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Nghin cu v y thut ca Ln ng

Nhn T Nguyn Vn Th
Tiu s Hi Thng Ln ng L Hu Trc

Mc Lc
Phn 1: QUAN NIM V THN CA LN NG I CHIU VI TY Y A. Quan nim v thn ca ng y qua cc thi i B. Sinh l hc v bnh l hc v Mnh mn C. Quan nim v Thn ca Ln ng i chiu vi Ty y Kt lun Tot yu / summary Phn 2: TR LIU PHP CA LN NG SO SNH VI TR LIU PHP CA T NHIU DANH Y TRUNG HOA A. Tr liu php ca t nhiu danh y Trung Hoa B. Tr liu php ca Ln ng Kt lun

Phn 1 Quan nim v Thn ca Ln ng i chiu vi Ty y [1]


Quan nim v Thn ca Ln ng c th ni c l ht sc c o. Quan nim ny c trnh by cn k trong quyn Huyn Tn Pht Vi v trnh by s lc trong quyn Chu Ngc Cch Ngn ca c. Cng nh Triu Dng Qu, tc gi b Y Qun, v Phng Triu Trng (Phng th, khong 1702), tc gi b Phng Th Cm Nang, Hi Thng Ln ng khng ly Tm lm trng, m li ly Thn lm trng.[2] Ln ng ch trng: Tri t bn ngoi c Thi Cc th thn th con ngi bn trong c thn. [3] Ch Thn y khng th hiu theo ngha thng thng nh l mt b phn bi tit nc tiu, m phi hiu nh l mt h thng gm: - Thn: c quan bi tit nc tiu. - Mnh mn: Mt hch ni tit (glande endocrine), ni theo t ng y hc hin nay.

Hnh trch t quyn Ln ng et la Mdicine Sino-vietnamienne ca P.Huard v Maurice, tr.295, hnh D

A. QUAN NIM V THN CA NG Y QUA CC THI I


vn c sng t, trc ht thit tng nn trnh by s lc v quan nim Thn theo ng y qua cc thi i. 1. Trc tin Bin Thc (Tn, Vit Nhn, khong 225 tcn), tc gi Nn Kinh, cho rng: Thn c hai tri, t v hu, y nh tri t c m Dng. Tri bn t l Thn; tri bn phi l Mnh mn.[4] Sau ny, Trng Trng Cnh (th k 2 cn) v nhiu danh y Trung Hoa cng theo thuyt ny. 2. Trng Gii Tn tc Cnh Nhc (1563-1640) cho rng: - Mnh mn chnh gia (Dng). - Hai qu thn hai bn (m). Tt c hp li thnh qu Khm, cng c mt ho Dng v hai ho m.

Qu Khm v qu thn

3. Ln ng, theo Triu Dng Qu v Phng th, da vo qu Khm v vo Thi Cc , cho rng Thn trong ngi chnh l Thi Cc. Theo Ln ng, Thn gm c: - Hai qu Thn hai bn t hu, tc l hai na vnh ln ca Thi Cc. - Mnh mn chnh gia, ch v nam tinh n huyt, tc l ch v sinh dc.

- Vng trn trng bn phi gi l Chn ha hay Tng ha. - Vng trn en bn tri gi l Chn thy. Hai vng en trng: Chn thy, Chn ha tng ng vi hai chm nh trng en m ta thy trong hnh Thi Cc. Trong quyn Huyn Tn Pht Vi, Ln ng v hai hnh suy din Thi Cc ra Thn v cc b phn. Trong h thng Thn ni trn, i vi Ln ng, th ch c Mnh mn, Chn thy, v Chn ha l quan trng nht. Quyn Huyn Tn Pht Vi v quyn Chu Ngc Cch Ngn ca Ln ng nguyn bn v Chn ha, Chn thy, cc chng bnh do chng pht sinh cng nh cch tr liu.

B. SINH L HC V BNH L HC V MNH MN


Nh ni, Mnh mn gm c ba phn: - Mnh mn chnh gia, ch tr Nam tnh, N huyt, tc l c nh hng nhiu n c quan sinh dc.[5] - Chn ha hay Tng ha, thuc Dng, ch tr v sinh dc ca con ngi. - Chn thy, thuc m, iu khin s chuyn ha v huyt dch trong ngi. Chn thy, Chn ha trong con ngi cn phi ha hp, cng tc vi nhau th c th mi c kho mnh, nu nh mt bn m thin thng, th c th s mt th qun bnh v s sinh bnh tt. Mt thy thuc gii chnh l ngi bit iu ha m Dng gy li c th qun bnh mt.[6] V Chn ha, Chn thy quan h bc nht nh vy, nn chng ta s kho st chng mt cch tng tn hn. 1. Chn ha (Tng ha, Long ha): le Principe thermique [7] Chn ha gp phn rt ln vo cng cuc bin dng ni con ngi (mtabolisme). - N ch tr mi sinh ha. - N gip cho t v hot ng hn hoi, gip cho s tiu ha c d dng. - N gip cho phi c hot ng hu hiu. - Gip kh huyt vn chuyn iu ha. - N gip cho da tht c sn kht. - N gip cho thn tr c minh mn.

a. Ha thnh Nu ha thnh (Dng thnh), con ngi s kho mnh, tht xng rn chc. b. Ha khng (ha thi qu) Nu ha thi qu (khng Dng), s sinh ha s b kch thch qu mc, v con ngi s to kht, c th s mt nc. l trng hp thng nhit, h to m Ln ng cp n trong Chu Ngc Cch Ngn (q.thng, tr.3a). c. Ha h Nu ha h, cc hin tng sinh ha s b nh tr , con ngi s tr nn yu ui, xanh xao, lng tc s d rng, t v s lm vic km i, s tiu ha s tr nn chm chp v con ngi s b snh hi, trng bng, n ung kh tiu, hay b u t. Mt khc, da cng khng c sn kht, khin cc khng (sphincters) khng c bn cht, cho nn hay b nn ma, i xng, di tinh, ra m hi trm, v.v. Ha h cng c th lm cho con ngi tr nn b quyn, hn trm. Ha h, Dng h cn gy ra chng ph ha. Ph ha l ha bc ln u, tan ra b phu, trong khi th chn tay lnh, tng ph lnh. Ln ng gi th l triu chng thng nhit, h hn (xem Chu Ngc Cch Ngn, q.1, tr.2a). 2. Chn thy (le Principe aqueux) Chn thy ch tr cc s vn chuyn tn dch, huyt dch trong ngi, lm cho c th tr nn nhun m, trin dng, lng tc ng mu m. a. Thy qu thnh Thy qu thnh s lm cho huyt dch trong ngi tr nn ng tr (stase, infiltration deau, rtention deau, aumentation du volume sanguin), ph thng (oedme). b. Thy h Nu thy h, m h, huyt dch trong ngi s b gim thiu (hmoconcentration, rduction des liquides extra-cellulaires), chng nhng th, cc tn dch (scrtions) trong ngi cng gim i. 3. Phng php tr liu Phng php tr liu y l phi iu ha m Dng. a. B thy Nu ha thnh, thy h, s b thy. B thy ch Dng quang (b thy d ch Dng quang). b. B ha

Nu thy thnh, ha h, s b ha. B ha dn ha qui nguyn, b ha tiu tr s u m, khut lp ca m (dn ha d phn nguyn; b ha d tiu m ). B ha bng bi bt v ; b thy bng bi lc v. c. Bt v Bi bt v do Trng Trng Cnh (th k 2 tcn) sng ch ra cha cho Hn V . Bi bt v gm 8 v nh sau: * B m (-) = 1. n b, 2. Phc linh, 3. Trch t. * B Dng (+) = 4. Qu, 5. Ph. * B m (-) = 6. Thc a, 7. Hoi sn, 8. Sn th.[8] d. Lc v Tin t (th k XI, khong 1093) chuyn tr v nhi khoa b hai v Qu v Ph trong bi bt v ni trn m ch thnh bi lc v. Thot tin Tin t dng bi lc v bi b cho tr con mau ln cn, chng ln. Sau ny cc danh y mi dng lc v b thy. Trong quyn Huyn Tn Pht Vi ta thy Ln ng ch dng c hai bi bt v v lc v ni trn vi nhng bin i gia gim m cha c v s k bnh, qui bnh. Tm li, i vi Ln ng: - Thn l Thi Cc. - Mnh mn l Thi Cc. - Thi Cc c m Dng. - Mnh mn c Chn thy, Chn ha. - Thi Cc, m Dng c quan trng th no i vi v tr th Thn, Mnh mn, Chn thy, Chn ha cng quan h n sc khe con ngi nh vy. Cha bnh m cha c ti cn bn, m bit ti bi cn bn th lo chi bnh khng lnh, ngi khng kho.

C. QUAN NIM V THN CA LN NG I CHIU VI TY Y


Quan nim ca Ln ng v Thn c rt nhiu im tng t vi nhng khi nim mi m nht v Tuyn thng thn (glandes surrnales; capsules surrnales; surrnales; adrenal glands) ca Ty y.

1. S phn chia Mnh mn ca Ln ng n khp vi s phn chia v thng thn (cortex surrnal; adrenal cortex) ca sinh l hc hin i. * Ln ng ch trng: - Chn ha ch tr v sinh kh, sinh lc trong con ngi. - Chn thy ch tr huyt dch trong ngi. - Mnh mn ch tr v sinh dc. * Khoa sinh l hc ngy nay ch trng: V thng thn gm 3 phn: - Vng chm (Zone fascicule du cortex surrnal) tit ra nhng cht glucocorticodes (nh Hydrocortisone hay compos F. cortisone) nh hng rt su xa n s bin dng (mtabolisme) ca cht m, cht tht (matire protidique), cht ng (matire glucidique) v cht m (matire lipidique) trong c th v nh vy nh hng n sinh lc trong ngi. - Vng vng i (Zone rticule du cortex surrnal) tit ra nhng cht Minralocorticoides (nh Aldostrone, Dsoxycorticostrone) nh hng ln n s chuyn dch ca cc cht in gii (lectrolytes) nh Na (Sodium), K (Potassium), v Cl (Chlore); v nh vy, nh hng ln n s lng tn dch, huyt dch trong ngi (mtabolisme hydrique). - Vng i cu (Zone glomrulaire du cortex surrnal) tit ra nhng kch thch t sinh dc (nh Hormone androgne, Hormone oestrogne, progestrrone, v.v.) nhng vi s lng rt t, snh vi dch hon (testicules) v bung trng (ovaires). 2. Cc bnh trng m Ln ng m t v Mnh mn cng tng t nh nhng bnh trng m Ty y hin nay m t v v thng thn. a. Ln ng cho rng nu ha h thy thnh, huyt dch trong ngi s ng, con ngi c th sinh m suyn, hay phnh nc. Nu ta cho bnh nhn dng nhiu cht Dsoxycorticostrone (thy thnh), ta cng thy nhng triu chng nh trn (oedme, alcalose avec respiration superficielle). b. Ln ng cho rng nu Tng ha m h, con ngi c th tr nn hn trm b quyn, n ung kh tiu; d u, d t; hoc b di tinh (spermatorrhe), bt lc (impuissance); tht nho, hay mt, hay au bng, au ngi v kh huyt chuyn vn khng c iu ha. Nu Chn thy h, con ngi s ngy mt tr nn kh kit (dessication progressive) hoc mc phi nhng chng huyt kh (hmoconcentration), gy rc (maigreur, cachexie). Trong bnh Addison (bnh lao tuyn thng thn), cc vng thng thn u b thng tn, ta thy:

+ Nhng triu chng m h nh: - S bin lon trong s chuyn dch ca nc v mu (pertubations du mtabolisme de leau, hmoconcentration). - Gy rc (cachexie progressive). + Nhng triu chng Dng h nh: - Mt mi (asthnie). - u (=nn ma), t (vomissement et diarrhe). - Ngi lnh (hypothermie). - Bt lc (impuissance), v t (=v sinh, strilit). - au bng. - Ngt (lypothymie), hn m (coma), xu (collapsus). c. Ln ng cho rng c nhiu bnh trng sinh ra l do s mt qun bnh ca thy ha. Gn y gio s Seylie cng ch trng rng trc s tn cng a din (situations stressantes) ca t kh, tht tnh, tai nn, vi trng, c t, nhiu khi con ngi phn ng li mt cch ba bi, khng thch nghi; chnh v th m c th b giao ng thc lon, chn kch nn sinh bnh. Nhng bnh chng do s giao ng, chn kch, thc lon y, truy nguyn l do no thy (hypophyse) b kch thch nn pht tit ra nhng kch thch t nh hormone corticotrope (ACTH), hormone somatotrope (STH). Nhng kch thch t ny s kch thch nhng vng ca v thng thn (cortex surrnal) lm cho n ty ln (hypertrophie) v tit ra nhng cht glucocorticodes, nh hng n s bin dng (mtabolisme) v minralocorticodes nh hng n tn dch (scrtion), huyt dch (sang et liquides extracellulaires). Nh vy cc bnh do s phn ng ba bi (syndrome de mal-adaptation, syndrome dadaptation) sinh ra cng l do s mt qun bnh gia thy (hormones minralocorticodes) ha (hormones glucocorticodes). d. Ln ng ch trng rng: Tr con thi thun Dng v m nn s bin dng rt d b kch ng, huyt dch rt d b suy vi, v th ch c dng lc v (cf. Chu Ngc Cch Ngn, tr.38). Nhng ngi ln th hai kh m Dng qun bnh hn. Cn nhng ngi gi th m Dng nh kh u suy.

Gio s Seylie cng vit: Tr con phn ng mnh, nn mau bnh cng nh mau lnh. Ngi ln phn ng t hn nn quen vi cc s kch ng ca ngoi cnh. Cn nhng ngi gi th yu t i vi bnh tt v cc s chn kch ca cuc i, v th nn d cht. [9]

KT LUN
Ta c th khng ng vi Ln ng ch ngi coi Thi Cc trong thn ngi l Thn v Mnh mn, v Thi Cc phi l ton th con ngi, khng phi l ci trng nguyn thy khi th tinh v bt u phn ha. Ta c th khng ng vi Ln ng ch ngi cho rng Mnh mn c trc tt c cc tng ph, v theo khoa phi thai hc (embryologie) ngy nay, thc t khng phi nh vy.[10] Nhng ta khng th khng bi phc ngi, v ngi i t Thi Cc, t qu Khm m suy ra c Mnh mn cng vi Chn thy, Chn ha, v p dng Dch l suy din ra cc trng thi m Dng suy thnh trong con ngi. Ty y dng khoa gii phu, dng knh hin vi, dng cc phng php khoa hc m khm ph ra c v thng thn (cortex surrnal) v cc cng nng ca n. Nhng khi ta i chiu li kt qu ca hai ng c mi, th thy i bn cng khng my khc nhau. chng phi l iu ng lm cho chng ta b ng hay sao? Ngoi ra cng phi ghi nhn rng Ln ng v Phng th bn v Mnh mn, cha v thy ha t th k XVIII. y l ta cha mun ni rng quan nim v Mnh mn manh nha t thi Bin Thc (225 tcn), cc phng dc tr thy ha c t thi Trng Trng Cnh (th k 2 tcn) v Tin t (th k 11). Ngc li, tt c nhng khm ph v Tuyn thng thn ch c t th k XIX n nay. Cc bi bt v, lc v c t thi Trng Cnh (th k II tcn) v Tin t (th k XI cn), cn cc cht ACTH, STH, Cortisone, Hydrocortisone, v Dsoxycorticostrone mi c tinh ch khong chng my chc nm nay. Thit tng nhng bi thuc hay nh bt v, lc v, nhng bi thuc t ra hiu nghim t nhiu th k qua rt ng c chng ta quan tm m kho st li. Gio s Huard cho rng khi so snh Mnh mn ca Ln ng vi cc Tuyn thng thn ca Ty y, ti c ho mun bc mt nhp cu gia ng y v Ty y.[11] Ti xt mnh cha xng ng vi li khen tng .

SUMMARY THE KIDNEYS IN ORIENTAL MEDICINE by NGUYEN VAN THO According to Oriental medicine, the kidneys are not only the two pea-shaped organs of modern anatomy. With this word, one must conceive a complicated system, including the genito-urinary tract and the endocrine glands, the adrenal cortex in particular. The author, analysing two volumes of Lan Ongs encyclopedia, suggests that the right kidney, known in traditional medicine as the Gate of Life with its three elements (thermal, aqueous, and sexual) might be likened to the three historical zones of the cortex, namely the zona glomerulosa, the zona fasciculata, and the zona reticularis. (Phuong Dong, November 1972, No 17)

Phn 2 Tr liu php ca Ln ng so snh vi tr liu php ca t nhiu danh y Trung Hoa [12]

Ni n tr liu php (thrapeutique, principes thrapeutiques), tc l cp n mt vn ht sc bao qut ca y hc. V th, trong khun kh mt bi bo chng ta khng th no i vo c ht cc chi tit. Chng ta ch c th phc ha t nhiu nt i cng, t nhiu ng li chnh yu ca cc danh y, ng hu soi sng cho chng ta mt phn no trn con ng kho st ng y. Chnh v th m trc ht xin qu v lng th cho s s lc ca bi ny.

A. TR LIU PHP CA T NHIU DANH Y TRUNG HOA


1. Trc ht, tng cng nn nhc li rng ng y c xy nn p tng trn b Ni Kinh. Ni Kinh gm hai quyn: - T Vn gm 81 chng. - Linh Khu gm 81 chng, ni v chm cu.

Tuy sch nh l thut li li m thoi gia Hong (2696-2598 tcn) vi K B, nhng c l sch ch c vit ra khong 1000 nm trc cng nguyn. C ngi li cho rng b Ni Kinh c vit khong th k 4 tcn.[13] B Ni Kinh cho chng ta cc khi nim v c th hc, bnh l hc, v tr liu php (thrapeutique). V phng din bnh l hc (pathognie) chng hn, Ni Kinh chia nguyn nhn sinh bnh thnh hai loi: a. Ngoi cm, do lc dm: phong, hn, th, thp, to, ha. b. Ni thng, do s thng tn ca kh huyt, tng ph, m Dng, gy ra bi: - Thng thc. - Lao lc. - Sc dc. - Tht tnh (h, n, u, t, bi, kinh, khng).[14] Tuy nhin Ni Kinh khng a ra mt phng thuc no nht nh v ch chuyn ch v chm cu. 2. i nh Chu, ta cn thy hai trit thuyt v bnh l: - Trit thuyt th nht cho rng bnh tt sinh ra l do nh kh m Dng trong ngi khng c iu ha. - Trit thuyt th hai cho rng bnh tt sinh ra do ng hnh trong ngi khng c qun bnh. Tuy nhin, trc i nh Hn (th k 2 tcn) th phng php tr liu nm gn trong cc khoa: - Chm (acupuncture). - Cu (moxa). - n ma (kinsithrapie, massage). 3. Mi n i Hn, Trng Trng Cnh ( tin s nm 163 i Hn Linh ) mi m mt tn k nguyn cho nn y hc Trung Hoa. ng kho st cc bnh theo bnh trng (manifestations cliniques) tm cn do bnh tt, nh phng php tr liu bng thuc men. ng vit hai quyn v y hc l: - Thng Hn lun. - Kim qu.

Trng Trng Cnh ch trng rng t kh xm nhp vo c th con ngi do 6 Kinh t ngoi vo trong (t biu vo l) theo th t sau y: (1) Thi Dng kinh (Th thi dng, Tiu trng kinh, Tc thi dng, Bng quang kinh) (2) Dng Minh kinh (Th dng minh, i trng kinh, Tc dng minh, V kinh) (3) Thiu Dng kinh (Th thiu dng, Tam tiu kinh, Tc thiu dng, m kinh) (4) Thi m kinh (Th thi m, Ph kinh, Tc thi m, T kinh) (5) Thiu m kinh (Th thiu m, Tm kinh, Tc thiu m, Thn kinh) (6) Quyt m kinh (Th quyt m, Tm bo lc kinh, Tc quyt m, Can kinh) Tng qut m ni: * Bnh kinh Dng, thuc Dng, Biu (ngoi), Nhit v Thc, cho nn c th dng nhng thuc: - Cng, nh pht hn (lm cho ra m hi) hoc bng bi Ma hong thang[15] hoc Qu chi thang[16] (bnh Thi Dng kinh). - H (cho i xng) bng bi Tha kh thang[17] (bnh Dng minh kinh). - Hoc Ha hon bng bi Tin si h thang[18] (bnh Thiu Dng kinh). * Bnh cc kinh m thuc m, L (bn trong), Hn v H, v th phi dng thuc n b nh: - T nghch thang (tng sc nng)(bnh Thiu m kinh).[19] - L trung thang (bnh Thi m kinh).[20] - ng qui t nghch thang (bnh Quyt m kinh).[21] Trng Trng Cnh c coi l mt v thnh y ca Trung Quc. ng li 113 phng (ordonnances magistrales) v 397 y n (schmas de traitement). Trn Tu Vin (khong 1803), trong thin C kim y lun, cho rng Trng Trng Cnh bit mi phng php cha bnh: - Cng (mdication agressive) - B (mdication tonique) - n (mdication rchauffante) - Lng (mdication rafrachissante) Li bit: - Tin cng hu b.

- Tin b hu cng. - Hn nhit kim thi. - Cng b tnh dng, v.v. Mi lng y sau ny ch khai thc c mt kha cnh no ca Trng Trng Cnh m thi. 4. Sau Trng Trng Cnh, bng i mt thi gian kh lu, khng ai a ra c mt ch xng g mi m. Mi n i nh Kim, Nguyn (1206-1368) mi thy c nhng danh y xut hin, a ra nhng ch xng mi m. i Kim Nguyn c 4 danh y m i sau gi l Kim Nguyn t i gia [22] hay Trng, Lu, L, Chu, t t. l: - Lu Hon T, t71c Th Chn (gia khong 1115-1260). - Trng Tng Chnh, tc Trng T Ha (1155-1260) - L Co, tc L ng Vin (1179-1251) - Chu Chn Hanh, tc Chu n Kh (1281-1358)[23] a. Lu Hon T, t Th Chn (gia khong 1115-1260). Lu Hon T ch trng rng cc bnh sinh ra trong ngi v Nhit thnh. V th ng ch trng dng cc v thuc hn lng. Ngoi ra ng cng dng cc loi thuc: - Th (vomitifs) - H (laxatifs ou purgatifs) - Hn (diaphortiques) Lu Th Chn cn ch trng rng m Dng, Ng hnh , Ng vn l nguyn nhn sinh ra bnh tt. Sau ny Trng Gii Tn (1563-1640) kch Lu Th Chn v cho rng cc mn thuc hn lng ca ng ch c ch cho nhng ngi Trung Hoa phng Bc, kho mnh, ch khng thch hp nhng ngi Trung Hoa phng Nam, yu hn.[24] b. Trng Tng Chnh, t T Ha (1155-1260). Trng T Ha ch trng rng cc bnh sinh ra l do t kh bn ngoi t nhp vo c th, nn cn phi tr kh bng cc thuc cng, h (mdication diaphortique, mtissantes, purgatives, laxatives). ng c bit a dng thuc h (purgatifs). c. L Co, t ng Chi, hiu ng Vin (1179-1251) L ng Vin cho rng cc bnh sinh ra l do s mt qun bnh gia T (-) v V (+); V th, ng chuyn mn b T. Chnh ng sng ch bi B trung ch kh thang.

d. Chu n Kh, t Ngn Tu, hiu Chn Hanh (1281-1358) Chu n Kh ch trng rng cc bnh sinh ra l do n ung thiu cht b dng. ng li cho rng trong ngi m thng bt tc, Dng thng hu d. V th ng chuyn b m. 5. n i Minh (1368-1644), ta li thy y hc chia ra thnh nhiu phi: a. Cng h phi. Phi ny ch trng nh Trng T Ha xa rng nn dng cc loi thuc cng, h. b. Dng m phi. Phi ny theo ch thuyt ca Chu n Kh, dng cc thuc b m. c. n b phi. Phi ny do cc l thuyt gia sau y lnh o: - Tit D, t Lp Trai (khong 1500-1560) - Trng Gii Tn, t Hu Khanh, hiu Cnh Nhc (1563-1640) n b phi ch trng: Dng kh trong ngi chnh l sinh kh, kh c v d mt, v th phi dng thuc n b dng Dng kh, ch khng c dng nhng thuc hn, lng. Tm li ta thy cc danh y Trung Hoa: a. Ngi th lu tm n t kh v ch chuyn dng thuc cng, h tr kh. b. Ngi th lu tm n c th con ngi, v cho rng cc bnh sinh ra l do m Dng nh kh khng iu ha, hoc T, V mt qun bnh cho nn: - Hoc ch trng b m (b thn thy, b huyt) - Hoc ch trng b Dng (b thn ha, b kh) - Hoc ch trng b T. V th c nhiu ngi tm tt tr liu php ca Trung Hoa bng bn ch Cng, Lng, n, B.

B. TR LIU PHP CA LN NG
Nhng nguyn tc tr liu ca Ln ng ht sc sng sut v vng vng. Trong quyn Y hi cu nguyn ni chng H Thc, ng vit i khi nh sau: Cc bnh ni thng cng ngy cng tng, v phong ha suy i, tit kh tr nn trc hn. Con ngi b nh hng ngoi cnh, cng ngy cng tr nn yu ui. V th thi c ngi ta dng cc bi thuc cng pht nh Ma hong, Tha kh. Thi trung c, ngi ta i phng lc, v dng nhng thuc va b va t nh Sm t thang, Nhn sm bi c tn. Sau ny, L ng Vin li sng ch ra cc bi:

- B trung ch kh - Nhn sm dng vinh thang, ch gm ton v b. Cc cch tr liu y, theo thi gian, u c kt qu, chng t rng c th con ngi ngy mt suy yu hn. Cho nn ngy nay nhng thuc cng, h t c dng, tri li, cc thuc n b ngy mt c dng nhiu hn. [25] Tuy nhin cc bnh do ngoi thng, ngoi cm. cc bnh thc chng khng phi l khng c. Nh vy phi c nhng tiu chun chnh xc phn bit thc chng do ngoi cm vi h chng do ni thng, m ty nghi t (trong trng hp thc chng) hay b (trong trng hp h chng). Ln ng cho ba tiu chun sau y: + Xem tng ngi bnh nhn mnh yu ra sao. + Xem mch mnh yu ra sao. + Xem bnh din bin ra sao. 1. Xem tng ngi bnh nhn mnh yu ra sao. Ln ng vit trong Chu Ngc Cch Ngn nh sau: Quan hnh d bm nhc bm cng, xc k vi h vi thc nhi tr. (Xem hnh sc nhn bit ngi yu hay ngi mnh, xc nh l h chng hay thc chng m tr.) ng bnh tip: Nhng ngi bm th phong hu, tui tr, sc mnh, kh huyt y , xng tht cn xng, nu l c au yu th nn ly thc chng m tr. Nhng ngi bm th s bc, tui gi sc yu, ngi mc bnh nng, ngi au yu lu ngy hay n b sn hu v ngi tui nhiu m cn , nu b cm thng, trc sau nht thit c theo h chng m tr. Sch Ni Kinh vit rng: Vic tr liu, trc nn xt v nguyn kh lm ch , ri sau mi tm n bnh tt, ngha y tht su xa.[26] 2. Xem mch mnh yu ra sao. Ln ng vit trong Chu Ngc Cch Ngn: St mch d hu lc v lc, minh kh b kh t chi c. (Xt mch nhn bit hu lc, v lc m quyt nh l nn b hay nn t cho r.)

ng bnh tip: Trong sch Mch yu quyt ca D Gia Ngn ni rng khng cn phi hi l mch ph hay trm, mch i hay tiu b no, ch thy c trng n n tn xng m cn thy hu lc, hu thn, l thc; nu v lc, v thn, l h. Ta mi xem qua cu sch y, tng ni nh vy th s lc, thin cn qu; nhng tng th nghim mi khi xt mch, m c s nghi ng l h hay thc, ri chim nghim li dy trn, th thc ch sai mt my may. Li dy ca bc Tin trit thc l ng. [27] Ta c th dch hai cu: Quan hnh d bm nhc bm cng, xc k vi h vi thc nhi tr. v St mch d hu lc v lc, minh kh b kh t chi c. thnh my cu lc bt nh sau: Xem ngi mnh yu ra sao, Bnh h, bnh thc l no chng phn. Mch ty mnh yu chuyn vn, Tc th t b s ln ra ngay. 3. Xem bnh din bin ra sao. a. Nhng thc bnh do ngoi cm, thng bo pht, nhng bo bin. b. Nhng h chng do ni thng, thng pht hin mt cch chm chp, nhng li dai dng, kh ht. c. Nhng bnh mi mc hoc do ngoi cm, hoc do ni thng. d. Nhng bnh kinh nin chc chn l do ni thng.[28] Khi nh c l h chng ri, th Ln ng li nhn nh thm nh sau: * Bnh nh mi mc l do: - Kh h, cha bng bi T qun.[29] - Hoc huyt h, cha bng bi T vt.[30] * Bnh mc lu ngy, hoc l k bnh, qui bnh, l do: - Ha h, s cha bng Bt v.[31] - Thy h, s cha bng Lc v.[32] Ln ng vit trong Chu Ngc Cch Ngn: Phm nhng bnh thuc h chng (kh huyt u suy yu), m nhng chng bnh lt vt ngoi n nhiu nh ong v t (v d: no l ho, au u, chng mt, no l au lng mi gi, no l au bng au rng, i th). Nhng nht thit khng tm ti quanh qun chi li, m

thy u tr , chng hn thy au u th tr au u; thy au chn th tr au chn, v.v. Ch cn tm cn bn m tr, h ci cy m vun p c th cnh l tt ti; h ci bnh gc m tr c, th cc bnh ngn t nhin ht. Sch Ni Kinh rng: Tr k nht, tc bch bnh tiu; tr k d tc u t lon.(tr mi bnh gc th trm bnh khc tiu; nu tr bnh d tha, th u mi ri beng). Cho nn nhng h chng va va th trch c vo kh huyt hu hnh hu thin m tr; nhng chng h nhiu, th tm vo thy ha v hnh tin thin m tr. Sch Ni Kinh rng: Tiu bnh tt do kh huyt chi s thng, i bnh tt cu thy ha chi vi hi. (nhng bnh nh hn do kh huyt lm au, nhng bnh ln hn do thy ha lm hi.) Nh vy tr bnh nh m b kh huyt khng tr; tr bnh ln m b thy ha khng tr, li i tm nhng bnh lt vt m tr, tht l k leo ln cy m kim c, lm sao c c c? [33] Ngoi ra, ta cng thy rng Ln ng ch trng cn phi lu tm n s suy yu dn d ca c th con ngi theo thi gian; n nhng iu kin a d, hon cnh x hi, nhng s khc bit v s phn ng ca mi mt ngi v v th khng c nhm mt dng nhng phng thuc cho bnh nhn mi loi, bt phn kho yu, m cn phi bit bin ch gia gim. [34] Ln ng a dng hai phng thuc Bt v v Lc v v dng hai phng y cha nhiu bnh khc nhau. S d c nh vy v Ln ng bit ch bin, gia gim, lm cho hai phng thuc y tr nn bin ha, linh ng v cng. Ni th tc l Ln ng khng dng thuc mt cch trn trn c nh, m bit ty nghi bin ch cho thuc xng vi bnh, thuc xng vi ngi. Phng th gi th l hot php.[35]

KT LUN
Snh tr liu php ca Ln ng vi tr liu php ca cc danh y Trung Hoa ta thy Ln ng lnh hi c ch vi diu ca y l Trung Hoa, nn c nhng ch xng ht sc c o, nhng sng kin ring t, khng chu l thuc vo nhng khun kh c nh ca tin nhn. Nh th mi gi l bit lm thuc. Cui cng xin mn php kt bi ny bng mt cu Ni Kinh: Tri yu gi, nht ngn nhi chung; bt tri yu gi, lu tn v cng. Dch: Bit thi mt ch l xong, Khng rnh yu ch, lung tung tn lon.[36]

CH THCH
[1] ng tp ch Phng ng, s 17, thng 11-1972, ch Y L ng Phng. - Bi ny phng theo chng tude critique du livre Les Secrets des Reins rvls trong Les Secrets des Reins rvls, lun n y khoa ca tc gi, trnh ti Y Khoa i Hc ng H Ni, thng 12-1952. Lun n ny c gii thng lun n nm y, v c gio s Pierre Huard tot lc v ph bnh trong quyn Bibliographie - tudes historiques sur lancienne mdicine au Vietnam et en Chine (B.S.E.I., N.S., Tome XXX, No2, 2 trimestre 1955, tr.180-181) v cp n nhiu ln trong cc sch khc nh: Ln ng et la Mdicine Sino-vietnamienne (B.S.E.I., N.S., Tome XXVIII, No, 3 trimestre 1953, tr.224), v P.Huard et Wong Ming, La Mdicine chinoise au cours des sicles, Les ditions Roger Dacosta Paris, 1959, tr.113. Gn y, BS H Chung T, trong quyn lun n ca ng, nhan l T Tng v S Nghip ca Ln ng (15-8-1971) cng trch dch on di cho vo lun n ca ng, t tr.76 n tr.101. [2] Phng th Cm Nang, q. 1, tr.47: Bnh Triu th Y Qun thuyt. [3] Ln ng, Huyn Tn Pht Vi, tr.3-9. [4] Xem Phng th Cm Nang, mc bn, q.2, tr.3b. Hi Thng Ln ng, Huyn Tn Pht Vi, tr.5b. [5] Xem Huyn Tn Pht Vi, tr.5b v 6a. [6] V Dng tc m v d sinh, v m tc Dng v d ha (Chu Ngc Cch Ngn, tr.15a) - B thy ch Dng quang, b ha d tiu m [7] Nhng ch Principe thermique v Principe aqueux l do ti sng to khi lm lun n dch nhng ch Chn ha, Chn thy. [8] Cch xp 8 v trn theo hnh qu Khm c thy trong P.Huard v Wong Ming, Bibliographie de la Mdicine chinoise (B.S.E.I., N.S., Tome XXXI, No3, 1956, tr.2). Ta cng c th phn chia nh sau: (1) B ha: Qu, Ph. (2) B thy: Thc a, Sn th. (3) B t: Hoi sn, Phc linh. (4) Thanh nhit: n b. (5) T: Trch t.

[9] Xem Nguyn Vn Th, Les Secrets des Reins rlvs, lun n, tr.125. - Guyton, Textbook of Medical Physiology, Saunders, 1963, chng 74, t tr. 99 tr i. [10] Xem Bradley M. Patten, Human Embryology, 1948, tr.74. [11] Corrig par une longue pratique mdicale, la thse de Ln ng, brillamment expos par M. Th, retient lattention, mme lorsquil assimile les 3 lments de la Porte de Vie (thermique, aqueux, et sexuel) aux 3 zones historiques (fascicule, rticule et glomrule) de la surrnale et lorsquil tablit une comparaison avec le syndrome dadaptation de Seylie. Elle joue sur la pathognie chinoise des maladies attribues soit des influences externes, soit des perturbation internes. Bien que nous soyons l en prsence dune extrapolation de la pense sino-vietnamienne, on doit savoir gr lauteur de son norme effort et de son dsir louable de jeter des ponts entre la mdicine extrmeorientale et de la mdicine extrme-occidentale. Pierre Huard, Bibliographie - tudes historiques sur lancienne mdicine au Vietnam et en Chine (B.S.E.I., N.S., Tome XXX, No2, 2 trimestre 1955, tr.181) [12] ng tp ch Phng ng, s 18, thng 12-1972, ch d Y L ng Phng. [13] P.Huard v Wong Ming, Bibliographie de la Mdicine chinoise (B.S.E.I. N.S., Tome XXXI, No3, 3e trim. 1956. B ch: Trong bi ny xin min bn v nhng vn thng thng nh: H thc, Hn nhit, Biu l, Thy ha, v.v. cng nh khng bn v cc phng php tr liu khi qut nh: b (toniques), hn (diaphortiques), h (laxatfs, purgatifs), ha gii (rgulateurs), thanh (dpuratifs, refraichissants), n (rchauffants), thm (diurtiques), th (vomitifs), tiu (dissolvants), c sp (astringents), trn (tranquillisants), v.v. [14] Bch bnh lp danh tuy phin, nhin bt vit m Dng, ng hnh sinh khc, lc dm, tht tnh, ng ha d m thc, lao quyn tng hip truyn bin nhi d. Kinh s v: Tri k yu gi nht ngn nhi chung; bt tri k yu, lu tn v cng gi th nh. Phng th Cm Nang, q.2, chng Tht tnh lun, tr.34a. Nh vy tht tnh y khng phi Ai, c, h, n, i, , dc nh ta thng hiu. Xem Phng th Cm Nang, q.2, chng Tht tnh lun, tr.33b v xem P.Huard et M. Durand, Ln ng et la Mdicine Sino-vietnamienne (B.S.E.I., N.S., Tome XXVIII, No, 3 trim.1953, tr.47) [15] Ma hong thang: tr thng hn. Thi dng chng, t cn ngoi, pht nng, nhc u, mnh my tht lng v khp xng au; c cng, s gi, s lnh, khng m hi, kh kh, mch khn. Ma hong (3 lng), Qu chi (2 lng), Hnh nhn (20 ht), Chch cam tho

(1 lng). (Cc bi thuc v li bnh rt trong: Phm Vn iu, ng Y Dc Hc Kha Tot Yu) [16] Qu chi thang: Tr Thi dng, trng phong, Dng ph m nhc, pht nng, nhc u, ght gi, ght lnh, nhy mi, o khan. Qu chi, Thc dc, Sinh khng (mi th 3 lng); Chch cam tho (2 lng); i to (12 tri). Ung nng sau n cho nng, ra m hi th thi; cha ra m hi th cho ung thm. [17] Tha kh thang (thuc x): Tr bnh thng hn, Dng minh chng, bao t y, to bn, pht nng, ni sng, m hi rm rp, no y, but rt. -- C 2 bi: i tha kh v Tiu tha kh. i tha kh: i hong tm ru (5 ch), Mang tiu (4 ch), Hu phc (3 ch), Ch thit (3 ch). Nu Hu phc v Ch thit trc, sau cho i hong; khi rt xung trn mang tiu. Tiu tha kh: Ch c i hong, Ch thit, Hu phc. [18] Tin si h thang: C tnh hon tr rt mi pht, hoc thng hn, ... kinh, Thiu Dng. Si h (8 ch), Nhn sm, Cam tho, Hong Cm, mi thm gng to. (cc ch l b mt ch trong bn photo) [19] T nghch thang: tr thng hn thuc tam m, mnh au, bng au, i tin nguyn n, ght lnh, khng nng, [] lnh ngt, hoc khng ght lnh m bt rt, trong lnh ngoi nng, hoc i ma, c au, mch trm, vi t, sp tuyt. - Ph t sng (1 c), Cn khng (1 [] ), Chch cam tho (2 lng). Nu cho ung. (ghi ch: cc ch [] l b mt ch trong bn in) [20] L trung thang: Tr thng hn, Thi m, tiu chy, khng kht, [] au bng, mch trm, khng sc, chn tay mp, co qup, tc ngc, nghn, i ra [] - Bch trut (sao vi t vch c) (2 [] ), Nhn sm, Cn khng (sao vng), Cho mi v 1 lng, tn nhuyn, cho ung tip 4 ch. [21] ng qui t nghch thang: Tr thng hn Quyt m, chn tay lnh, mch nh, sp tuyt.- ng qui ( [] ), Bch thc, T tn mi v 3 lng, Cam tho, Thng tho mi v 2 lng, To (25 tri). Nu cho ung nhiu [] nhiu thang. B ch: D nhin, y chng ta ch [] s lc mt vi phng thang ca Trng Cnh. Thc ra ng c hn 100 thang. c thm: Trn Tu Vin, Thng [] phng thang ca quyt. nh Tun, ng Y lc kho [] (chng Lc kinh chnh bnh, tr. [] ). Phm vn iu, ng y dc hc kho yu, cc tr. 252, 254, 262, 279. (ghi ch: cc ch [] l b mt ch trong bn in) [22] P. Huard, Bibliographie de la Mdicine chinoise, p.186. No 50. [23] Ibid. pp.199-200

[24] P. Huard et Wong, Bio-Bibliographie de la Mdicine chinoise, p.191. [25] Xem Y hi cu nguyn, chng H Thc, tr.36. [26] Xem Chu Ngc Cch Ngn, q.thng, tr.6b, 7a. Trch: bn dch Chu Ngc Cch Ngn ca c nh Ninh L c Thip (bn nh my), tr.24. [27] Xem Chu Ngc Cch Ngn, q.thng, tr.6a v 7b. Xem bn dch Chu Ngc Cch Ngn ca c nh Ninh L c Thip (bn nh my), tr.24. [28] Xem Y hi cu nguyn, chng m Dng, tr.8 v chng Tri Tc, tr.22. [29] T qun thang: Nhn sm, Bch trut (mi th 2 ch), Bch linh (3 ch), Cam tho (2 ch). [30] T vt thang: Thc a (2 ch), ng qui, Bch thc (mi th 1 ch), Xuyn khung (1 ch). [31] Bt v: Qu, Ph, n b, Hoi sn, Sn th, Phc linh, Trch t, Thc a. [32] Lc v: Bi Bt v b Qu, Ph. [33] Xem Chu Ngc Cch Ngn, q.h, tr.22b. Xem bn dch Chu Ngc Cch Ngn ca c nh Ninh L c Thip (bn nh my), tr.57. [34] Chnh v th m Ln ng khng dng Ma hong thang v Qu chi thang ca Trng Cnh. Xem P.Huard et M. Durand, Ln ng et la Mdicine Sino-vietnamienne, p.225. [35] Ni h cn y x ch linh ch bin chi l, nhi chp bt linh bt bin chi thnh phng. Th d T vn v phng , Nn Kinh v phng; phi v phng d; vi phng hot php d. Hn th ti hu phng phng d. Phng th Cm Nang, q.1, tr.43b [36] Phng th Cm Nang, q.2, chng Tht tnh lun, tr.34a. B Ch: Bi ny hu ht c trch ra t chng Parallle entre Ln ng et les auteurs chinoises t tr.103 n 109 trong lun n Y khoa bc s ca tc gi, nhan l Les Secrets des Reins rvls, lun n y khoa ca tc gi, trnh ti Y Khoa i Hc ng H Ni, thng 12-1952. Lun n ny c gio s Pierre Huard nhiu ln cp ti cng nh tot lc v ph bnh. Xin c: - Pierre Huard et M.Durand, La Mdicine Sino-vietnamienne (B.S.E.I., N.S., Tome XXVIII, No, 3 trimestre 1953, tr.224-240) - Pierre Huard, Bibliographie - tudes historiques sur lancienne mdicine au Vietnam et en Chine (B.S.E.I., N.S., Tome XXX, No2, 2 trimestre 1955)

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