cng bach, ngi benh nhan biet o
la sai, tm cach chong lai nhng khong sao thang c. Am
anh khac vi t duy b ap at do ngi benh nhan biet cac
y ngh gay kho chu nay la cua chnh ho ch khong phai
do s chi phoi t ben ngoai. S chong lai cac am anh cung
la mot ac iem quan trong v giup phan biet chung vi
cac hoang tng. Tuy nhien, khi cac am anh a hien dien
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mot thi gian dai, s chong lai nay se giam i nhng s thay
oi nay t gay kho khan ve chan oan v, vao luc no xay
ra, tnh chat cua trieu chng va chan oan thng a c
xac nh.
Hnh thc cua am anh
Y ngh am anh (obsessional thoughts) la cac t hoac
cum t xuat hien lap i lap lai trong au, gay kho chu cho
ngi benh, v du nh cac cum t tuc tu hoac bang bo
mot ngi sung ao hoac cac y ngh ve mot s co au
kho nh cac ban tay cua mnh a b lay nhiem vi trung se
lam lay benh cho ngi khac.
Nghien ngam am anh (obsessional ruminations) la s
xuat hien lien tiep cac y ngh lam cho ngi benh rat kho
chu nh tai sao trai at lai tron, ieu g se xay ra neu trai
at hnh vuong...
Nghi ng am anh (obsessional doubts) la s khong
chac chan ve viec a thc hien hay cha mot hanh ong
trc o, v du ngi benh phan van khong biet mnh a
bep ga trc khi ra khoi nha nen c s b chay nha. Loai
am anh nay luon a en s kiem tra, tuy nhien ieu nay
cung khong lam ngi benh yen tam va buoc ho phai
kiem tra mot cach lien tuc.
Xung ong am anh (obsessional impulses) la s thoi
thuc thc hien cac hanh vi, thng co tnh chat gay han,
nguy hiem hoac gay lung tung; v du, cam dao am ngi
than, nhay vao xe la, thot ra nhng li tuc tu ni trang
nghiem. Du la thoi thuc nao, ngi benh nhan thc c
ieu nay la vo ly va khong muon thc hien cac hanh vi
nay. ay la iem quan trong giup phan biet vi hoang
tng, c ngi benh cho la hp ly va co the a en
hanh ong nh gay han chong lai ke cho la am hai mnh.
Am anh s (phobia) la s s hai dai dang, vo ly va
qua mc mot s vat hoac tnh huong chuyen biet; benh
nhan biet la khong ung nhng khong xua uoi c va a
en s tranh ne co tnh chat bo buoc cac kch thch gay s.
Cac am anh s hay gap la am anh s khoang rong
(agoraphobia), am anh s cho cao (acrophobia), am anh s
cho ong kn (claustrophobia), am anh s vat nhon
(aichmophobia), am anh s xa hoi (social phobia), am anh s
o mat (erythrophobia), am anh s ngi la (xenophobia), am
anh s am ong (ochlophobia), am anh s suc vat
(zoophobia), am anh s con trung (insect phobia), am anh s
mau-vet thng (blood-injury phobia), am anh s tiem chch
(needle phobia), am anh s sam chp (astrapophobia), am anh
s em toi (nyctophobia), am anh s ai dng
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noi, khong mau hoac co mau sac sac s, bat ong hoac
sinh ong. Noi dung cua ao th co the lam ngi benh say
me, nhn ngam mot cach thch thu hoac ng ngac, bang
hoang s haiAo th hay gap trong cac benh loan tam than
do nhiem trung, nhiem oc, trong hoi chng cai ru hoac ma
tuy, trong tam than phan liet, au au migraine, ngi
mu Mac du ao th thng c xem la ac trng cua cac
roi loan tam than thc the, chung cung c gap en
benh nhan tam than phan liet, nhng khong phai luc
nao cung ket hp vi ao thanh.
Ao xuc (tactile or haptic hallucinations) Ngi benh co
cam giac s mo, cham chch, te lanh, nong bong, con
trung hoac sau bo bo di da, cam giac tnh duc Ao xuc
gap trong cac trang thai nhiem oc nh suy gan, cac hoi
chng cai ru hoac ma tuy, tam than phan liet, nhng
ngi b cat cut chi (hoi chng chi ma). Ao xuc nh co sau
bo bo tren hoac di da hay gap trong sang run va ngo oc
cocaine, con cam giac tnh duc hay gap trong tam than phan
liet, ac biet khi c benh nhan giai thch mot cach khac
thng.
Ao khu va ao v (olfactory and gustatory hallucinations)
t gap, thng i oi vi nhau. Trong ao khu, ngi benh
ngi thay nhieu mui khac nhau, thng la cac mui kho
chu nh mui trng thoi, mui cao su chay; trong ao v, ngi
benh cam thay mot v von khong co trong thc an nh
ang, chua, cay Ao khu va ao v thng ket hp vi
benh nao thc the, ac biet vi cac cn moc cua ong
kinh cuc bo phc tap. Ao khu cung co the gap trong tram
cam loan than, ien hnh la cac mui thoi ra, muc nat,
chet choc.
Ao giac noi tang (visceral hallucinations) ngi benh
cam thay trong ngi ho co nhng d vat, nhng sinh vat
nam yen hay ong ay, v du, ran trong bung, ech trong da
day
Ao giac luc gi thc, gi ngu la cac ao giac,
chu yeu la ao th, xuat hien ngay trc khi vao ngu
(hypnagogic hallucinations) hoac khi mi va thc giac
(hypnopompic hallucinations). Ao giac luc gi thc, gi ngu
la cac ao giac sinh ly, gap ngi bnh thng, di dang
cac ao giac ngan ngui va tho s nh nghe tieng chuong reo
hoac tieng goi ten mnh. Cac ao giac nay cung la trieu
chng ac trng cua benh ngu ru, trong o chung thng
keo dai hn va co noi dung a dang hn.
Ao giac phan xa(reflex hallucinations) c dung e
mo ta mot tnh trang hiem gap trong o mot kch thch
giac quan nay a en mot ao giac mot giac quan khac;
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