1

B y t







Bnh hc ngoi - ph
y hc c truyn
Sch o to Bc s chuyn khoa y hc c truyn
M s: .08.Z.25 - .08.Z.27
Ch bin:
PGS. TS. Phm vn trnh
PGS.TS. L th hin










Nh xut bn y hc
H ni - 2008
2





Ch o bin son:
V Khoa hc & o to, B Y t
Ch bin:
PGS. TS. Phm Vn Trnh
PGS. TS. L Th Hin
Nhng ngi bin son:
PGS. TS. T Vn Bnh
TS. L Lng ng
TS. L Th Hin
ThS. Thi Hong Oanh
PGS. TS. Phm Vn Trnh
ThS. Trn Hi Vn
Th k bin son
TS. L Th Hin
Tham gia t chc bn tho
ThS. Ph Vn Thm
TS. Nguyn Mnh Pha




Bn quyn thuc B Y t (V Khoa hc v o to)

3
Li gii thiu
Thc hin mt s iu ca Lut Gio dc, B Gio dc & o to v B Y
t ban hnh chng trnh khung o to bc s chuyn khoa y hc c truyn,
B Y t t chc bin son ti liu dy - hc cc mn c s, chuyn mn v c bn
chuyn ngnh theo chng trnh trn nhm tng bc xy dng b sch chun
trong cng tc o to nhn lc y t.
Sch Bnh hc ngoi - ph y hc c truyn c bin son cho 2 mn hc
Bnh hc ngoi khoa Y hc c truyn v Bnh hc Sn ph khoa da trn chng
trnh gio dc i hc ca Trng i hc Y H Ni trn c s chng trnh
khung c ph duyt. Sch c cc nh gio giu kinh nghim v tm
huyt vi cng tc o to bin son theo phng chm: kin thc c bn, h
thng; ni dung chnh xc, khoa hc, cp nht cc tin b khoa hc, k thut hin
i v thc tin Vit Nam.
Sch Bnh hc ngoi - ph y hc c truyn c Hi ng chuyn mn
thm nh sch v ti liu dy - hc chuyn ngnh bc s a khoa ca B Y t
thm nh vo nm 2007, l ti liu dy - hc t chun chuyn mn ca ngnh
Y t trong giai on hin nay. Trong qu trnh s dng sch phi c chnh l,
b sung v cp nht.
B Y t xin chn thnh cm n cc nh gio, cc chuyn gia ca Khoa Y
hc c truyn, Trng i hc Y H Ni dnh nhiu cng sc hon thnh
cun sch ny; cm n GS. Hong Bo Chu c v phn bin cun sch
sm hon thnh, kp thi phc v cho cng tc o to nhn lc y t.
Ln u xut bn, chng ti mong nhn c kin ng gp ca ng
nghip, cc bn sinh vin v cc c gi ln xut bn sau c hon thin hn.

V khoa hc v o to
B Y t






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5
Li ni u
Thc hin ngh quyt 226/CP ca Hi ng Chnh ph v vic pht trin y
hc c truyn Vit Nam, cn c cng vn s 7227/YT - K2T ca B Y t ngy
27/9/2004 v vic thm nh sch v ti liu dy - hc h i hc v cao ng
chnh quy, Khoa Y hc c truyn - Trng i hc Y H Ni bin son ti liu
Bi ging ngoi - ph y hc c truyn nhm cung cp cho sinh vin chuyn khoa
y hc c truyn c ti liu hc tp v tham kho v y hc c truyn theo chng
trnh ci cch.
Mc ch yu cu ca ti liu:
- V mt l thuyt: sinh vin nm c nhng c im c bn ca y hc c
truyn v bnh ngoi khoa v ph khoa.
- V mt thc hnh: nm c cc phng php chn on v iu tr mt
s bnh thng gp trong ngoi khoa v ph khoa phc v cho vic chm sc
sc kho ca nhn dn. Sch trnh by nhng im c bn c tnh cp nht, c
kt hp gia y hc hin i v y hc c truyn.
Ch bin v cc tc gi bin son cun sch ny l nhng cn b ging
dy y hc c truyn c nhiu kinh nghim v ngoi khoa v ph khoa ca Khoa
Y hc c truyn - Trng i hc Y H Ni son tho.
Trong qu trnh bin son v xut bn mc d c nhiu c gng nhng
chc chn cn c thiu st, chng ti mong nhn c nhng kin ng gp
ca ng nghip v bn c.


PGS.TS. Nguyn Nhc Kim
Trng khoa Y hc c truyn
Trng i hc Y H Ni




6
ch vit tt

BN Bnh nhn
TB Tim bp
TC T cung
TCBT T cung bnh thng
T/M Tnh mch
YHCT: Y hc c truyn
YHH: Y hc hin i


















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Mc lc
Phn 1. Ngoi khoa 9
Bin chng trong ngoi khoa y hc c truyn
Phm Vn Trinh 10
S lc lch s iu tr chn thng trong y hc c truyn
L Lng ng 21
Bong gn (Nu thng)
Phm Vn Trnh 24
To thng (ng gip phn mm)
Phm Vn Trnh 27
Vt thng phn mm (Sang thng)
Phm Vn Trnh 29
i cng v gy xng (C tit)
L Lng ng 37
Nguyn tc iu tr gy xng kt hp Y hc c truyn
L Lng ng 42
Mt s loi gy xng (C tit)
L Lng ng 65
Thuc y hc c truyn dng ngoi trong iu tr bnh da liu (Bnh b phu)
T Vn Bnh 75
Chm (Phong chn)
T Vn Bnh 82
Bnh my ay (n chn)
T Vn Bnh 90
Tr
Phm Vn Trnh 97
R hu mn (Giang lu)
Phm Vn Trnh 102
Mn nht (Tit inh)
Trn Hi Vn 106
Si tit niu (Thch lm)
Phm Vn Trnh 109
Phn 2. Sn ph khoa 117
Chng 1. i cng 118
c im sinh l ca ph n
L Th Hin 118
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Bnh nguyn bnh sinh theo YHCT ca bnh ph khoa
L Th Hin 121
c im v chn on bnh ph khoa (T chn)
L Th Hin 123
Bt cng
L Th Hin 126
Nguyn tc iu tr bnh ph khoa
L Th Hin 130
Chng 2. iu tr mt s bnh ph khoa 134
Kinh nguyt khng u
L Th Hin 134
Rong kinh (Kinh lu)
L Th Hin 142
Rong huyt (Huyt lu)
L Th Hin 146
au bng kinh (Thng kinh)
L Th Hin 153
B kinh, v kinh (Trn huyt)
L Th Hin 157
i h
L Th Hin 162
Vim lot c t cung (m sang)
Thi Hong Oanh 166
Vim m o (m dng)
L Th Hin 169
Vim phn ph (Trng h)
Thi Hong Oanh 173
Do sy thai (ng thai, thai lu)
L Th Hin 177
Nn ma khi c thai (c tr)
L Th Hin 182
Ph khi c thai (T thng)
L Th Hin 186
Vim tc tia sa, vim tuyn v (Nh ung)
L Th Hin 190
Thiu sa (Khuyt nh)
L Th Hin 193
Sa sinh dc (m nh)
L Th Hin 197

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Phn 1
Bnh hc Ngoi khoa
y hc c truyn
10
Bi 1
Bin chng trong ngoi khoa
y hc c truyn
Mc tiu
1. Hiu v gii thch c cc nguyn nhn gy bnh ca ngoi khoa y hc c truyn.
2. Thuc v trnh by c v bin chng bnh l ca ngoi khoa y hc c truyn.

1. Quan nim v phn loi
Bnh ngoi khoa thc ra c rt sm v c trc cc bnh ca cc khoa
khc k c ni khoa, v con ngi sinh ra phi lao ng sinh tn cho nn
trc tin phi xut hin cc kinh nghim iu tr: tai nn lao ng, cn trng,
th cn Nhng t xa cc y vn li, nc ta cha xp ring ngoi khoa,
Trung Quc thi nh Chu xp l dng khoa, thy thuc iu tr bnh dng
khoa gi l dng y.
Thi xa cho rng cc bnh sinh ra bn ngoi c th mt nhn thy, tay s
thy c chng trng cc b u thuc phm vi ca ngoi khoa. V d: inh, ung,
th, hu bi, tin bi, n c, loa lch, d, nham, bu c Sau ny do khoa hc
pht trin c s kt hp gia y hc c truyn (YHCT) vi y hc hin i (YHH)
cho nn phm vi ngoi khoa rng hn, phong ph hn (v d: sa lm, chn
thng, cn trng, th cn, cc bnh da liu, vim tc ng mch, tr).
Trong ngoi khoa y hc c truyn, da vo cc bnh tnh v nguyn nhn
c th chia cc loi:
Loi nhit (thuc loi vim nhim theo y hc hin i): inh, ung, th,
dng, n c, loa lch, d
Chn thng: trit thng, nu thng, toa thng, huyt , kh tr tng
ph do chn thng, trt .
Cc loi khc: nham, bng (ho sang), lnh cng (ng sang); trng, th cn.
Ngoi ra cn chia ra cc bnh theo v tr tn thng, kt hp vi tnh cht
ca bnh.
+ Cc bnh vim nhim da, c, xng, khp, hch v tuyn v.
+ Cc bnh cp tnh.
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+ Cc bnh hu mn trc trng.
+ Cc bnh da liu.
+ Cc bnh thuc chn thng.
+ Cc bnh u.
+ Cc bnh bang.
+ Cc bnh b trng - th cn.
+ Cc bnh ngoi khoa khc: si gan - mt - tit niu, vim tc ng
mch, tnh mch.
2. Khi qut v bin chng bnh ngoi khoa
2.1. Bin chng nguyn nhn sinh bnh
Nguyn nhn gy bnh ngoi khoa l do cc nguyn nhn bn ngoi (lc
dm), cc nguyn nhn bn trong (ni nhn) v cc nguyn nhn khc (bt,
ngoi ni nhn) gy nn; nhng c c tnh gy bnh khc vi ni khoa.
2.1.1. Nguyn nhn bn ngoi
Lc dm t c cn gi l ngoi cm lc dm, tc l ngoi t gy nn, bao
gm: phong, hn, th, thp, to v ho xm nhp vo c th lm tn thng c
th m pht bnh. Bnh c th pht ti ch (cc b), cng c th pht ra ton
thn l tu thuc vo chnh kh (sc khng) ca c th. Chnh kh ton thn
h gy bnh ton thn (mn, nht ton thn); chnh kh ti ch h gy bnh ti
ch (nht, ung ti ch). Bnh cc b chim t l 70 - 80%.
Nguyn nhn gy bnh trong ngoi khoa thng do ho, 5 loi t kh khc
kt hp vi ho gy bnh, nhng bn thn chng cng bin thnh ho gy
bnh cn gi l ho c hoc nhit c. V vy Ni kinh c ni: Chnh kh cn
bn trong, t kh khng lm g c.
Phong t: phong t l dng t, tnh ca phong l to nh v tn ln trn
ra ngoi, cho nn bnh da thng ri rc nhiu ni, c khi pht ton
thn hoc tp trung u, mt, c, bnh nga v kh (hoc c vy mng
hoc t b).
V d: phong xm nhp lm cho huyt to, b phu km nui dng m sinh
bnh nh vim da thn kinh, vy nn
Phong thch hnh (di ng) m li bin ha nn pht bnh nhanh v thay
i, phn nhiu thuc dng chng (hoc xut hin sng, , au khng c v
tr nht nh; hoc ln kinh git co rt).
V d: b vt thng cm phi phong t gy bnh ni phong c th gp ph
thng phong (ging nh un vn, nu l un vn cn phi phng v iu tr y
hc hin i trc tin).
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Hn t: hn t l m t, tnh cht bnh su, thm, t b, cn xng...
bnh phn nhiu thuc m chng. c im bnh ngoi khoa ca hn l
sng m khng cng, mu sc da thm ta hoc mu da trc khi b bnh
khng , khng nng, au nhiu v tr nht nh, bnh m thm nng.
V d: nguyn nhn do hn lm cho kh huyt tr gy nn nhc u; chi
lnh but ti nht, thm ch thiu huyt nui dng, teo nh, rng t tay t
chn... gp trong thot th (ng mch); hoc nu do hn t xm nhp nhiu,
lu, ngng tr kh huyt ton thn gy ton thn cng , lnh but, l bnh
ng thng (bnh lnh cng).
Ha t: ha t thuc dng t, cc triu chng chung l: nga, au, l
lot u do ha hoc phong, hn, th, thp t ho ha gy nn.
c im: pht bnh nhanh, cp tnh (sng, , nng v au). V d: nhit
vo huyt c th gy n c ha nhit c nh bnh: inh, th, ung nht; tu
theo v tr m gy chng bnh khc nhau nh: da l n c, c biu nh nh ung
nht kinh mch nh vim hch, trc ngc l tin bi sau lng l hu bi.
T v tr ca bnh c th bit cc nguyn nhn kt hp vi ha, c th: nu
pht bnh phn trn c th nh: u, mt, c, chi trn... l thng kt hp vi
phong; nu bnh pht ngc, sn, bng... l thng ha lu gi l ha ut v
kh ho thng ut gia c th; nu pht bnh phn di c th nh hu mn,
chi di, sinh dc, tit niu thng kt hp vi thp v tnh cht ca thp l h
ging. Tuy vy khi chn on nguyn nhn cn phi kt hp vi triu chng ton
thn ti ch v v tr bnh trn c th iu tr mi li kt qu tt.
Thp t: thp t l m t, c tnh cht nht, dnh, bn c... Tu theo s
thin lch ca hn nhit trong c th v ca qu tit kh tri m ha hn,
ha nhit; m kt hp thnh thp hn, thp nhit.
c im: nu c nhc th da lot nt, chy nc hoc chy m; su th
r, da m t.
V d: thp nhit gp tr lot nt, ung thng; thp hn gp chi di th
gp cc lot mn, lot
To t: to l dng t, c im ca to l lm tn hi tn dch, huyt to
sinh phong, phn nhiu bnh pht tay - chn v da (b phu)
Tnh cht ca to l: b phu kh, n, nga, mn, bong vy, nt k V d:
nu nhit to xm nhp vo huyt sinh huyt to, huyt nhit... c th gp
bnh vy nn; nu huyt to c th gp bnh thp mn tnh, da mn nga.
Th t: th l dng t, thng hip (bc), th thp b trng t lu ha
nhit phn nhiu pht ra c - da - u - mt.
c im l: sng , nung m, au, gp lnh au gim. V d: th thp
nung t b phu thnh rm sy hoc cm phi th c thnh vt thng l lot,
mn nc.
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2.1.2. Nguyn nhn bn trong
Nguyn nhn bn trong gi l ni thng tht tnh, l nhn t tinh
thn, c th l: h (vui), n (gin), bi (bun), ai (lo), kinh (hi), khng (s), u
(suy ngh)... b ri lon lm cho m dng khng iu ha, kh huyt khng ha
hp, cng nng ca cc tng ph v kinh lc b hn lon m gy bnh. Trong
bnh ngoi khoa hay gp lo ngh, tc gin qu . V d: tnh ch khng thng,
tc gin qu lm cho can kh ut kt, kh tr m ngng... hay gp trn lm
sng l bnh vim hch (loa lch), vim tuyn v, tc tia sa, u gip trng, cc
khi u Ngoi ra cn gp cc bnh ngoi da nh: vim da thn kinh, bnh sn
nga cng do yu t tinh thn gy nn.
2.1.3. Cc nguyn nhn khc
n ung khng iu : theo Hi Thng Ln ng ni: n ung l bi
p nhng cht cho ch thiu, n ung qu mc th thng tn ti t v
o trng, cho nn n ung khng iu cng l nguyn nhn gy
bnh ngoi khoa. V d: n nhiu th cay, nng, bo, ngt gy v trng
tch nhit, ha c ni sinh gy nn bnh l lot, inh, nht, rm sy;
hoc n ung qu nhiu gy nn thc tch, sinh bnh cp tnh bng, n
thc n lnh hoc qu i gy nn cc bnh giun: tc rut do giun, giun
chui ng mt
Phng dc: trong tp Ni kinh yu ch Hi Thng Ln ng ni r:
Sinh hot l k cng ca hnh ng say m v sc gi l phng dc,
tu sc ba bi gi l hao, say m sc dc qu mc th gi l tinh cn,
ba bi th tinh kh tn mn. Nh vy nu phng dc qu gy thn
kh tn thng, phong t, hn thp d xm nhp m sinh bnh (v d:
vim tu xng, xng gy lu lin).
Ni : y cng l nhn t gy bnh v n c lin quan cht ch ti lc dm
v cng l yu t sinh ra lc dm. V vy bnh ngoi khoa do ni gy nn
chnh l do lc dm gy nn.
Cc nguyn nhn khc:
+ Chn thng.
+ Trng th cn.
+ Ha thng v ng thng.
Cc tn thng trn nu bnh nh th c da, gn, xng b tn thng; nu
bnh nng th cc tng ph b tn thng; nu bnh nghim trng hn th bin
bnh ton thn.
2.2. Bin chng v bnh l
Bnh l l mt tri thc hiu bit v bnh, gii thch c nguyn nhn gy
bnh trong c th v phn tch c s bin ha ca bnh, nh gi tin lng
ca bnh... cho nn n ht sc quan trng trn thc t lm sng, n c ngha
ch o trng yu trong chn on, iu tr, phng v tin lng bnh.
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2.2.1. Bin chng v kh huyt
Kh huyt trong c th gip ln nhau m lu hnh, tun hon trong
kinh mch... trong th nui dng tng ph, ngoi th nui dng c da
duy tr s sng v c tc dng chng ngoi t. V vy kh huyt vng thnh,
bo v bn ngoi s mnh th ngoi t khng d xm nhp; kh huyt h yu,
bo v bn ngoi s km th cc nguyn nhn gy bnh rt d xm nhp c th
m gy nn bnh. Trong sch Ni kinh ni: Kh thng th au, hnh (huyt)
thng th sng. Sng v au l phn ng bnh l khng ging nhau ca 2 loi
kh huyt b ngng tr. V vy pht sinh ra tn thng bnh l ngoi khoa nht
thit phi do kh huyt ngng tr gy nn. V d nh trong ngoi khoa, chn
thng kh huyt ngng tr l bnh l ch yu pht sinh v hnh thnh bnh
(nh bnh l lot, inh, nht nu kh huyt xung thnh () thi k u d
dng khi, thi k c m d thu nh v v m, thi k v m d thu nh
ming vt thng v sinh c (lin so).
V vy khi bin chng trong lm sng nht thit phi lm r quan h kh
huyt vi bnh ni tn thng mi hiu c bn cht ca bnh m tin hnh
nh ra phng hng iu tr. Cc biu hin ca tn thng kh huyt nh sau:
Kh tr: kh t th c hnh, kh tn th khng c vt tch, kh gy bnh th
au, kh au th bt thng. Bnh thng gp nh: ngc sn y tc, kh
th do chn thng vng ngc sn (khng c triu chng gy xng, trn
kh, trn dch mng phi, khng v gan lch) hoc li ko gy au; hoc
nh nhau vng bng gy tc bng, trng hi; hoc ln gy ct sng gy
chng bng, b i tiu tin; hoc cng c th do ni tng b ri lon gy
kh tr nh bnh kh h h hm (sa cc ph tng)
Kh ut: kh ut trong ngoi khoa c th sinh ra tch t hoc ut ho ho, t
chy thnh dch m thnh m, m tch li thnh khi. Nu kh ut m tch
t th thnh sng, thnh khi mu sc da khng thay i, c th thay i
theo tnh ch (v d: vim tuyn v, tc tia sa, u gip trng); nu kh ut
thnh m th thnh khi, sng nhng mm (v d: vim hch mn).
Kh h: kh h tc l dng kh khng th khng t c biu vo bn trong
c th c. Nu kh h ton thn gy c ng kh khn, hay gp trong di
chng ca cc chn thng thn kinh, c, xng, khp Nu kh h ti
ch th sc chng ti ch yu, c t d xm nhp gy ra l lot, inh,
nhtgy cho cc ni b tn thng kh hi phc (v d: bnh kh h ca
tng ph, t kh h gy nn sa cc ph tng). Nu kh h ti ch v ton
thn th bnh sng m kh ph m, kh thu ming, th yu, n km, cht
li nht, mch t.
Huyt : theo y hc c truyn, trong ngoi khoa thng kh tc kh tr,
thng huyt tc huyt ngng. Kh tr khin huyt ngng, huyt ngng
c th cn tr kh hnh, v vy huyt l gy ra bnh. Nu huyt ngng
c nhc, b phu th sng, au, (v d: tn thng c, da, dy chng
(tn thng phn mm)); nu cn tr dinh v th ut m sinh nhit, c
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triu chng bnh sng, nng, , au da, c (v d: bnh inh, nht,
lot); nu huyt tch ngc sn th c triu chng y chng au tc,
(v d: bnh vim ng mt, tn thng vng ngc do chn thng).
Huyt lu ut sinh nhit (ni phn di) huyt cng gy ra chy
mu (v d: tr chy mu).
Huyt nhit: huyt nhit do huyt lu, ut trong m sinh nhit; hoc
nhit c xm phm vo huyt phn. Nu da, c, khp th c triu
chng cp tnh nh: sng, nng, , au m gp inh, n c, nht
l do huyt lu ut thnh nhit gy nn. Nu c triu chng chy mu
th do nhit bc huyt lon hnh gy ra nh th huyt, nc huyt do
sang chn
Huyt h: huyt h thng xut hin thi k sau ca bnh. Trong y hc c
truyn cho rng kh h bt dng, huyt h bt nhn. Cho nn cc ni tn
thng m huyt h th khng nui dng c v ni tn thng khng
th hi phc c (v d: cc vt thng m huyt h th rt kh thu
ming v lin c hoc trong cc trng hp gy xng nu huyt h
khng bao gi lin xng c).
2.2.2. Bin chng v cn xng
Cn lin quan ti can, xng lin quan ti thn, cn xng l ngn ca can
thn, c kh huyt n m, can thn nhu dng. V vy cn xng m b tn
thng th nht thit tn thng ti kh huyt v nh hng ti can thn.
Thanh nin c can thn kh thnh, cn xng pht trin chc cho nn cn
xng b tn thng th rt d hi phc. Ngi gi th can thn kh suy, cn x-
ng h yu; cho nn cn xng b tn thng th hi phc rt chm, thm ch
khng hi phc. V vy iu tr bnh cn xng l iu tr bnh bn trong nn
cn ch n iu l ca kh huyt, can thn lm ch. V d: gy xng giai
on u cn sng, nng, , au cn hot huyt hnh kh tiu lm ch;
n giai on ht sng, nng, th phi tip lin xng, b can thn lm ch
2.2.3. Bin chng v tng ph
Trong ngoi khoa bnh c quan h cht ch vi tng ph. Bnh c th t
biu truyn vo tng ph (v d: cc bnh ngoi da, c, cn, xng tuy do ngoi
t gy bnh nhng nu khng iu tr tt s gy bnh tng ph nh inh,
nht; nu ngi bnh chnh kh km s gy st cao, ho m ton thn v co git
dn n t vong ). Ngc li bnh thuc tng ph cng c th gy bnh cc
b (v d: kh h ch yu trung kh h gy ra nh tr).
Cc biu hin bnh tng ph thng gp l:
Ho c cng tm:
+ Triu chng: st rt t, st nng cao, vt v, hn m, ni nhm, li
ta, mch hng sc; c th ln cn git do chnh kh h, t kh thnh gy
ho c mnh xm phm tm bo gi l ho c cng tm.
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Cc bnh trong ngoi khoa hay gp do ho c cng tm l: l lot, mn
nht ton thn
Can phong ni ng: bnh hay gp sau khi b vt thng cm phi phong t
gy ng can kh, xut hin triu chng ming kh h, hm rng nghin
cht, ngi un cong, c th gy ph thng phong (lin h y hc hin i
gi l un vn, nu l un vn phi iu tr y hc hin i l ch yu).
Kh ca lc ph ri lon: kh ca lc ph phi lu thng m khng dng,
thng ly thng ging lm ch, nu pht sinh ra bnh th kh s ngng
tr. Tu theo v tr tn thng m gy bnh v tr khc nhau (v d:
vng bng gy au bng, nn hoc bun nn, bng trng, i tin to
gp trong chn thng vng bng hoc ct sng tht lng v lng). Nh
vy kh khng thng th au ph, kh khng ging th nn hoc bun nn,
kh tr qu nhiu th gy bng trng, ph kh kt gy b i tin cng
thng gp chng bnh cp tnh bng: giun chui ng mt, si gan, mt,
si tit niu.
H tiu thp nhit: trong ngoi khoa hay gp thn h khng kh ho c
bng quang gy nn thp nhit v ngng kt h tiu v sinh chng tiu
tin , t i, i rt, i but, thm ch i ra mu (do nhit t xm
phm huyt phn), i c hoc b i, c th gy au tht lng, bng
di tc, ru li vng, nht, mch huyn sc thng gp si tit niu, u
tin lit tuyn.
Ph kh bt c: bnh da c lin h vi ph, t v tm. Ph ch kh, lin
quan ti b mao; nu kh ph bt c th tu l khng ng m c, phong
hn tha c m xm nhp v gy bnh ma chn, mn nga, mn m ay
mn tnh do lnh.
Ni tng tn thng: thng do ngoi lc tc ng lm tn thng ni
tng, tu theo cc v tr b ngoi lc tc ng khc nhau m gy cc tn
thng khc nhau (v d: tn thng u c triu chng au u, chng
mt, bun nn hoc lc tnh, lc m, hn m (y hc hin i gi l chn
ng no, chn thng s no gy xut huyt no); tn thng mi gy
sng au v chy mu mi; tn thng ngc th au ngc, kh th, ho ra
mu; tn thng bng c chng au bng, trng bng, b trung i
tin, nn ra mu, i tin ra mu).
Can thn h: can ch cn, nu can huyt h th khng th nui dng
c cn gy nn khp au, c ng kh, t mi v yu khp. Hay gp
cc tn thng khp v cc t chc phn mm nh: sai khp, tn thng
bao khp, dy chng khp sau chn thng, ng hoc cc c ng bt
thng.
Nu bnh lu ngy th m dch hao tn, nh hng ti thn m gy chng
st v chiu, o hn, li , mch t sc, khp cng kh c ng (thoi ho
khp).
17
Bng biu hin cc triu chng c tn thng tng ph

Tng ph Triu chng
Tm Hn m, ni nhm, vt v, li kh, hoc ni khng r
Can Ton thn co cng, mt m trng trng, thng hay tc gin, hi hp
T Khng mun n, ung thuc thng nn ra, ngi gy t
Ph m nhiu, ho suyn - ngc au, ho c th m ln mu, th nhanh, ngt
mi hoc mi php phng
Thn Ming kht, hng kh, m nang co rt, lng gi mm yu
Tng ph u h Ton thn ph, nn nc, a chy, ming y m di
Kh huyt u h Th v ni yu, da xanh, li bu nht, chn tay lnh, ra m hi
2.2.4. Bin chng v h kinh lc
Kinh lc phn b khp c th, bt ngun t cc tng ph thng ra ngoi b
phu, mch, c, cn ct lm cho kh huyt lu thng v nui dng cc tng
ph, b phu, mch, c cn, xng hot ng. Cho nn bt lun nguyn nhn gy
bnh no, d trong (tc l tng ph), d ngoi (l b phu), mch, c xng
u nh hng ti kinh lc, u lm cho kh huyt tc tr m pht sinh ra
bnh. V d: bnh l lot da, c (biu) c t c th theo kinh lc vo c quan
ni tng (l) gy bnh l lot tng ph; ngc li trong tng ph b bnh c
th c t t tng ph theo ng kinh lc ra ngoi da, c, xng, khp m gy
bnh.
Cc bnh da, c, xng, khp d chn thng hay cc c t gy ra u
lm kh huyt tc tr gy nn kinh lc ngng tr, cho nn trn lm sng phi
da vo b v ca ng kinh lc m bin chng. V d: bnh gy c (lot, l,
nht) l thuc b v ca ng kinh bng quang; bnh vim tuyn v, tc
tia sa l thuc b v ca ng kinh v
Nh cc huyt nm trn ng kinh lc c lin quan cht ch vi cc tng
ph cho nn tng ph no b bnh s phn ng trn ng kinh lc (nht l
phn ng ln cc huyt ca ng kinh). V d: bnh can m n huyt dng
lng tuyn au, bnh ca h thng i tiu trng n tc tam l au cho nn
da vo chn on tng ph b bnh (v d: chn on vim rut tha n
huyt lan v au).
Da vo lin quan ng kinh lc vi ng quan, v tr v ng ph (ni c
tr ca tng ph) chn on v iu tr, v d:
Bnh nh u thuc kinh c
Bnh tai thuc kinh thn.
Bnh mi thuc kinh ph.
Bnh lng bn tay thuc tm bo lc.
18
Bnh lng bn chn thuc kinh thn.
Bnh vng lng thuc ng kinh dng.
Bnh trong cnh tay thuc th tam m kinh.
Bnh pha trong i thuc tc tam m kinh.
Bnh pha ngoi i thuc tc tam dng kinh.
Cc kinh lc lin quan cht ch vi kh huyt v cc c quan cho nn bnh
kinh lc hoc c quan no cng c th gip cho chn on v iu tr theo
kh huyt.
+ Nhiu kh, t huyt:
C th: bnh tam tiu kinh, tm kinh, m kinh, thn kinh.
+ t kh, nhiu huyt:
C th: bnh tm bo lc, tiu trng, can kinh, bng quang.
+ t huyt, nhiu kh:
C th: bnh ph kinh, t kinh.
+ Nhiu huyt, nhiu kh:
C th: bnh i trng kinh, v kinh
Bnh ni nhiu huyt, nhiu kh hoc nhiu huyt, t kh d khi hn
nhiu kh, t huyt hoc t kh, t huyt (v huyt l nui dng kh l thc y
kh hot ng).
2.2.5. Bin chng v sng, au, m, nga
Trong qu trnh tin trin ca bnh ngoi khoa thng c du hiu sng,
au, m v nga.
Sng: trong c th ngi ta kh huyt tun hnh khng ngng, khng ni
no khng n, khng ni no khng qua. Nu do nguyn nhn no lm
kh huyt ng li hoc ngng tr th ti ni c sng au. Hnh thi
cng nh mu sc ch sng u khc nhau. Ch sng tn mn thuc h;
ch sng cao, tp trung thuc thc; sng thuc phong th ch sng ni
phng m hay chy; sng thuc m th mm nhn nh bng hoc ngoi
cng trong mm khng , khng nng, mu da nh thng; v huyt
m sng th sc hi hng hoc bm tm; nu thnh m th mu sc bin
i, c th tm bm ln vng hoc mu xanh; sng do huyt khng chy,
sng do kh th chy.
au: au chnh l do kh khng lu thng nhng kh l thng soi ca
huyt, huyt l m ca kh nn kh khng lu thng th huyt cng khng
lu thng. Cho nn au l do kh huyt khng lu thng, tu theo nguyn
nhn m c tnh cht au khc nhau; nu au thuc h th a xoa bp,
19
nu au thuc thc th xoa bp li au tng; au thuc hn th t li mt
ch, mu da khng thay i, gp nng th bt au; au thuc nhit th
mu hng , gp lnh th au gim; v lm m m au th va au va
sng to; v phong m au th au chy khp ngi rt nhanh, km theo
nga, t b hoc kin cn; v kh m au th au chy quanh khng nht
nh ch no.
Lm m: m l do kh huyt ho sinh ra. Nu kh huyt suy km th
khng th y c ra ngoi c, v th s bi nng ca cc chng ung
nht, sang ungl do chnh kh y c ra ngoi lm cho c theo m ra
ngoi cho nn bnh lm m nh ung, nht, thng, c n giai on
thnh hnh th phi khm xt k xem lm m cha, m su hay nng
x l cho ng; ng thi khi c m th v cha v xem xt tnh cht
mi mu ca m:
+ Phng php xem c m: ly hai ngn tay n nh ni sng, nu thy
bp bnh l c m, c nc. Ni ung nht n vo thy nng l c m,
khng nng l khng c m; n vo thy cng rn l cha c m, mm
nhn trong l c m chn; n nh thy au ngay l c m nng,
n nng mi thy au l m trong su; da phng mng l m nng,
mu da khng thay i li khng co ln l m su.
+ Tnh cht ca m: do nguyn nhn khc nhau nn tnh cht m cng
khc nhau. Ngi kh huyt thnh vng th m ra c v vng, ngi
kh huyt h yu th m ra long v trng, nu m ra nh nc c
hoc nc bt m thi th l chng cha c. Nu lc u ra m
vng c, sau ra m nh mu hoa o, ri ra nc nht, l hin
tng bnh thng d thu ming ln da non. Nu sc m nh du tru
hoc chy nc vng hoc nc trong thng nm trong chng cha lu
v kh.
Nga: nu mn nht trc khi v m pht nga l phong kt hp nhit.
Sau khi v m m pht nga l bnh thng, l hin tng kh huyt dn
dn y , d ln da non nhng nga phi nh kin b mi l tt.
Nu bnh bin m pht nga, c th h, c m chy, cm phi phong m
sinh ra, l bnh nng kh khi. Mn nht li phnh nh bt go m nga,
khi gi chy nc l thuc t kinh c thp, chy ra mu ti l t kinh to qu.
2.2.6. Phn bit bnh lnh - d v chng thun - nghch
Nm im lnh v by im d:
Ngi xa tng kt kinh nghim lm sng lu di a ra:
+ Nm im lnh:
Tinh thn tnh to khoan khoi, ting ni ho nh thng sut, li
nhun khng kh, n ng bnh thng.
C th nh nhng, yn vui khng bun bc, mng tay ti nhun, khi
nm khi dy yn tnh.
20
Mi ti nhun; m c vng m khng hi thi.
Ting ni rn ri, da d ti nhun, khng ho suyn, i tiu tin
bnh thng.
Khng pht nng, ming rng khng kh.
+ By im d:
Thn tr bun bc khng yn, ming li kh ro, ni nng lu kh,
ni tn thng ming rng thm en.
Thn th cng thng, mt nhn nghing, ming vt thng chy mu.
Hnh dng gy cm, khng mun n, ch vt thng c m mm lm
su, khng bit au nhc, m trong t m hi thi.
Da kh rp, nhiu m, thanh m ngng, lu li, ho suyn, mi
php phng.
Da en xm, c hng kh ro, bun bc, kht, bu di co ln.
Tay chn mnh my ph thng, nn ma, nc, a chy, y bng.
Ni tn thng lot nt nham nh nh t con ln, mu t nhin
chy ra, tay chn quyt lnh.
Chng thun, chng nghch:
+ Chng thun l ni tn thng v cc chng trng ca bnh pht trin
bnh thng v tin lng tt.
+ Chng nghch l ni tn thng v cc chng trng th hin bin
chng, tin lng bnh xu.
T lng gi
1. Anh (ch) hy trnh by v cho th d v cc nguyn nhn bn ngoi ca
ngoi khoa y hc c truyn.
2. Anh (ch) hy gii thch v cho th d v bin chng bnh l ca kh v
huyt trong ngoi khoa y hc c truyn.
3. Anh (ch) hy gii thch v cho th d v bin chng sng, au, m v
nga theo y hc c truyn.
4. Anh (ch) hy phn bit bnh lnh - d v chng thun - nghch ca
bnh theo y hc c truyn.



21
Bi 2
s lc lch s iu tr chn thng
trong y hc c truyn
mc tiu
1. Hiu c qu trnh hnh thnh pht trin iu tr chn thng theo y hc
c truyn.
2. Hiu bit v tnh hnh kt hp y hc c truyn vi y hc hin i v iu tr
gy xng


1. S lc lch s iu tr chn thng theo YHCT n thun
T khai thin lp a, y hc phng ng i u vi iu tr chn
thng ni chung v iu tr gy xng ni ring. Tri qua hng nghn nm
kinh nghim, iu tr gy xng ngy cng c b sung v hon thin.
Ngi nguyn thu cn trong i sng hoang d, khi i kim n thng
dng nhng v kh th s nh gy, ru chng c vi th d; hoc leo tro
ln cy cao, chy nhy hi lm d b tai nn. Lc by gi ngi ta bit dng
l cy hoc ru bi hoc xoa vo vt thng, l c s nguyn thu v
ngoi khoa chn thng.
1.1. Y hc c truyn Trung Quc
T i nh Chu (1066-255 TCN) n nh Tn (306-207 TCN) c chia ra
bn loi thy thuc l thc y, tt y, dng y (cha nht) v th y. Dng y cn
cha c m chm, ng gy xng...
n i nh Hn (206-25 TCN) v i nh Tn (265-420) c mt s sch
ni v chn thng.
T i nh ng (608-917), ngi ta a khoa xng gp vo khoa xoa bp.
n i nh Thanh (1616-1911), v lun lun c chin tranh nn khoa
xng c ch c bit. Nm Cn long th nht (1737) triu tp cc danh y
bin son cun Chnh ct php trong c ni v nguyn nhn, triu chng,
cch khm, cch iu tr gy xng, sai khp.
V thuc c chia ra thuc ung trong giao thng huyt mch v chng
sng au; thuc dng ngoi b v c nh.
22
Cc loi dng c b xng nh: trc lim (ci mnh mnh) c nh
xng di; lam ly (ci git tha) c nh xng cng tay, cng chn; mc
thng (ming g m vo lng) c nh xng sng; yu tr (ci m lng);
bo tt (m bao) c nh u gi...
1.2. Y hc c truyn Vit Nam
Xa kia, v cha c sch v ghi chp nn y hc dn tc ch c truyn
ming t ngi ny qua ngi khc. Ring nn b gy xng c tnh cht gia
truyn v chuyn nghip.
n th k XIV Tu Tnh trong b Nam dc thn hiu ghi chp
phng php iu tr thng khoa v dc vt ng dng nh: b mc t ra tro
rc, rt; l cy thanh hao gi ra p; nha cy giao hng (cy thau)
bi hn vt thng; cy t rng (ct toi b) c tc dng lm lnh vt thng v
lin xng; r cy mng nc (phng hoa tin), v cy go (mc min) p cha
gy xng....
u th k th XVIII, Ln ng gp thm trong quyn Bch gia trn tng
c phng thuc cha gy xng, sai khp ca nc Lo truyn sang (cng thc
xin xem mc: thuc dng ngoi).
Trong cc phng php c truyn cng c nhiu mn thuc n gin: nh
vp ng sng au th p b ch ti gi vi mui, p l cc tn gi vi mui,
p nc g vang sc vi b ch...; chy mu th p lng culi, mng nhn, b
hng, lng t ngc con c...; bong gn th chm, b l nng h nng, l ngi
tng qun, mo cau, b chui...
2. s lc lch s iu tr gy xng bng phng php
kt hp YHCT v YHH
2.1. Trung Quc
Tt c cc bnh vin u c kt hp Trung - Ty y trong iu tr gy xng
ngoi tr v ni tr. nhm khoa hc ho Trung y, cc bc s Ty y hc
phng php nn b c truyn ri ci tin, trc tip nn b, theo di v kim tra
bng X quang. Rt nhiu bnh nhn c nm vin theo di mt thi gian.
Trc khi nn bao gi cng phi tim t, tr em th phi gy m.
t chi t th trung bnh sinh l (c trng thi chng gin nht), dng
lc ko v lc ko ngc li gii quyt di lch chng, di lch gp gc, di lch
bn, di lch xoay....
Dng c b c khc nhau v cht liu mi bnh vin: np tre nh cho
ngn tay, ngn chn, np bt ngn (Bc Kinh); np g liu c dn mt lp d
mng cho m (Thin Tn), nhng u di gi ton b xng hoc chm khp,
cho php khp c th c ng c mt phn. Ngoi vic t np, m cng gi
mt vai tr quan trng nhm chng di lch th pht. m c lm bng giy
bn tt, c nhiu hnh dng khc nhau ph hp vi ni m. V tr t m tu
thuc c ch di lch v nhim v c nh.
23
tt c cc bnh vin kt hp iu tr, cc thy thuc u nhn nh:
xng lin nhanh hn 1/3 thi gian so vi iu tr b bt, y l cha k n c
nng chi gy phc hi nhanh hn, khng mt nhiu thi gian tp luyn vn
ng nh sau tho bt.
u im ca phng php l nh khng bt ng hon ton khp trn v
di gy, cc khp khc u c th c ng nh nhng ngay, ri cc ng tc
tng dn. V tp c ng c rt sm cho nn mu lu chuyn tt, xng
khng b mt cht vi (nht l ngi gi), c khng teo, do xng gy chng
lin.
2.2. Vit Nam
Bt u t 1960, Khoa Chn thng Bnh vin Hu ngh Vit - c v
Bnh vin Xanh - Pn (Saint-Paul) phi hp vi Vin Nghin cu ng y (nay l
Bnh vin YHCT Trung ng) p dng phng php YHCT iu tr
nhng chn thng gy kn. Trong nhng nm u p dng cho mt s gy
xng n gin ngi ln ri tr em. T thng 5 nm 1960 n cui 1963
iu tr 1841 trng hp chn thng kn, trong c 658 ca gy xng, 1183 ca
chm thng bong gn v trt khp.
Nm 1966; Khoa ngoi - Vin nghin cu ng y bc u ci tin np
iu tr cc trng hp gy thn xng di nh cng chn, cng tay, xng i
ngi ln.
T 1977 Vin Y hc dn tc H Ni (Vin Nghin cu ng y trc y)
tha k, pht huy u im ca c hai phng php YHCT v YHH, khc phc
nhc im ca chng, xy dng phng php iu tr gy xng kt hp
YHCT vi YHH nh chnh hnh bng dng c hoc bn chnh hnh, kim tra
X quang: sau khi v cm bng gy t, chm t hoc thu chm t th tin hnh
chnh hnh theo phng php YHH, c nh xng gy bng np tre. Np
khng ngng c ci tin, t np g th s n np c vt iu chnh ngoi, c
m bc lt, un cho n khun chi kt hp vi m lm bng giy bn gip cho
vic chnh phc thm hon thin, chng di lch th pht c nh xng gy
ngy mt tt hn. Cc bi sau y l ni dung ca phng php iu tr kt hp
YHCT vi YHH.
T lng gi
1. Hy trnh by qu trnh pht trin YHCT Vit Nam
2. Hy trnh by tnh hnh iu tr kt hp YHCT v YHH trong gy xng.
24
Bi 3
bong gn
(Nu thng)
Mc tiu
1. Hiu v trnh by c quan nim nguyn nhn, triu chng chn on nu
thng, trng thng khoa ca ngoi khoa y hc c truyn.
2. Bit v vn dng c phng php iu tr nu thng bng y hc c truyn.


1. Quan nim v nguyn nhn
Nu l xoay vn, thng l bnh, v xoay vn c khp lm tn thng kinh
lc cn c, kh c tc tr gy au yu nng, huyt tr gy sng nng . Theo y
hc hin i l hin tng bong gn, gin dy chng hoc co tht c dy chng
gy ra gi tt l bong gn, c th sinh ra cp tnh hoc mn tnh.
Nguyn nhn: do ng tc tri t th, t ngt qu mnh hoc ng tc g
b ko di gy nn. V d: quay lng t ngt hoc mnh, hoc xch nng, quay
c mnh, nm gi u cao, i guc cao gt hoc tro chn do bng Theo y
hc c truyn do xoay vn qu mc, kh c tc tr gy au yu nng, huyt tr
gy sng nng .
2. Triu chng, chn on
Nu thng hay gp tht lng, c chn, c gy, c tay hoc khuu tay.
Ti ch: sau cc nguyn nhn r rng c th xut hin ngay cc triu
chng: c th sau vi ting ng h hoc vi ngy.
Triu chng au ti ni tn thng: au tng dn nh hng ti vn ng,
tu theo c tn thng phn mm hay khng m dn dn sng nng , cng c
khi au n thun (khng rch dy chng hoc bao khp), khng c du hiu
gy xng sai khp. Nu khng iu tr ngay s gy sng n, khng tm (nu
khng tn thng mch mu); nng hn c th gy cng khp, long xng.
Theo y hc c truyn: do tc ng gin tip ca cc ng tc hoc ngoi
lc gy nn kh tr ti ch nn au; sau huyt gy sng nng , thp tr
gy n.
25
3. iu tr
3.1. Nguyn tc iu tr chung
Php iu tr: hot huyt, hnh kh, th cn, thng kinh, ch thng.
3.2. Thuc dng ngoi
3.2.1. Thuc p
Bi 1: p cao thng nht.
Bi 2:
Bt cc tn 8 phn Bt i hi 0,8 phn
Bt ngi cu 4 phn Sp ong 2 phn
Bt qu chi 1,6 phn Du ve 20 phn
Trn u, ng vo l dng dn. Khi dng tu theo v tr tn thng rng
hay khng m p trc tip vo ni tn thng.
Bi 3:
+ V cy go va gi nt sao vi ru, ngy p 1 ln.
+ L nng h nng p vo ni tn thng.
3.2.2. Thuc xoa
Bi 1: Mt gu ha vi ru bi.
Bi 2: Trt tn
Nh hng 1 phn T mc 4 phn
Mt dc 1 phn Huyt gic 4 phn
Bng phin 1 phn Qu chi 1 phn
i hi 2 phn Nga trut 2 phn
Dy kim ngn 1 phn
Tn bt, mi ln dng ha vi ru va xoa ln ni tn thng, ngy 2 ln.
3.2. Thuc ung trong
Cao tiu vim
Ngi cu 12g T mc 10g
Huyt gic 12g L mng tay 10g
Ngh vng 10g
Ngy ung 1 thang, hoc nu thnh cao ung, ngy ung 3 ln (sng, tra
v ti).
26
3.4. Xoa nn, bm huyt
Phng php ny nhiu khi mang li kt qu rt tt.
Ko gin: ko t t theo hng sinh l, lc va phi, bnh nhn cm gic
d chu, gi 1-2 pht, sau lm ng tc tr li (ngc li) hng ng
tc gy tn thng.
Bt gn: dng ngn ci bt nh kiu bt dy n, lm 2-3 ln vo ni c co
tht c hoc dy chng vng au.
Bm, im huyt: dng cc huyt xa ni tn thng.
3.5. Chm cu
Chm t cc huyt ti ch.
Chm ton thn cc huyt:
au vng c gy : lc chm, hp cc, c du, kin tnh, phong tr.
au vng c chn : huyn chung, thi xung, tam m giao.
au vng tht lng : thn du, u trung, i trng du, th huyt.
au c tay : th tam l, hp cc, ngoi quan, dng tr.
au khuu tay : hp cc, trung ph, th tam l, th huyt, khc tr.
Thu chm: dng cc thuc gim au hoc gim au chng vim ca y hc
hin i tim vo cc huyt
vng c gy : c du, kin tnh.
vng c chn : huyn chung, tam m giao.
vng tht lng : thn du, i trng du, th huyt.
vng cng tay : th tam l.
Khng nn dng cc thuc du tim ni t c.
T lng gi
1. Anh (ch) hy trnh by quan nim, nguyn nhn, triu chng v iu
tr nu thng theo y hc c truyn.
2. Anh (ch) hy trnh by phng php iu tr nu thng bng y hc c
truyn.


27
Bi 4
Ta thng
(ng gip phn mm)
Mc tiu
1. Hiu v trnh by c quan nim, nguyn nhn, triu chng v chn on ta
thng trong thng khoa ca ngoi khoa y hc c truyn.
2. Bit v vn dng c phng php iu tr ta thng bng y hc c truyn.


1. Quan nim v nguyn nhn
Ta thng l gip nt phn mm (ch yu l da, c, mch mu, thn
kinh), khng c rch da do ngoi lc trc tip gy nn.
Nguyn nhn: do cc vt cng p mnh vo vng da - c ca c th nh
nh v, ng, th dc, va p.
Vng hay b tn thng l i, mng, lng, bng chn, cnh tay, cng tay
v vai gy. Y hc hin i gi l chng ng gip.
2. Triu chng, chn on
Vng da c sau khi b ngoi lc trc tip th nng, , au... tu mc
ngoi lc trc tip m vng tn thng to nh khc nhau.
Cng hay km theo gy xng hoc sai khp.
3. iu tr
Tn thng ny theo y hc c truyn vn l kh tr huyt .
3.1. Php iu tr
Hot huyt, kh , hnh kh, th cn. Nu n nhiu th li thu, thm
thp; nu sng nng nhiu th thm lng huyt.
3.2. Thuc dng ngoi
p cao thng nht hoc cao song b tn (trc bch dip, i hong, bc
h, trch lan.
28
3.3. Thuc ung
Cao tiu vim.
T vt o hng gia dy kim ngn.
3.4. Tp vn ng
Nu tn thng cn khp cn tp ngay t u nhng phi nh nhng
ng mc khi nm ng phi k chn cao.
3.5. Chm
Chm cc huyt quanh ni tn thng kt hp vi cc huyt huyt hi,
huyn chung.
4. Kt lun
Ta thng (ng gip) nu tn thng nhiu phi iu tr tch cc ch
yu l thuc dng ngoi, chm cu, tp luyn v dng thuc y hc c truyn kt
hp thuc y hc hin i, gim au v chng ph n bng alphachymotrypsin
ung hoc tim.
T lng gi
1. Anh (ch) hy trnh by quan nim, nguyn nhn v triu chng chn
on ta thng theo y hc c truyn.
2. Anh (ch) hy trnh by phng php iu tr ta thng theo y hc c
truyn.
29
Bi 5
Vt thng phn mm
(Sang thng)
Mc tiu
1. Hiu v trnh by c quan nim v bin chng ca vt thng phn mm
theo y hc c truyn.
2. Nm c cc trnh t s dng cc bi thuc dng ngoi v dng trong ca y
hc c truyn.
3. Bit v ng dng tt phng php iu tr vt thng lu lin bng y hc c truyn.


1. Quan nim v bin chng
Cch y 770 nm trc Cng nguyn, do y hc c truyn pht trin
cho nn bit phn loi trong chn thng, hn na con ngi bit s dng
kim kh cho nn khi cc loi kim kh ny gy rch da - c th gi l kim thng.
Sau ny do cc nguyn nhn gy ra vt thng c rt nhiu, ngoi kim kh
ra cn nhiu loi sc nhn khc gy nn, cho nn ngi xa t tn chung l
sang thng.
Sang thng l ch cc tn thng rch t da, c, mch mu c th to
nh hoc su nng tu thuc vo lc v vt rn sc nhn trc tip gy nn.
1.1. c im tn thng ca vt thng
Y hc c truyn rt coi trng ti tn thng ti ch, c miu t theo m
dng, kh huyt nh sau:
STT c im vt thng Dng - kh m - huyt
1 au nhiu + -
2 Chy mu - +
3 Sng khng + -
4 Sng c - +
5 Thm nt + -
6 Sng khng thot m + (kh h) -
7 Vt thng chy nc vng - + (huyt h)
8 Vt thng khng lin hoc khng thu ming + (dng h) + (dng h)
9 Vt thng thm nt + (kit) + (kit)
30
1.2. S lin quan gia vt thng vi tng ph, kh huyt
Theo quan im ca y hc c truyn: vt thng mau lnh hay khng cn
tu thuc chnh kh ca c th c th l
Kh: biu hin v au, thot m, vt thng sch. Do vy, nu kh h th
vt thng au lin tc m , khng thot m, bn; nu kh cha h th
vt thng au t, m thot d dng, vt thng ti sch.
Huyt: biu hin v sng nng, v lin vt thng. Nu huyt , huyt h
u gy chy mu, chy nc vng vng tn thng; nu huyt khng h
th ni tn thng c nui dng tt cho nn vt thng chng lin.
T: t lin quan ti c nhc, nhip huyt v sinh kh huyt ca hu thin.
Trm bnh u do t gy nn v ngc li t nh hng tr li ti trm bnh.
Do vy, nu t tt th vt thng chng lnh, t chy mu, d thot m.
Can: can tng huyt, can ch cn; nu can tt th vt thng lnh
khng nh hng ti vn ng.
Tm: ch thn minh, tm tt th huyt y , gic ng lnh, ngi bnh
c ngh lc chu kh tp luyn khng li di chng.
Thn: ch ct tu, thn tt th vt thng khng nh hng ti xng.
Nh vy vt thng phn mm khng nhng cn ch ti tn thng ti
ch m phi ch ti ton thn, phi bin chng chnh xc gia triu chng ti
ch v ton thn mi c php iu tr tt, bnh s chng khi.
Trong iu tr vt thng phm mm phi kt hp gia y hc c truyn vi
y hc hin i, ch yu l cn tim phng un vn hoc ATT. Ngi xa c dng
rau mung sng 120g ha vi nc si 25ml gn ly nc ung nhng cha c
chng minh chc chn cha c nn vn ch vt thng mch mu ln v
dy thn kinh khu cm mu v ni thn kinh.
2. iu tr
2.1. Thuc dng ngoi
2.1.1. Thuc cm mu phng nhim trng
Bi 1: Vi ti (vi n tru)
B hng bp ( long v)
Liu bng nhau, luyn thnh thi hoc ming p vo vt thng k c
a cn cng cm mu.
Bi 2: L mn ti (hoc l ch rng ca)
Bt i hong
Gi nt l mn ti ho vi nc tiu tr em (ng tin) va gn ly
nc ha vi bt i hong va p vo vt thng.
31
Bi 3: L tru khng
L kim ngn
Liu bng nhau gi nt p vo vt thng
Bi 4: Nn chui tiu ln, ly cy non cao 60cm, b b ct tng khc gi
nt p.
Bi 5: Mc cy cau (phn cau) 40g
long v 20g
Trn u dng dn, p rc vo vt thng.
Bi 6: T kim an
T kim ng (ging hng) 200g Huyt kit 40g
Nh hng 40g Ng bi t 40g
Mt dc 40g Bng phin 1g
Cc v thuc tn nh trn u cng vi bng phin, cho vo l nt tht kn
dng dn, cng lu cng tt.
Bi 7: Ht nhn (sao) 40g
Bng phin 8g
Tn nh cc v, trn u, ng trong l y kn dng dn.
2.1.2. Thuc ra vt thng
Dng cho cc vt thng bn hoc lot, nt c m hoc nc vng.
Bi 1: L tru khng 40g
Nc l 1 lt
un si nc vi l tru khng 15 pht, ngui ly nc trong ha vi
bt phn phi, dng ra vt thng, ch dng trong 3 ngy.
Bi 2: Si t 1 phn T mc 1 phn
B cng anh 1 phn Nc 600ml
un si trong 2 gi cn 250ml gn nc cho vo chai dng dn, trong ngy
c th p gc.
Bi 3: Tru khng 200g Phn phi 20g
B cng anh 200g Nc 2 lt
un si 2 lt nc vi tru khng, b cng anh cn 250ml ri ra vt thng.
Bi 4: Cam thng tin
Cam tho 1 phn
Hnh ti 1 phn
Hai th un si ngui, ra vt thng.
32
Bi 5: T hong
i hong 8g Hong lin 12g
Hong b 12g Hong cm 12g
Nu cao p hoc nc sc ra
2.1.3. Thuc lm sch vt thng
Dng cho cc vt thng lot, nt, chy nc vng, lu lin, lu thnh so
v da non.
Bi 1: L m qu (thin chu sa)
Cch lm: ly l b cung, ra sch (c th ra thuc tm 1/1000) ro
nc, gi nt p vo vt thng, p hng ngy khi vt thng sch c ln da
non th thi. C th nu thnh cao dng dn nhng khng hiu qu bng l ti.
Bi 2: Cao gii phng
M cy chai 1 phn
Du lc 1 phn
un du lc vi m cy chai, khi no m cy chai chy ra th quy u
n khi thnh hn hp ng u ri pht ln ming vi kh, khi s dng dn
cao ln vt thng ra sch.
Tc dng: ht m xanh, lm sch t chc hoi t, lm vt thng chng
kh v sch nht l i vi trc trng m xanh, d ln da non.
Bi 3: Len-t-uyn (cn gi l cy ui phng, dy sng rn, dy leo dc
b ro hoc cy c th ven sui): ly 1kg, b l co ht r, ra sch len-t-uyn,
bm nh. Ly 3 lt nc un si 3 gi, lc qua khn vi, ly nc sc c li cn
700ml va ra va p, dng gc thm nc len-t-uyn p ln vt thng,
sau bng li, cch 2-3 ngy thay bng 1 ln.
Dng cho vt thng rng nh bng.
Tc dng khng mong mun: xt, gy phn ng sng .
Bi 4: L sn thuyn (sn xm thuyn nhn dn dng v cy sm
thuyn, c ni dng l).
Dng 2 cch:
Dng p ti: lm ht m vt thng, t chc ht mc nhanh, da non ln
dn vo ngy th 2.
Dng bt: vt thng sch, kh, khng chy nc nhng khng tt bng
dng ti.
Bi 5: L vng nem
Bt l vng nem rc vo vt thng m ht nhanh v sch, au, d
chu, chng khi.
33
2.1.4. Thuc lm lin vt thng
Vt thng b lot su, sau khi ra sch th p loi thuc lm y vt
thng t chc ht mc nhanh v y.
Bi 1: L m qu ti
L bng bong
Lng bng nhau, b cung, ra sch, gi nt, sau khi ra sch vt thng
th p thuc, sau bng li, ngy thay bng 1 ln.
Bi 2: L sn thuyn
B cung, ra sch, gi nt, p ngy 1 ln, thuc lm sch vt thng v
ln da non nhanh.
2.1.5. Thuc lm chng ln da non hoc so
Bi 1: Bo sinh c
Thch cao 30g Xch thch 30g
Khinh phn 30g Nh hng 12g
Hng n 12g Mt dc 12g
Long ct 12g
Gi thnh bt mn, sau khi ra sch vt thng th rc thuc, nu kh th
rc 1 ln.
Bi 2: Can khng sinh c tn
Can khng 40g
Nghin nh mn, rc vo vt thng thch hp vi vt thng c tnh
cht hn.
2.1.6. Thuc lm tan tht thi, thu ming ln da non
Bi 1: Cu nht tn
Hng n 4g (1 phn)
Thch cao 36g (9 phn)
Tn thnh bt mn rc vo vt thng.
Bi 2: L m qu
L bng bong
L nc si
Lng bng nhau, gi nh, sau khi ra sch vt thng th p thuc vo,
p n khi no kn vt thng th thi.

34
Bi 3: L m qu
L bng bong
Hn the
Lng bng nhau, gi nt p vo vt thng ngy 1 ln sau khi ra
sch vt thng, p n khi no vt thng y kn v ln da non th thi.
Khng nhng c th dng cho vt thng lu lin, su rng, kh y m dng
cho c vt thng so li khng ln da non.
2.1.7. Vt thng lu lin, khng ln da non, so li, r nc vng
Bi 1: Phn cau (sao kh) 20g
Phn cy ch 16g
long v 8g
Phn phi 4g
Cc v tn nh, ry k, y kn, ng trong l dng dn; sau khi ra sch
vt thng rc thuc vo, ch rc 1 ln bt s thnh vy, khong 5-7 ngy sau
bong vy v khi.
Bi 2: Phn phi 55g
Bt hong ng 20g
Bt bng sa 55g
Hot thch 250g
Tn nh, ry k, ng vo l dng dn, khi dng phi ra vt thng v
rc bt.
Bi 3: Sp ong 1 phn
Nha thng 3 phn
Lng trng g 3 phn
un si, quy u thnh hn hp, sau qut vo vi p ln vt thng
ra sch, ngy p 1 ln.
Bi 4: M cy m u ( sn xut thnh kem balsino) dng iu tr vt
thng lu lin, vim tu xng v vt thng mi khi. Thuc ny c tc dng
gim au.
2.2. Thuc ung
Ngoi vic ch iu tr ti ch th cn ch ton thn, nhiu trng hp
sc khng ca ngi bnh tt ch cn iu tr ti ch. t kt qu iu tr
tt chng ta phi da vo c tnh ca vt thng v s h thnh ca tng ph,
kh v huyt, tn dch iu tr.
35
2.2.1. Vt thng th huyt (khng nhim trng)
Php iu tr: hot huyt thanh nhit, lng huyt, hnh kh, sinh c.
Phng:
i hong 8g Hng hoa 10g
Phc tiu 6g Mc thng 8g
Ch xc 6g T mc 10g
Hu phc 6g Trn b 6g
ng quy 10g Cam tho 4g
2.2.2. Vt thng th nhit c (nhim trng thi k u)
Php iu tr: thanh nhit gii c, hot huyt, lng huyt, hnh kh,
sinh c.
Phng:
Bch ch 6g Sinh a 12g
ng quy 10g an b 12g
Xch thc 10g Xuyn khung 12g
Nh hng 6g Mt dc 10g
Bch trut 12g Cam tho 6g
C th sc ung hoc ngm ru ung.
2.2.3. Vt thng th thp nhit
Triu chng: vt thng lu lin, chy m hoc nc vng.
Php iu tr: thanh nhit tr thp, gii c, bi m, hot huyt, sinh c.
Bi thuc: Thc l bi nng thang
ng sm 12g Lin kiu 10g
Bch trut 10g Kim ngn hoa 12g
Bch thc (sao ru) 12g Xuyn bi mu 8g
Phc linh 12g Sinh hong k 10g
ng quy 10g Nhc qu 6g
Cam tho 6g Sinh khng 6g
Trn b 6g
Sc ung ngy 1 thang.

36
2.2.4. Vt thng lu lin (kh huyt h)
Php iu tr: b kh huyt sinh c.
Phng:
ng sm 12g Bch trut 12g
Bch linh 10g Xuyn khung 10g
ng quy 12g Bch thc 12g
Thc a 12g Cam tho 4g
Hong k 12g Ut kim 10g
Sc ung ngy 1 thang.
3. Kt lun
Khi b cc vt thng cn phi ch tim phng un vn. i vi cc vt
thng mch mu ln v thn kinh th phi theo di st c ch nh phu
thut.
Cc vt thng khc kt qu iu tr rt tt.
T lng gi
1. Anh (ch) hy trnh by quan nim v bin chng ca vt thng phn
mm theo y hc c truyn.
2. Anh (ch) hy trnh by phng php iu tr vt thng lu lin bng
thuc y hc c truyn.

37
Bi 6
i cng v gy xng
(C tit)
mc tiu
1. Nu c nh ngha v nguyn nhn ca gy xng.
2. M t c triu chng lm sng v bin chng ca gy xng.
3. Nm c tin trin ca gy xng.


1. nh ngha
Gy xng l s ph hu t ngt cc cu trc bn trong ca xng do
nguyn nhn c hc, do gy ra s gin on v truyn lc qua xng. Hoc
ni cch khc, xng mt tnh lin tc v hon chnh do ngoi lc gy nn.
2. Nguyn nhn v phn loi
Hu ht cc gy xng l do chn thng, do lc un b (hoc xon vn,
hoc c hai), trc tip hoc gin tip gy nn. Nu mt xng c bnh (vim,
u...) b gy c gi l gy xng bnh l hay cn gi l gy xng t nhin.
Ngoi ra cc chn thng tuy nh, nhng lp i, lp li nhiu ln gy gy
xng c gi l gy xng do stress.
Ngoi cc loi gy xng in hnh th tr em thng gp cc loi gy
cnh ti, gy xng cong to hnh, gy bong sn tip; ngi cao tui v ph
n mn kinh gy ln, gy c xng i, gy u di xng quay...
Xng c th gy khng hon ton, cong to hnh, phnh v xng, gy
cnh ti; gy hon ton lm hai hay nhiu on, nhiu mnh. Ngoi ra cn cc
loi gy ci, gy ln, bong sn tip hp...
Cc loi di lch in hnh: bn - bn, chng, gin cch hai mt gy, gp gc
v xoay.
3. Bin chng
Chong do au.
Mt mu (k c gy kn).
Tc mch mu do m tu.
38
Hi chng chn p khoang.
Thng tn mch mu ln, thn kinh ngoi bin.
Gy h v nhim trng.
Hi chng ri lon dinh dng.
Can xu.
Ri lon chc nng vn ng.
4. Triu chng lm sng
4.1. Ba du hiu chc chn gy xng
Bin dng.
C ng bt thng.
Ting lo so (thng c nhn bit t cm gic ngn tay ngi khm).
4.2. Ba du hiu khng chc chn
au.
Hn ch hoc mt vn ng.
Sng, vt bm tm.
Ngoi gy xng, cn ch bin chng v cc tn thng km theo (a
chn thng).
4.3. Cc du hiu gy xng bng hnh nh
Trn phim X quang chp theo hai bnh din (t th khc nu cn), ly c
hai khp ca mt thn xng; chp ct lp c in hoc cng hng t (t dng)
vi cc gy phc tp... cho thy v tr gy, ng gy, cc di lch.
Cn ch n cc tn thng sn khp, m mm.
5. Tin trin ca gy xng
Lin xng gy l phn ng sinh hc t nhin ca c th sng. Cc thnh
tu v sinh hc lin xng n nay hay nu hai yu t chnh gip cho xng
lin vng:
S phc hi giao thng mu gy xng: quan trng nht l phc hi
tun hon cng sm, cng phong ph, giao thng tt... th cng m bo s
nui dng vng xng gy, cho n khi h thng mch mu trong ng tu
m ng tr li chc nng nui dng chnh yu.
S bt ng gy: l yu t c - sinh hc m bo cho xng lin vng;
khng c bt ng gy au n d di, gy co mch v lm gim giao
thng mu vng gy. Cc u gy di ng c hi s ph hu cc mch
39
mu tn to, cc mt gy khng p st vo nhau (iu kin xng lin).
Vic bt ng khng tt cn gy ra di lch th pht, can lch...
Tm li, xng gy c th lin tt cn c cc iu kin sau:
+ Phc hi lu thng mu y vng gy.
+ p st hai mt gy, khong cch khng vt qu mc cho php tu loi
gy, tu la tui.
+ Bt ng vng vng gy, ng thi cho php vn ng sm c khp.
+ Khng c cc yu t ngoi lai lm cn tr lin xng.
C th tm tt qu trnh lin xng gy gm ba giai on lin tip, xen k
nhau:
Giai on sung huyt (hypermie): tiu sch m hoi t, lm sch gy.
Giai on phc hi: m hn gn vng xng b gin on.
Giai on to hnh xng: m ti to c thm cc cht v c tr thnh
m xng chnh thc.
Tu theo cht lng bt ng m xng gy c lin theo ba hnh thc c
bn: lin xng trc tip, lin xng gin tip v lin xng theo phng php
cng gin.
5.1. Lin xng trc tip
Lin xng trc tip l s lin xng thng t m xng do mu to ra.
M xng ch pht trin bn trong khe gia cc mt xng gy, khng c can
bc cu. Trn film X quang: t c hnh nh cc ng can bn ngoi, ng gy
hp dn v bin mt.
iu kin quan trng nht c lin xng trc tip l:
Cc on gy phi c bt ng vng chc n mc gn nh khng cn
mt di ng no gia 2 u gy (nht l nhng di ng c hi nh di ng
xon vn, un b, di lch ngang), ch cho php di lch nh theo trc t nn
(di lch hu ch l tng s tip xc gia hai mt gy).
Cc iu kin khc nh: m bo lu thng mu nui dng y
vng gy, 2 mt gy cng p st nhau cng tt.
Nhng kh khn trong qu trnh lin xng trc tip: qu trnh lin
xng trc tip ph thuc vo s nn chnh chnh xc v mt gii phu v cht
lng c nh. Gii hn giao ng cho php l rt nh. Trn thc nghim v
trn lm sng ngi ta chng minh l khe gia cc u gy khng nn qu
0,5-1mm nu mun c s lp y khe gy bng xng trong 4-6 tun.
5.2. Lin xng gin tip
Hon cnh lin gin tip: bt ng khng hon ton vng chc.
40
Hnh thc lin xng: can xng hnh thnh khng nhng khe gia cc
mt gy vi nhau m cn bc cu c bn ngoi thn xng to thnh can xng
to bao bc ly gy.
Theo Hunter (1837) qu trnh lin xng theo cc bc nh sau:
1. Vim ty.
2. Can x mm.
3. Can sn cng.
4. To hnh can xng.
V din bin sinh hc, lin xng gin tip cng din bin tng t nh
lin xng trc tip.
5.3. Lin xng bng phng php cng gin
Ilizarov t thp k 60 c cng xut dng phng php cng gin dn
dn cc on gy m to ra xng mi. iu kin lin xng theo phng
thc ny l:
Khng ph hu tu xng: nhm bo ton v khng lm tn thng cc
m sinh xng cng nh cc mch mu nui xng.
Cng gin chm, chnh xc: 1mm /24h chia lm nhiu ln, ( > 4 ln). Nhp
cng gin khong 2mm c th lm ngng hn hin tng sinh xng do
thiu nui dng; ngc li nhp ko cng gin chm (khong
0,5mm/24h) c th dn n s lin xng sm, cn tr mc ch ko di
xng.
Phi c nh vng chc, n hi: ch cho php mt kiu di ng xng duy
nht theo trc dc trong sut qu trnh iu tr.
T nn sm trn chi cng gin (i vi chi di).
5.4. Ri lon ca lin xng
Cc ri lon ny bao gm: chm lin xng v khp gi.
Chm lin xng l mt khi nim quy c, khi mt xng gy phi bt ng
di hn thi gian bt ng trung bnh ca loi gy xng mi lin vng.
a s cc tc gi coi thi gian phi bt ng thm bng 1/2 thi gian bt
ng trung bnh ni trn.
Khp gi: theo kinh in l s lin xng ngng giai on can sn, x
khng t c vng chc d c bt ng lu di.
Nguyn nhn ph bin gy khp gi l xng gy khng c bt ng tt
hoc bt ng qu ngn khng thi gian.
Mt loi khp gi lng lo do mt nhiu xng, trn phim X quang c gin
cch > 1cm c gi l mt on xng.
41
Nguyn nhn: a s nguyn nhn ton thn ch gy chm lin xng, cn
nguyn nhn khp gi thng do thiu st trong iu tr, nht l bt ng
khng vng hoc khng thi gian c th gy nn chm lin xng hoc
khp gi.
V t iu chnh di chng bin dng: di chng bin dng sau gy xng
thng thng c bn loi l ngn chi, bc thang (hnh li l), gp gc v xoay
ngoi hoc xoay trong. Phn ln cc bin dng u c sa cha theo xu hng
tt hn theo thi gian (tui cng nh, kh nng t sa cha cng ln). Ring
xng gy lin t th cn di lch xoay th trong qu trnh pht trin, c th t
t iu chnh c di lch ny. Do vy trong khi nn chnh cn phi sa di lch
ny, i khi ngi ta phi phu thut c xng sa li.
Nhng nghin cu trn thc nghim cng nh nhng kinh nghim c rt
ra t lm sng, cn lm sng lm r quy lut chung ca qu trnh lin
xng, c hot ho v iu tit bi cc trm pht tn hiu khu vc v cc
trung tm iu tit nm trong tng th mi lin h cc cng ng t bo, to ra
cc hot ng ngn hn, phm vi hp. iu m bn nm chc thp k qua c
cc nh chuyn mn coi l chn l trong iu tr gy xng l: sau khi phc
hi hnh th gii phu, cc on gy phi c bt ng tt, lin tc, thi
gian, m bo cung cp mu nui dng cho cc u gy v t chc phn mm,
m bo khng lm ri lon qu trnh sinh hc t nhin ti gy, ng thi vn
ng sm h c khp phc hi c nng.
T lng gi
1. Hy in cm t thch hp vo ch trng
Gy xng l.qua xng.
Ba du hiu chc chn ca gy xng l..
Ba du hiu nghi ng gy xng l.
2. Hy in ch cho cu ng v ch S cho cu sai
* iu kin c xng lin trc tip l
Cc on xng gy phi c bt ng vng chc /S
Mu nui dng y /S
* Di chng bin dng sau gy xng l
Ngn chi /S
Gp gc, xoay ngoi hoc xoay trong /S
Tui cng ln kh nng sa cha xng cng ln /S
42
Bi 7
Nguyn tc iu tr gy xng
kt hp Y hc c truyn
Mc tiu
1. Trnh by c cc nguyn tc iu tr gy xng theo YHCT.
2. M t c 10 th thut nn chnh c bn.
3. K c cc phng php ch to dng c nn b gy xng.


1. i cng
iu tr gy xng theo YHCT, ngoi vic c nh xng gy cn ht sc
ch trng vn ng c khp trong thi gian c nh. Xng gy sau khi nn
chnh, c c nh mt cch hp l, c th gi cho cc on xng gy v tr
tng i chnh xc l xng gy c th lin bnh thng; mt khc cn bt chi
gy v ton thn luyn tp vi cng v bin trong gii hn cho php
gip cho thng tn chng lnh, xng gy chng lin v c nng chi sm bnh
phc: trong tnh c ng, ng tnh kt hp.
Cc xng hot ng c nh t chc phn mm, ngc li b xng li
l im bm ta cho cc c, gia chng c mi tc ng v nh hng ln nhau.
Khi gy xng di lch, thng km theo thng tn phn mm; do vy, khi iu
tr gy xng, cn ch trng iu tr c xng gy ln t chc phn mm.
Xng gy cn c nn chnh v c nh sm, t chc phn mm khi b tn
thng thm.
Tuy nhin, khi t chc phn mm tn thng nghim trng, nguy cp ti
tnh mng v tn hi chi b thng (v d nh t mch mu, ni tng tn
thng...) th cn phi c x l trc, sau mi iu tr gy xng. Cp cu
tnh mng v phng nga tn ph, li hu qu nghim trng l nguyn tc
trong iu tr bc u.
Quy trnh iu tr mt gy xng gm 4 nguyn tc c quan h hu c
tun th theo nguyn l: kt hp ng - tnh v quan tm ti ch - ton
thn. Bn nguyn tc l:
Nn chnh sm xng gy.
43
C nh ngoi cc b mt cch hp l.
Luyn tp cng nng.
Dng thuc.
Ch nh iu tr theo y hc c truyn cho cc loi gy xng c ch nh
b bt v gy xng sm khng do bnh l
2. Nn chnh sm xng gy
Ch dng cho gy xng c di lch
2.1. Thi gian nn chnh
Xng gy cng c nn chnh sm cng tt, tt nht l nn chnh trong
vng 1- 4 gi sau khi b nn v lc ny ti ch cha sng n ln, th php thao
tc d dng, c li cho vic lin xng. Khi chi gy sng n nghim trng th c
th dng trong ung, ngoi p thuc, c nh np hoc ko lin tc; ng thi
gc cao chi, i cho sng n gim mi nn chnh. Tr em do xng gy chng lin
nn cng cn nn chnh sm, khng ch i n khi ht sng n mi tin hnh,
m phi nn trong m. Chng hn, tr b gy trn li cu xng cnh tay, ti
ch cho d sng n nhiu hay t u cn phi nn chnh sm. Khi nn c th
dng hai tay p vng gy lm bt sng n gip cho vic nn chnh d hn.
2.2. V cm trc khi nn chnh
2.2.1. Phng php v cm
Trc y YHCT trong nhiu trng hp khng cn hoc khng c thuc
v cm th ng tc ca th thut nn chnh phi c thc hin nhanh, mc
thch hp, ng tc dt khot. Hin nay hay dng gim au bng phng
php chm t hoc thu chm t bng novocain, lidocain.
Mc ch v cm l lm cho bnh nhn ht hoc gim au v gin c
gip cho vic nn chnh c d dng. Ngy nay, v cm c p dng theo my
phng thc di y:
Gy t gy: dng 5-20ml dung dch novocain hoc xylocain 1% tim
thng vo gy. K thut ny n gin, d lm, gim au tng i tt,
thi gian ch i ngn (5-10 pht). Phng php i hi v trng tuyt i,
v nu khng v trng tt th vic tim v tnh bin gy kn thnh gy
h, c th c bin chng nghim trng l nhim trng gy. Mt s tc gi
cho rng a vo gy mt lng thuc lm thay i ni mi sinh hc t
nhin ti gy lm xng chm lin hn.
Gy t cc b: i vi ngi ln, c th gy t vng nh gy chi trn c th
gy t m ri thn kinh cnh tay, gy chi di c th gy t ngoi mng
cng (t lm)... u im ca phng php l gim au tng i tt, thi
gian v cm ko di v gim dn cho n 2 gi sau.
44
Nhc im ca phng php l i hi k thut cao v kinh nghim.
Trong mt s trng hp gy t m ri khng thnh cng v c th c tai bin
do tim vo mch mu, kim tim gy tn thng ngoi mun, sc..
Thu chm t: thu chm t l phng php v cm kt hp YHH vi
YHCT. Dng 10-20ml thuc novocain hoc xylocain 1% tim vo cc huyt
nm ln cn hoc nm trn cc ng kinh i qua gy. Phng php n
gin, an ton, khng c nguy c nhim trng gy, khng lm thay i ni
mi gy nh tim t gy, gim au tng i tt, thi gian ch i
khong 15- 20 pht.
Nhc im ca phng php l v cm khng hon ton; ngi thu
chm t cn bit huyt v tim.
Chm t: chm t cng cho kt qu gim au tng i tt. Hiu qu cn
c ko di khong 30 pht sau khi ngng tc ng.
Tuy nhin thi gian i t di (t nht l 30 pht), khng gim au hon
ton, phi ph thuc vo loi gy v bnh nhn thuc nhm p ng tt vi
chm t; ngi chm t cn phi chuyn su v phng tin chm t nh dy
in i khi lm vng, cn tr th thut nn chnh xng gy.
Gy m: gy m l phng php v cm tuyt i, lm cho c mm to
iu kin ht sc thun li cho nn chnh xng gy. Vi thnh tu ca
khoa hc gy m ngy cng tin b cho php gy m ko di v ngy cng
an ton hn. Phng php cn c u im gip tr em di 10 tui khi b
kinh s.
Tuy vy, gy m i hi phi c cn b chuyn su, ch c th tin hnh
nhng c s y t c y trang thit b chuyn ngnh. Thi gian ch i cho
php gy m an ton l nhn n ung t nht l 6 gi, i khi chi gy sng n
ln hn. iu ny t nhiu nh hng xu cho vic nn chnh di lch ca xng
gy. Mt s bnh nhn mc bnh mn tnh quan trng nh bnh gan, thn,
bnh phi... chng ch nh gy m.
Nh vy, gy m c nhiu u im, nhng hin nay cn kh ph cp trong
hon cnh nc ta.
2.2.2. X quang
X quang c vai tr ht sc quan trng, n cho php hiu r cc loi di lch
ch nh th php nn chnh v ch tc cc np c nh, ng thi kim tra
s n nh ca cc on gy trong qu trnh iu tr.
Khi nn chnh: tu tng loi gy khc nhau m v tr cc khp hoc chi
gy c t th cho ph hp (v d: c nhc trong trng thi chng, th
gin tin hnh nn chnh thun li hn).

45
2.3. Cc th php nn chnh c bn
Thng dng 10 th php (ly gy xng cnh tay minh ha).
2.3.1. S
Trc v sau khi nn chnh, cn thit phi s nn r tnh hnh di lch ca
xng gy v kt qu sau nn chnh.
Dng hai tay s nn vng gy mt cch thn trng, xc nh tnh hnh cc
on xng gy (v v tr, hng di lch), cng nh nhit v mch ca on
ngoi vi; cc tn thng khc v mch mu, t chc mm.
Khi nh nhng s khm hai on xng gy c th cm nhn c ting c
xt ca hai u xng gy, ting c xt ny khi c kinh nghim s phn bit
c l ting c ca hai v xng hay hai mt gy vi nhau, thng qua phn
no xc nh c hng di lch sang bn ca cc on gy vi nhau, ting c
xt vi nhau trong trng hp b gy vn nhiu mnh.
Phim X quang cho php chn on chnh xc xng gy v kiu di lch,
trnh lm bnh nhn au n do thm khm gy nn. Tuy nhin cng cn
khm ton din nm c tnh trng chi gy cng nh ngi bnh.
2.3.2. Ko
Dng bng vi c nh ngc vi chiu s ko, sau ko t t vi lc ko
tng dn cho ht di lch chng ri tin hnh cc th php nn chnh (hnh 7.1).
Ko ch yu lm gin trng lc c (trng lc ny co ko gp phn lm cc
on gy di lch, nht l di lch chng, di lch gp gc, di lch xon vn).
2.3.3. y
Dng lc y ngc vi chiu di lch gii quyt di lch bn (hnh 7.2).
Cn c vo v tr gy m cn s dng lc y nn mnh hay yu, tu sc kho
ca ngi nn m ch dng bn tay hay dng hai cng xit (sau khi an ci
cc ngn vo nhau) lc mnh hn.

Gy xng cnh tay
Hnh 7.1. Dng lc ko v
ko ngc li
Hnh 7.2. y v y
sang bn
Hnh 7.3. p vo
46
2.3.4. p
Trong trng hp xng gy vt, cho, gia hai mt gy ca xng c
khong cch, chi gy khng hoc ngn t, ngi nn dng hai bn tay n p hai
mt thuc hai on gy trung tm v ngoi vi p st vo nhau (hnh 7.4).
2.3.5. Nn
Dng trong trng hp xng gy ngang, di lch chng lm chi gy b co
ngn so vi bn lnh. Ngi nn dng mt tay hoc hai tay nm ly on ngoi
vi; ngi th hai hoc tay kia dng bn ngn tr n ngn t nh nhng ko
on ngoi vi v gp thnh gc khong 30
o
-50
o
so vi trc chi. Sau dng tay
hoc ngn tay y on ngoi vi trt hng ra u gy ca on trung tm (c
th gp t t n 90
o
) cho n khi hai on gy tng ng th dui on ngoi
vi tr v hng trc xng (hnh 7.4).
Khi dng th php ny ch , gc gp khng c qu ln, hng gp gc
khng c m v hng c th lm thng tn thn kinh, mch mu, v xng
c th lm thng tn phn mm, thm ch lm rch da bin gy kn thnh gy
h. Ngoi ra c th kp t chc khc vo gia hai mt gy.

Hnh 7.4. Nn ngc li ni gy
2.3.6. Rung
Mc ch ca phng php rung l lm cho cc din xng gy khp li
vi nhau. Hay dng cho gy xng kiu din gy rng ca. Th php ny c
tin hnh cc chi di, chiu ko thng lc va phi, sau lc i vi gc
5-10
o
(hnh 7.4).
2.3.7. Nn vng ra sau
Dng trong trng hp hai on gy tr lng vo nhau, gia hai on c
th c chn t chc phn mm. Trc ht, cn cn c c ch gy hng di lch
chn phng php nn vng hp l phc hi gii phu. Ngi ph ko
gin hai on gy vi lc va phi, ngi nn mt tay c nh on trung tm,
47
tay kia nm on ngoi vi dn vng v bn i din theo ngc ng c ch di
lch a hai mt xng gy v v tr (hnh 7.6). Li dng th php p (mc
2.3.4, hnh 7.3) hai mt gy p st nhau.

Hnh 7.5. Rung theo nhiu hng Hnh 7.6. Nn vng pha sau
Khi p dng th php ny cn ch : khi ko, khng c ko qu mnh
v s lm thng tn c; ngc li nu ko qu yu cng lm tn thng c (do
c ph ln cc mt gy) thm ch nghin nt phn mm m gia hai on gy.
Khi thao tc hai on gy cn da st vo nhau trnh thng tn thm
phn mm xung quanh.
Khi tin hnh nn quay vng on gy, nu thy vng t chc phn mm
th cn thay i phng hng, la ng i d v nh hn.
2.3.8. n ba im (tam im ni an php): p dng trong cc trng hp gy
cnh ti v ch n thun c di lch gp gc.
Mt im l nh gc di lch, hai im kia l hai u xng gy c n
ngc li vi im nh gc v nn ht di lch gp gc (hnh 7.3).
2.3.9. Tng tip xc (xc nh hp)
Dng trong cc trng hp cc on xng gy di lch xa nhau (v d gy
xng cnh tay, do trng lng ca phn ngoi vi gy ko xung lm nhc v
gin di c nh u v tam u cnh tay, on ngoi vi tch ri on trung tm).
Tng tip xc l lm cho hai u gy ca xng p st nhau lm tng cng
thm tnh n nh. Vi gy ngang xng sau khi c nn chnh thng trc v
di lch xoay, ngi nn nm cht ly on gy trung tm, tay kia nm ly on
ngoi vi, tr th nh nhng n p hai on lm cho hai mt gy p st nhau
thm (hnh 7.8). Khi nn chnh xng gy ngang cng c th dng php xc nh
kim tra hiu qu. Nu nn chnh thnh cng, cc mt gy tip xc tt th khi
tr th n dn hai on gy vo nhau chi gy khng b ngn li.
48

Hnh 7.7. Nn n ba im Hnh 7.8. Dn p hai mt gy
2.3.10. Tch
Dng trong cc trng hp gy hai xng cng tay, xng bn tay, xng
sn, xng bn chn. Trong cc trng hp ny, cc on gy do s co ko ca
mng lin ct hoc cc c gian t lm cho khe gia cc xng b hp li. Ngi
nn dng hai ngn ci v cc ngn tr, gia, nhn bm phn tch gia cc
xng, nn thng cc di lch gp gc, lm cho cc u gy v hp ng ch ca
mnh l t mc ch nn chnh (hnh 7.9). Khi c nh, thng dng m hnh
a tch xng.
Trn y l 10 th php thng
dng. Cn cn c tnh hnh di lch v
loi gy c th m dng mt hay phi
hp nhiu th php khi ng dng.
2.4. Tiu chun nn chnh
2.4.1. Phc hi gii phu
Xng gy sau khi nn chnh cn
phi c phc hi v hnh th chi.
Thng so snh vi chi bn lnh hoc
so snh cu trc tng ng thn th
ngi thng. Cc ch gy phi c tip xc nhau cng nh bnh thng cng
tt tin lng c li cho lin xng v phc hi cng nng.
X quang cho php kim tra tt kt qu nn chnh.

Hnh 7.9. Phng php tch xng
49
2.4.2. Phc hi cng nng
Sau khi xng gy c nn chnh, c nh, lin xng cn ch trng
phc hi c nng chi gy. Mt s trng hp khng th phc hi v hnh th th
cn cn c vo tui tc, ngh nghip, thi gian sau gy, v tr gy chn mc
tiu hi phc cng nng chi lm chnh; khng nn th bo hay c nn chnh
nhiu ln lm thng tn thm cn, c, dy chng lm cho xng gy kh lin
v nh hng c nng chi gy v sau. Y hc hin i cng chng minh rng
do nn chnh th bo hay nhiu ln gy ct ho t chc phn mm lm cng
c, khp, nh hng xu n chc nng chi gy. Hu qu ny cng thng gp
i vi gy trn li cu xng cnh tay nh ct ho ngoi khp, cng khuu...
Mt s trng hp b vim xng mn tnh ko di.
3. C nh ngoi cc b hp l
Xng gy sau khi nn chnh cn c c nh mt cch hp l duy tr
tt v tr cc on gy.
Cn lu :
(1) Tnh cht, hng ca lc gy chn thng.
(2) Trng lng ca on ngoi vi gy.
(3) Lc co ko ca cc c.
(4) nh hng ca vn chuyn v phng php iu tr.
y l nhng nhn t dn ti pht sinh di lch th pht trong qu trnh
iu tr v s lin xng. C nh ngoi hp l hon ton c th hn ch ti a
t l bin chng ny.
3.1. Cc nhn t gy di lch th pht sau khi nn chnh v c nh
xng gy
3.1.1. Tnh cht v phng hng ca lc gy gy
Xng gy sau khi nn chnh v c nh, nu x l khng ph hp s gy
nn di lch th pht. Thng gp my loi sau y:
Phn mm nm trn ng di lch b tn thng to thnh ni yu.
Lc tc ng khng theo hng trc xng do cn di lch: gp gc, bn - bn...
3.1.2. nh hng ca co c
Cc c lun lun duy tr trng lc c nht nh. trng thi bnh thng,
h xng c phn b c ph tr chng gi mc qun bnh. S phi hp co gin
ca cc c to nn cc ng tc ht sc tinh vi. Do vy li dng tt s co ko v
trng lc cc c gp phn hon thin vic nn chnh v c nh xng gy.

50
3.1.3. nh hng bi trng lng ca on gy ngoi vi
Sc nng ca on ngoi vi gy c th lm cho xng gy gp gc, di lch
bn hoc to thnh di lch xa nhau. y cng l mt nhn t nh hng. Xng
cnh tay thng hay b gy ngang, do vy sau khi nn chnh, c nh, trng
lng on ngoi vi b ko xung gy gin cch gia hai mt gy v hu qu l
chm hoc khng lin xng.
3.1.4. nh hng ca vn chuyn v phng php iu tr
Sau khi nn chnh v c nh xng gy, bnh nhn c a t bung
th thut v phng bnh hoc t bnh vin v nh. Trong qu trnh vn
chuyn, nu thiu cn trng c th lm xng gy di lch th pht. i vi tr
em cn c phng php vn chuyn ng, khng to nn lc gp dui qu
mc. Ngoi ra vic c nh khng chc chn hoc tho b phng tin qu sm
cng c th dn ti xng gy b di lch th pht.
3.2. Tc dng ca c nh ngoi
u im ca c nh np - dy buc l d dng iu chnh cht theo
tin trin ca sng. Sng cng gim bao nhiu, dy cng c buc cht tin
theo n .
Vic s dng lt giang cho php iu chnh cht m i, nh nhng,
khng nh hng n bt ng. Tuy nhin lt giang khng c n hi thch
ng cn thit cho din bin ca sng n, nht l trong thi gian u. S dng
dy bng vi khc phc c nhc im ny, nhng vic tho m nt iu
chnh cht kh khn hn.
Hin nay, ti Bnh vin Hu ngh Vit - c chng ti s dng dy dn
(dy vencro) c n hi v cho php thao tc d dng, nng cao hn kh nng
v cht lng c nh.
3.2.1. Lc tc dng bn ngoi ca dy, np, m c nh
Khi dng np v dy qun buc to nn lc p nht nh. y l loi lc
thng qua np, m c nh v tc dng ca t chc phn mm vng gy, l
nhn t trng yu chng li di lch th pht ca xng gy. Chng hn dng 3
m t vo xng gy phng ti di lch gp gc; dng hai m t c nh
phng di lch bn - bn. i vi ngi ln khi b gy xng ln (nh xng
i), do c dy, lc co ko ln c lc chng li gy nn di lch th pht
cn phi phi hp ko lin tc bng bng keo dn da hoc inh xuyn qua li
cu xng.
3.2.2. Tc ng ca lc co c
Cc khp v c ca chi gy c th phi hp hot ng co dui nh sc ko
qun bnh ca cc nhm c i lp c th gip v duy tr tc dng c nh.
Do vy, cn phi cn c vo gy, loi gy, ni gy, la tui, sinh hc lin
51
xng xc nh cng , bin tp luyn chi gy mt cch ph hp. Cc c
ti di vng c nh hot ng co gin (ln gn), c th tc dng ln xng gy
mt lc nht nh, mt mt to nn lc p dn hai u xng gy tip xc cht
hn, hai on gy nh vy n nh hn; mt khc khi c ln co gin, tun hon
kh huyt cng tng hn, m v np cng sn sinh lc gin tip tc ng ln
xng gy, ngoi mc ch c nh v chng di lch th pht th vic t np v
m hp l cn gip hon thin thm s nn chnh cha c hon ho, chuyn
nhng nhn t bt li thnh c li.
3.2.3. cc khp ca chi gy v tr ph hp
Sau khi nn chnh v c nh, chi gy c v tr ph hp c ngha
quan trng duy tr s n nh ca cc on gy. V d: gy xng cnh tay,
on ngoi vi di lch vo trong v ra trc, on trung tm di lch ra ngoi v
ln trn to thnh gc m ra trc trong. T chc phn mm pha trc gy
cng b tn thng, to thnh ni xung yu. Sau khi nn chnh v c nh, cn
phi a cnh tay ra ngoi, ln trn, khuu gp th mi c th duy tr tnh n
nh ca xng gy. Gy trn li cu xng cnh tay kiu dui, cn c nh
khp khuu t th khuu gp khin cho c tam u cnh tay ko cng gn
tam u to cho on ngoi vi c tnh n nh v tr nn chnh.
Nh vy, t cc khp ca chi gy nhng t th khc nhau c th iu
tit trng lc ca c nhm to nn nhng nh hng nht nh i vi tnh n
nh ca cc on xng gy, duy tr s n nh ny trong 2-3 tun. Khi tp
luyn, cn trnh cc ng tc bt li cho vic c nh xng gy, phng di
lch th pht.
Tm li, xng gy sau khi c nn chnh v c nh, c nhiu nhn t
c th dn ti vic pht sinh di lch th pht. Nu sau khi nn chnh ng dng
c nh ngoi cc b mt cch uyn chuyn, hp l, phi hp tp luyn mt cch
ng n th c th phng trnh c di lch th pht, hon thin thm vic
nn chnh, c nh n, xng gy lin nhanh, cng nng chi phc hi tt... kt
qu iu tr tt.
3.3. Ch nh c nh np dy buc
T chi gy kn: ring i vi gy xng i, do i c c ln, li c sc c
mnh, cn dng phng php ko lin tc bng phng php YHH phi
hp c nh np.
T chi gy h: vt thng nh hoc c x l lin vt thng.
Gy xng c cn nn chnh sa li.
3.4. Cc loi c nh ngoi cc b
n thun dng np v dy vi c nh ngoi cc b: thch dng i vi
cc gy xng ng di (tr gy xng i).
C nh np vt khp: dng vi gy xng gn khp v gy ni khp.
Nh gy li cu ngoi hoc li cu trong xng cnh tay, gy xng cnh
52
tay 1/3 trn v 1/3 di, gy trn li cu xng cnh tay, gy mm khuu,
gy xng chy on trn c chn...
C nh np kt hp khung c nh: thng dng cho gy xng i (gy
mt on).
Np kt hp ko lin tc: thch dng trong gy xng i (gy mt on),
cc trng hp gy sng n ln, phng lon dng khng cho php nn b
mt th. Ngi ta thng ko lin tc trong giai on u, khi gim sng
n th chuyn sang b np.
C nh np dy buc kt hp ngoi gi c nh: thch dng trong iu
tr gy xng cnh tay c di lch xa nhau lm xng gy chm hoc
khng lin.
Np kt hp gi c nh chi trn: thch dng cho trng hp gy xng
cnh tay xoay trong v xoay theo trc phng on ngoi vi gp gc
vo trong.
Np kt hp quang cao su: thch dng trong trng hp gy thn xng
cnh tay c di lch xa nhau do trng lc ca on ngoi vi ko xung.
C nh vng my: thch dng khi b gy xng bnh ch tch hai mnh,
di lch xa nhau.
Bn kim loi hoc kt hp np: thch dng trong cc trng hp gy xng
bn v t ngn tay...
Mt s loi c nh c bit:
+ C nh bng keo: dng trong trng hp gy xng sn v xng chu.
+ Bng vi hnh ch s 8 kt hp bng keo: dng trong trng hp gy
xng n.
+ B bt trn keo, b bt trn keo kt hp vi np: dng trong trng hp
gy xng bn chn.
Mt vi lng y gi trn thuc vi l khoai lang b.
3.5. Phng php ch to dng c
Nhng vt liu thng dng l np, bao vi bc np, mnh, m , dy
buc, bng, bng keo, dng c ko, bn kim loi, quang cao su...
3.5.1. Np
Np l mt dng c quan trng dng c nh xng gy theo phng php
YHCT.
Nguyn liu: np c th lm t nhiu loi vt liu khc nhau nh g, v cy,
ba cng, mo cau...v thng dng nht l lm bng tre hoc cy h tre.
53
Tiu chun k thut:
+ Np phi c rn lm gi cho xng gy, li cn c do v
n hi nht nh, thch hp cho p lc ni b vng b khi co c tp
luyn sinh ra.
+ Hnh dng thch hp ni vng b.
+ Kch thc di, rng tng ng theo yu cu c nh, sao cho sau khi b
khe gia cc np khong 1cm.
+ c bc hoc m m trnh thng tn do chn p ln da.
Phng php ch to: tu loi nguyn vt liu khc nhau m c phng
php ch to khc nhau. Vit Nam, np ch yu c ch t np tre.
+ Chn tre: tre tt l loi tre bnh t (tre khng gi qu, cng khng non
qu), tui tre khong 1,5-2nm, ngoi v cn mu xanh, cc cnh ngang
(thng gi l tay tre) phn gn gc trng thnh, khng cn tay tre
no di dng mng, v thn cy c bc lp phn ng, cc t tre di
chiu di ca np nh lm.
Khi tre qu gi, l vng a, thn tre chuyn vng, ngoi ph phn nh
bn t l loi tre cng, chc, nhng kh nh hnh sau un.
Ch : khng dng tre ct ngn (tre b gi bo lm gy ngn khi ang cn
l cy mng). Loi tre ny cht mm, gin, un d gy v tnh n hi km.
+ Cch lm: ch tre thnh phin mng 4 - 5mm, bn rng 3-5cm.
Cho tre vo un si trong nc mui long 10 - 15 pht tr mi mt ri
a ra h nng, nc trong np si xo xo ri ht si, phin tre tr nn tng
i do l c th cho vo khun hoc un th cng theo hnh dng yu cu. Sau
khi un xong, nhng phn un vo cn 70-90% hoc dung mi hu c (c th
dng dm) nh hnh.
3.5.2. Mnh
c lm t cc nan tre, na. Nan c b rng t 5- 10mm, dy khong
1mm c lin kt vi nhau bng lt giang. n sau ny Nguyn Quang Long
ci tin cho vo ti vi qun vo ni cn c nh.
3.5.3. m
m c nh cng l mt thnh phn quan trng cng vi np trong c
nh xng gy. Mc ch chnh ca m l phng di lch th pht v phn no
gip cho s chnh phc thm hon thin.
Nguyn liu: m thng c lm bng giy bn gp xp nhiu ln.
Tiu chun k thut:
+ m, ht m v khng kch thch da.
54
+ Hnh dng kch thc ph hp ni vng m: m c nh to, nh, dy,
mng, hnh dng u nhm tc dng lc ni vng m. m qu b
hoc qu nh u nh hng khng tt cho vic n nh cc on xng
gy. C th phn lm nhiu loi m v ng dng khc nhau.
Cc loi m
+ m phng: hnh vung hoc hnh ch nht l loi m hay s dng
nht, ( rng nh hn np v ph thuc ni tip xc; di, cn c
di ca chi gy v ni m, m c th di khong 5-15cm; dy cn
c vo dy v mnh yu ca t chc phn mm ni m m nh,
thng thng m dy khong 1,5-4cm). T chc phn mm mng, nho
th dng m tng i mng; t chc phn mm dy th dng m c
kch thc dy.
ng dng: cn c vo hnh dng xng gy, tnh hnh di lch, nguyn l
c lc hc t m cho ph hp. Thng dng phng php: dng 2 m, 3
m v 4 m.
* Dng 2 m: thch dng cho xng gy c di lch bn. Sau khi nn
chnh, mi m c t pha i lp ca mi on gy (hnh 7.10).
* Dng 3 m: thch dng trong trng hp xng gy di lch gp gc. Sau
khi nn chnh, 1 m t vo ni nh gc; 2 m cn li t hai u xng gy,
i din vi m th nht. Ba m hnh thnh i lc phng xng gy ti di
lch gp gc (hnh 7.11).









Hnh 7.10. C nh c 2 m Hnh 7.11. C nh c 3 m Hnh 7.12. C nh c 4 m
* Dng 4 m: thch dng trong trng hp xng gy va c di lch gp
gc, va c di lch bn - bn. Sau khi xng gy c nn chnh, tu tnh hnh
di lch ca xng gy m s dng kt hp phng php dng hai m, ba m
(hnh 7.12).
+ m tch xng: thng dng trong trng hp gy hai xng cng tay,
gy xng bn tay hoc bn chn. Sau khi nn chnh, dng bng hay
55
giy bn qun trn thnh m hnh a ng knh 1-1,5cm, di 6-
10cm lm m tch hai xng phng gia cc xng (v d xng
quay v xng tr) khng c khong cch thch hp lm nh hng n
c nng ca ni gy. Khi t m cn phng s chn p lm tn
thng, lon dng t chc phn mm (hnh 7.13).

Hnh 7.13. m
tch xng
Hnh 7.14. m
hp ct
Hnh 7.15. m
trng tm
Hnh 7.16. m
nghing
Hnh 7.17. m
hnh li
Hnh 7.18. m
u ln
Hnh 7.19. Bng keo
dn dng ko lin tc
Hnh 7.20. Vng dy c
nh gy xng bnh ch
56
+ m hp ct: thch dng trong trng hp gy mm khuu v gy li
cu trong xng cnh tay. Sau khi nn chnh, dng m phng, ct
khuyt hnh bn nguyt t ln mnh gy phng di lch th pht
(hnh 7.14).
+ m trng tm: dng trong gy li cu trong, ngoi hoc v mm chy,
mt c chn. Sau khi xng gy c nn chnh, phn trng tm m
s c t ln phn li ca li cu hay mt c chn... phng s chn
p cc b trn phn li ln ca xng gy (hnh 7.15).
+ m nghing hay m bc thang: dng m gn khp, ni phnh to ca
on hnh xng. m hnh nghing gip cho m ph hp khun chi
ni cn m (hnh 7.16).
+ m hnh li: ng dng m cc u np. Cn c u np v cc b ni
tip xc m dng m hnh li mt cch ph hp (hnh 7.17).
+ m u ln: ng dng trong trng hp gy li cu ngoi m mnh
gy tch ra. m u ln c t trm ln li cu, cn bn i din t
hai m bc thang (hnh 7.18).
2.5.4. Bng keo
Lm bng vi pht nha dui hoc ngy nay dng bng dnh. i vi gy
xng c c ln nh xng i, bng keo dnh da c ko lin tc kt hp vi
b np.
3.5.5. Vng dy
c s dng khi gy v xng bnh ch, vng dy c t m ly xng
bnh ch v dng dy nt c nh ra sau.
3.5.6. Bng vi
c dng lm bng qun c nh hoc lm dy buc.
3.6. Phng php c nh (hnh 7.21)
gy c bt ng tng i, hai khp trn v di gy c gii
phng hon ton hoc b bt ng mt phn (gy gn khp).

Hnh 7.21. Phng php c nh
57
3.7. Nhng im cn ch sau c nh np cc b
3.7.1. Gc cao chi gy
Phng php ny c tc dng lm gim sng n. C th dng chn, m,
khung... lm gi .
3.7.2. Quan st theo di
Sau nn chnh, c nh, cn theo di cht ch 1- 4 ngy v mch, mu sc,
m, cm gic, mc sng n v vn ng t ch ca phn chi thuc ngoi
vi vng b. Nu pht hin tun hon tr, cn ch theo di v iu chnh
cht dy buc, trnh cc bin chng ri lon dinh dng do thiu mu nui.
3.7.3. Ch c nhng im au do c nh gy nn
Nu trong np ti vng chi b c im au chi (c th do m, c th do
cc u np gy nn) cn kp thi tho np kim tra phng bin chng lot,
hoi t, nhim trng...
3.7.4. Thng xuyn ch iu chnh cht ca dy buc
Khi chi gy gim sng, s pht sinh hin tng lng np, do vy hng
ngy cn phi kim tra cht dy buc kp thi iu chnh tng ln.
3.7.5. Theo di on xng gy di lch th pht
Xng gy sau khi nn chnh, c nh cn nh k kim tra tnh hnh di
lch th pht ca cc on xng trong khong hai tun u. Nu c di lch th
pht cn xem xt li cht ca dy buc v v tr cc np tm nguyn nhn
di lch, nu qu mc cho php mi cn phi nn chnh li.
3.7.6. Hng dn ngi bnh tin hnh tp luyn (xem mc tp luyn
cng nng)
3.8. X l nhng bin c sau khi b np
3.8.1. Tun hon tr
Thng do buc cht qu hoc sng n trong giai on cng vim, chi th
tm lnh, au but. Cn ni lng np, treo gc chi cao v theo di cht ch.
3.8.2. Lot do chn p
Cha nguyn nhn gy chn p, x l nhim trng. Nhn chung nu kim
tra ng ch v tin th him gp loi bin chng ny.
3.8.3. Theo di thng tn kinh lc
B np c th gy tn thng kinh lc nh lit, ri lon cm gic
Trong trng hp nghi dy thn kinh b t hoc b chn p nng, cn can
thip bng phu thut.
58
3.9. Thi gian b np
Tu tng loi gy, thi gian c nh c khc nhau. YHCT thng cn c
khi trn lm sng c du hiu lin xng. C nhiu yu t nh hng n qu
trnh lin xng bnh thng nh v tr gy, tui tc...
3.10. Tiu chun lin xng
3.10.1. Tiu chun tho np
Ti ch n khng cn au.
C ng chi gy v mi hng khng au.
Ht c ng bt thng.
Trong iu kin ngy nay X quang cho php khng nh lin xng bi
hnh nh can xng.
3.10.2. Tiu chun lin xng thc s (kt hp YHH)
C y tiu chun lin xng trn lm sng.
X quang mt ng gy.
Lin xng thc s nhanh nht 6 thng sau gy. Tr s sinh c th sm hn.
4. Luyn tp cng nng
Luyn tp c coi l bc quan trng trong iu tr gy xng theo YHCT
nhm t ti mc ch iu tr l phc chc nng chi gy. Nn chnh xng
gy sm, c nh xng gy cc b mt cch hp l, ng thi tin hnh luyn
tp chnh xc theo tin , pht huy c tnh nng ng ch quan ca ngi
bnh c coi nh l nguyn tc iu tr.
Nguyn tc tp luyn: tp t nh n mnh, t bin nh n bin
ln, t n gin n phc tp v khng c ng tc tp no gy au.
4.1. Th t tp luyn
4.1.1. Thi k u (thi k thay i c ho ti gy)
Thi k ny thng tin hnh 1-2 tun sau gy.
Ti ch sng, au, cc on xng gy cha n nh d di lch th pht, t
chc phn mm cha bnh phc, do vy luyn tp trong thi k ny ch yu l
co dui c ti ch, hay ni cch khc l ln gn ti ch. Cc khp trn v di
gy c bn l gi yn, cc khp khc ca thn th c th luyn cng nhm giao
thng kh huyt gip cho tiu sng, phng c bp teo nho, hn ch chc
nng khp v lm cho hai mt xng gy tip xc nhau.

59
4.1.2. Thi k gia (thi k hnh thnh can xng)
Lin h vi YHH th thi k ny bao gm t bt u hnh thnh can
xng n lin xng lm sng.
Thi k ny sng n gim, ti ch tng i ht au, tn thng t
chc phn mm hi phc, xng gy c can dnh kt, cc on gy bt u i
vo n nh. Hnh thc luyn cng trong thi k ny l tip tc tin hnh hot
ng co dui c ti chi tn thng, nh tr gip ca chi kho hoc cn b y t
tng bc hot ng cc khp trn v di ni gy. ng tc phi chm, phm
vi phi t nh n ln, v sau khi xng gy c can cng hn kiu lin xng
lm sng th cn gia tng s ln hot ng, gia tng bin v cng .
4.1.3. Thi k cui (can xng cng)
Thi k ny hnh thc luyn cng ch yu l tng cng hot ng ch
ng ca cc khp ca chi gy lm cho hi phc phm vi hot ng bnh thng
ca cc khp.
4.2. Nhng iu cn ch khi luyn tp cng nng
Cn c vo s khc nhau gia cc giai on gy, ni gy, bn cht ca
thng tn phi hp ng dng cc phng php tp luyn khc nhau.
Cc hot ng nht thit tin hnh di s ch o ca nhn vin y t.
Luyn cng phi tin dn tng bc. Ngay sau khi nn chnh c nh cn
bt u luyn cng kin tr cho n lin xng. Cn c tin trnh lin
xng, phm vi luyn cng tng bc gia tng, tng dn s ln, nhng cn
phi trnh khng ch gy b au v ton thn qu mt.
Luyn cng khng c nh hng n cht ca c nh xng gy,
nht thit cm tuyt i mi hot ng bt li cho s lin xng.
5. dng Thuc
Ngoi nguyn tc c nh xng gy: kt hp ng v tnh trn, nguyn
tc th hai trong iu tr gy xng theo YHCT l kt hp ti ch vi ton thn
cn th hin trong dng thuc xoa hoc p ngoi c tc dng ti ch v thuc
ung trong c tc dng ton thn.
5.1. Thuc dng ngoi
Kinh nghim trong dn gian cng nh sch ghi chp li v thuc dng
ngoi p b gy xng rt phong ph. Th k XIV, Tu Tnh trong sch
Nam dc thn hiu c phn dnh ring cho thng khoa v dc vt ng dng.
u th k th XVIII Hi Thng Ln ng (L Hu Trc) trong quyn Bch
gia trn tng c nu bi thuc t Lo truyn sang:
60
Bi thuc p:
G con 1 con (b lng v lng) Ba bt cm np
Tm gi, v go, qu chi tn bt 20g. u b v 3 cn
Tt c cc th gi nh ln nhau p vo vng gy sau khi ko nn.
C kh nhiu bi thuc p ngoi, tuy nhin nhc im ca phn ln cc
bi thuc l nhiu v, phi thay thuc nhiu ln lm bnh nhn au v d gy
di lch th pht.
Cc thuc dng ngoi c s dng tu thi k, hng theo cc php iu
tr nh ung thuc trong. Hai php c ch trng: hot huyt tiu v b can
thn, tip lin xng. Cc bi thuc c cu to t cc v thuc c tc dng
hot huyt, li thu, lm n m gn ct, gim au, thc y lin xng v c tc
dng st trng.
V sau cc thy thuc c xu hng ci tin theo hng gim s v v dng
dng t dng th n dng bt ri n dng cao dn, cn xoa.
Di y l cng thc cao dn c sn xut ti khoa dc vin YHCT
Vit Nam:
+ Cng thc cao thng nht:
Bt ngi cu 4 phn Bt i hi 0,8 phn
Bt cc tn 8 phn Bt qu chi 1,6 phn
Sp ong 2 phn Du thu du 20 phn
Tt c c trn u, p ln vi mng hoc giy dai dn vo vng gy
(Lng y Phm Vn Su, Vin YHCT).
+ Cng thc bng vt thng gy h (Lng y Bi Xun Vn, Th Xun,
Thanh Ho):
Hng n 12g; Bng phin 4g; Bch cp 8g
Cng thc mt s ru v thuc dng ngoi c nghin cu ti vin
YHCT Vit Nam xin xem phn tham kho.
Ngy nay di nh sng khoa hc, tc dng ca nhiu bi thuc c
lm sng t. Tuy nhin vic xoa bp, p thuc trong chn thng gy xng
cng cn ng phng php tun theo c ch ca sinh hc lin xng.
5.2. Thuc ung trong
Da trn quan im iu tr ton din, kt hp ti ch v ton thn, sau
khi xng gy c nn chnh v c nh, YHCT ch trng dng thuc tc
ng ti ch bng xoa, p v thuc ung trong c tc dng ton thn. iu ny
c coi nh l mt nguyn tc iu tr. Thuc YHCT dng trong iu tr chn
thng ni chung v trong gy xng ni ring rt phong ph v a dng. Di
61
y xin ch trnh by thuc ng dng c th trong tn thng xng khp. Cc
bi thuc c phng xin ch c nu tn, phn cng thc xin tham kho
Tuyn tp phng thang (NXB ng Nai 1995).
Tn thng gy xng ch yu l do ngoi thng. Sau khi tn thng tt
yu kh huyt, tng ph cng nh kinh lc ton thn u bin ho. Ngi xa
ni: Chi th tn thng bn ngoi tt kh huyt thng bn trong, phn v c
s bt n, tng ph do vy bt ho hoc Ngoi thng tn b phu gn xng,
bn trong ng kinh lc, tng ph. iu ni ln cc b v chnh th lin
quan mt thit vi nhau. Vn dng bin chng lun tr, ung trong v dng
ngoi thuc YHCT c th iu chnh ni b c th, iu ng nhn t c li, xc
tin xng khp mau bnh phc. Qua kinh nghim c truyn v cc quan st
trn lm sng khng nh: thuc YHCT c tc dng thng hot kinh lc, tiu
thng, ch thng, nhu dng kh huyt, ho dinh sinh tn.
Trong thc tin lm sng, da vo bin chng lun tr ng dng thuc
YHCT iu tr gy xng c th phn chia lm ba thi k: thi k u, thi k
gia v thi k sau.
Thi k u dng theo php hnh , hot huyt, sinh tn; thi k gia
dng php b ch can thn tip lin xng; thi k sau dng php cng cn,
cng ct phc nguyn.
5.2.1. Hot huyt ph
Gy xng trong thi k u (1-2 tun sau khi b thng) c th dng
php hnh hot huyt sinh tn. Ngi xa ni: Nht n th thng, kh
huyt tc tr, dc tr k thng, tin hnh k , dc tiu k thng, tt hot k
huyt, t thng khoa dng dc chi s d hnh hot huyt v bt nh php
mn gi, ngha l: Mt khi b thng, kh huyt vn hnh lp tc b tr tr
dn ti sng n. Mun tr au u tin phi hnh ; mun tiu sng tt phi
hot huyt. V vy, s d trong thng khoa khi dng thuc khng th khng
dng hnh , hot huyt. Tuy nhin cn phi tu tnh hnh c th thng tn
nng nh v bn cht ca tn thng s dng php tr thch ng.
5.2.2. Hnh kh hot huyt
Trng hp thng tn th cht t, chng trng nh c th dng php ny
iu tr. Sch Ni kinh ni: Kt gi tn chi ngha l chng kt dng phng
php tn iu tr. C th dng cc bi thuc p ti ch, hoc Tht l tn (1)
hoc dng ru T kim xoa ti ch. Ung trong c th dng Tht l tn hoc
Trt hon. Thuc sc c th dng bi Phc nguyn hot huyt thang, Hot
dinh ch thng thang, Phc nguyn thng kh thang, Thun kh tn, Chnh ct
mu n b thang, Nht bn chu thang.
5.2.3. Cng ph tr
Ngi b nn kho mnh, tr tng i nghim trng, ti ch sng v
huyt lu tiu. Trong trng hp ny hot huyt c th thu kt qu. Sch Ni
kinh ni phng php: Kt gi tiu i.
62
5.2.4. B can thn, tip lin xng
K gia ca gy xng (sau gy 1-2 tun n khi lin xng trn lm
sng) c th dng php b ch can thn, tip lin xng. Can ch cn, Thn ch
ct, do vy php b ch can thn l tc cn, tip ct. Thng dng cc bi nh
Tinh qu kt ct cao, Ni phc bt l tn v Kt ct tn. Ngoi dng thuc nh
trn ni, bn trong c th dng thuc B thn trng cn thang hoc Tn
thng iu kinh thang, l b thuc cng hay cng b kim tr.
5.2.5. Cng cn trng ct
K sau ca gy xng, sau khi xng gy lin lm sng dng php
cng cn trng ct php. C th dng cc dc vt nu trn. Khi chi gy b
cng khp, c bp teo nho, gn c co qup, c th dng Th cn thang lm
tng kh nng tp luyn, tng bc phc hi cng nng chi gy. Vi ngi th
cht yu nhc, c th dng thuc b nh Bt trn thang, Thp ton i b
thang...
5.2.6. Thanh nhit hot huyt
Dng trong cc trng hp huyt ngng tr, huyt ho nhit, vt
thng sng nng au. Dng cc thuc hnh hot huyt nu trn, gia
thm mt s v hn lng thanh nhit nh hong lin, hong cm, sinh a, n
b, hong b... nhng cn ch phng hn lng thi qu ngn cn vic tiu
tan tr.
5.2.7. n kinh thng lc
Nhng thng tn lu nhim phong, hn, thp sng au nng ln c th
dng php n kinh thng lc khu phong, tn hn, hot huyt tiu sng.
Thng dng thuc ung trong nh Thu ct an, Th cn hot huyt thang
v.v.. T chi thng tn lu, b phong, hn, thp xm nhp cng c th dng Th
cn thang. au vng lng hoc au lng cp, tn thng mn tnh kim phong
hn c th ung nh thng hon.
Khong ba thp k li y, c nhiu bi thuc kinh nghim, bi thuc dn
gian c vin YHCT Vit Nam su tm, tha k. Di y l cng thc mt
s bi thuc c dng:
Ru (bi thuc gia truyn nhiu i ca lng y Bi Xun Vn Th
Xun - Thanh Ho)
Phng phong 8g Sa nhn 4g
Huyt gic 12g Thin nin kin 5g
Xuyn quy 8g c hot 8g
Tc on 2g i hong 8g
C 1 lt ru ngm 65g thuc, ngm 7 ngy ri lc ru ung.
63
Tiu vim (thuc nam x)
L mng tay 10g Ngh 8g
Huyt gic 12g T mc 10g
Ngi cu 12g
Nu thnh cao lng, mi ngy ngi ln ung 30ml.
Thuc b gn xng (thuc nam x)
Bt lc gic xng 10g Bt ct toi b 12g
Mu l 4g
Mt s bi thuc khc xin tham kho phn ph lc.
Tm li, mt trong nhng vn qu ca YHCT l iu tr gy xng. Kinh
nghim v lnh vc ny c lu truyn qua nhiu th h mang tnh cht gia
truyn. iu tr gy xng n thun theo YHCT trong nhiu trng hp hiu
qu nn chnh cha tt, phng tin c nh n gin, d ph cp nhng cht
lng c nh cha cao trong cc trng hp gy xng ln, c c co ko mnh
nh xng i hoc mt s trng hp gy gn khp. iu tr gy xng theo
YHCT hay theo YHH u c u im v nhc im nht nh. Vic kt hp
YHCT vi YHH nhm pht huy u im v khc phc nhc im ca tng
phng php cho php iu tr cht lng ngy mt cao hn, hon ho hn.
Phng php iu tr gy xng kt hp YHCT vi YHH l mt trong
nhng phng php bt ng uyn chuyn mang tnh c nng, mt xu hng
m ngnh chn thng chnh hnh v ang hng ti (Ilizarov G.A). Qu
trnh lin xng ca phng php c nh sinh hc to lin xng gin tip (lin
xng k 2), kiu lin xng nhanh chng, cn lin xng trc tip (lin xng
k 1) l mt qu trnh chm chp. Theo ng Kim Chu th iu tr gy xng
theo YHCT l mt trong nhng phng php iu tr ton din. Chng ti
mong c nhiu nghin cu nhm hin i ho YHCT, xy dng phng php
iu tr gy xng vi cht lng cao, mang m bn sc YHCT dn tc Vit
Nam.
T lng gi
1. Hy in ch cho cu ng v ch S cho cu sai
C 4 nguyn tc iu tr gy xng /S
C 8 th php c bn nn chnh gy xng /S
Tiu chun nn chnh gy xng tt l
phc hi gii phu v phc hi chc nng /S
64
2. Hy in vo ch trng cm t thch hp
Sau khi xng c nn chnh v c nh cn lu :
Tnh cht chn thng.
Trng lng. gy
Lc co ko c
nh hng..iu tr
3. Nu 3 tc dng ca c nh ngoi.
4. M t 6 phng php ch to dng c nn b gy xng ?
5. Nu 2 tiu chun lin xng ?
6. Trnh by cc dng thuc YHCT dng kt hp trong iu tr gy xng ?




65
Bi 8
Mt s loi gy xng
(C trit)
Mc tiu
1. M t c cc loi gy xng thng gp.
2. Trnh by c phng php iu tr gy xng.


1. Gy u di xng quay
1.1. c im
Gy u di xng quay chim khong 50% cc gy xng ni chung.
Gp mi la tui, nhng thng gp nht tui 50-60, nht l ph n
mn kinh.
L loi gy gi, d chn on, d lin xng, nhng vic iu tr khng phi
l n gin.
1.2. Phn loi
Da vo c ch chia 2 loi chnh:
+ Gy dui: do ng chng tay, c tay dui l thng gp nht. i din
cho nhm ny l Pouteau- Colles; on gy xa di lch ln trn, ra sau v
ra ngoi.
+ Gy gp: do ng chng tay c tay gp, loi ny t gp hn. i din cho
nhm ny l Goyrand- Smith; on gy xa di lch ln trn, ra trc v
ra ngoi.
Ngoi ra cn chia theo v tr gy, gm c:
+ Gy ngoi khp.
+ Gy thu khp (trong c cc loi nh gy b khp trc, gy mm trm).
Gy Pouteau - Colles v Goyrand - Smith l nhng gy xng ngoi khp,
ng gy n gin. Nu ng gy phc tp nhiu mnh v thu khp th
khng xp vo loi gy ny. Nu mt mnh ca b khp trc b gy di lch ln
trn, lm trt khp c tay ra trc th c gi l kiu gy Barton.
66
1.3. Chn on
Da vo:
Bnh s: ch nguyn nhn, c ch v tui.
Triu chng lm sng.
Phim X quang.
1.3.1. Triu chng lm sng
Triu chng c nng: au vng c tay, vn ng gp dui hoc sp nga
hn ch.
Triu chng thc th:
+ Sng vng c tay, t khi thy bm tm, nu gy thu khp s thy bao
khp cng phng.
+ n au nhi u di xng quay.
+ Bin dng:
Mm trm quay ln cao, c th ngang bng mm trm tr (du Laugier).
Nhn thng: trc cng tay ko di khng qua ngn 3 m lch qua
ngn 4. Bin dng ny cn c gi l du hiu li l (ng hn l
li l cm trn u sng) hay du hiu bayonet l gy.
Nhn nghing:
Nu l gy dui: u di xng quay lch ra sau to nn bin dng hnh
lng na (hay mu tha). Nu l gy gp: di lch ngc li, c tay gp v pha
lng nhiu hn.
Ngoi ra cn tm hiu thm cc triu chng ca thng tn i km:
n vo gia khp quay- tr di, nu au tng c th bong khp quay tr di.
n mm trm tr nu au tng c th gy mm trm tr.
n h lo nu au tng c th gy xng thuyn.
n pha trc c tay, nu au tng v c du hiu khng dui thng c
ngn 3, c th l trt xng bn nguyt.
1.3.2. X quang
Nn chp ng t th cng tay nga. Phim xc nh c gy xng,
ng gy, di lch, loi gy v tn thng i km. Khi nghi c gy xng thuyn
nn chp thm phim c t th c bit cho xng ny.
Gy u di xng quay kiu dui (Pouteau- Colles):
+ V tr gy: cch b khp trc khong 2cm.
67
+ ng gy thng gy ngang, khng thu khp.
+ Di lch; chng ngn; sang bn ra ngoi, ra sau; gp gc m ra sau.




Hnh 8.1. Gy u di xng quay v di lch in hnh
Gy Goyrand- Smith:
+ V tr v ng gy nh loi Pouteau- Colles.
+ Di lch: chng ngn; sang bn ra ngoi, ra trc; gp gc m ra trc.
1.4. iu tr
C nhiu phng php iu tr nhng chn phng php no th cn da
vo loi gy, kh nng di lch th pht, tui v ngh nghip bnh nhn.
C 2 phng php chnh l nn xng v b np
1.4.1. Nn xng
Gy t gy vi 10ml novocain
1-2%, gy t vng, thu chm
t hoc gy m.
Nn chnh: ko sa di lch
chng trc v nn on gy
xa theo on gy gn. C th
nn bng tay (2 ngi nn)
hoc bng khung (1 ngi
nn).
Ch : ch ko 1 ngn ci
lc tc ng thng vo u di
xng quay, cng tay na sp na
nga. Kim tra ht di lch chng
bng o chiu di xng hoc xem
s chnh lch gia 2 mm trm.
Gy dui: nn on xa ra
trc, c tay gp v pha lng 0- 10
0
.
Gy gp: ln on xa ra sau,
c tay dui 30 - 45
0
.
Nu gy khng di lch hoc di lch t, c th khng cn nn.
Hnh 8.2. Gy u di xng quay kiu
dui: ko nn di lch on gy ngoi vi
theo on trung tm
68
1.4.2. B np



Hnh 8.3. Phng php t np v m trong gy Poutau - Colles
Khi bo tn tht bi, phu thut kt hp xng c th l: xuyn kim
Kirschner; xuyn kim qua khe gy (phu thut Kapandji): xuyn 2- 3 kim (c
th dng kim Kirschner) qua khe gy v on gy gn cht chn on gy xa
khng cho i lch, t np c nh, t c nh ngoi (dng trong gy h v gy
nhiu mnh).
1.5. Bin chng v di chng
1.5.1. Bin chng sm
Chn ng c tay: th hin bng s p thn kinh gia.
Chn p thn kinh tr v ng mch quay: t gp.
Gy h: do xng gy m ra.
1.5.2. Bin chng mun
Can lnh: thng gp; nu di lch nhiu xt thy cn thit sa cha th
chuyn iu tr phu thut; nu lch t: chp nhn can lch v tp vn
ng phc hi chc nng.
Khp gi: rt him
Ri lon dinh dng: thng gp nht l hi chng Soudeck, hi chng vai
bn tay, gy au v mt chc nng vn ng c tay bn tay; ri lon dinh
dng thng gp do bnh nhn thiu tp luyn trong thi gian mang np,
nht l iu tr theo phng php b bt.
S dng mt trong cc bi thuc ngm 15 n 30 pht ri tp luyn.
Trnh xoa bp th ng cng lm ri lon thm dinh dng ti ch, ung thuc
trong (b kh huyt, thng hot kinh lc).
2. Gy trn li cu xng cnh tay
2.1. i cng
Gy trn li cu xng cnh tay l loi gy ph bin nht la tui tr em
(74% gy xng tr < 10 tui; 50% cc gy vng khuu). y l loi gy c th
km theo bin chng mch mu thn kinh, c bit c th b hi chng
Volkmann li di chng nng n. Tuy tin lng xa v mt c nng l tt,
nhng di chng hn ch gp dui khuu ko di, cng tay vo trong (cubitus
varus) cn rt ph bin (35% n 70%).
69
2.2. Nguyn nhn v c ch
Gy dui (96% n 98%): tr ng chng tay, khuu dui, ng gy t
trc di n sau trn, u gy ca on trung tm nhn, di lch ra trc
e da b mch v thn kinh cnh tay; on ngoi vi di lch ra sau.
Gy gp (t gp tr em): tr ng chng khuu, khuu gp, ng gy t
sau di n trc trn, u gy ca on trung tm nhn di lch ra sau,
c th chc thng gn c tam u gy gy h.
ng gy: ng gy ngoi khp, ngang hoc cho trn hai li cu qua
cc h khuu, h vt.
Di lch:
+ Gy dui: on ngoi vi di lch ra sau, ln trn v vo trong (him khi
ra ngoi) do c tam u co ko.
+ Gy gp: ngc vi di lch ca gy dui (on ngoi di lch ra trc do
c nh u v cnh tay trc co ko).
Phn loi (theo Marion et Lagrange):
+ I: gy mt bn v xng.
+ II: gy c hai lp v xng, khng di lch hoc di lch khng ng k.
+ III: gy di lch nhng cc u gy cn tip xc vi nhau.
+ IV: gy vi cc u gy di lch xa nhau.
2.3. Triu chng lm sng
Trong trng hp gy dui in hnh:
C nng: au nhiu vng khuu, mt vn ng khp khuu.
Thc th: sng n vng khuu, sau vi gi c th sng n gp hai lc
thng. C th bm tm vng trc khuu ( bm tm c hiu Kirmisson).
Nhn nghing: du hiu "nht ru" pha sau khuu.
S nn thy au chi trn li cu v c th pht hin ting lo xo, c
ng bt thng khi lm ng tc dng, khp.
Cc mc gii phu bnh thng, "tam gic khuu" bnh thng.
X quang: chp hai t th thng v nghing cho php xc nh ng gy
v di lch. Tuy nhin mun xc nh di lch xoay trong hay xoay ngoi cn
chp chch.
2.4. iu tr
2.4.1. Bo tn
Ngi ta thng dng phng php bo tn l chnh, ch phu thut trong
mt s trng hp hn hu khi c gy h, bin chng mch mu lm ri lon
dinh dng ngoi vi vng gy v lit thn kinh ngoi bin khng hi phc.
70
Trong trng hp nn chnh khng thnh cng, sng cng n, phng dch
khng cho php nn b mt th c th ko lin tc ti ging hoc di ng
trn khung di ng kiu Pouliquen.
Phng php nn chnh gy trn li cu xng cnh tay tr em:
V cm: tt nht l gy m v n gim au tuyt i; hoc dng mt trong
nhng phng php sau:
+ Gy t gy 8 n 10ml xylocain 1%: gim au tt. Cn phng trnh
nhim trng gy.
+ Thu chm t huyt: cc huyt gn gy nh khc tr, khc trch...
hoc cc huyt nm trn cc ng kinh i qua gy nh hp cc, cc
tuyn.
Th 1: ko theo trc cng tay, cng nga hon ton. Lc ko tng dn v
lin tc, nn cc di lch trong - ngoi.
Th 2: t t gp khuu, sp dn cng tay ng thi dng ngn ci y
on ngoi vi ra trc. Sp cng tay v gp khuu n ti a, sau dui
dn n 90
0
.
Kim tra ng mch quay. Trong trng hp ng mch b chn p, sau
khi nn chnh mch c th phc hi v ngoi vi vng gy hng v m
dn ln.
2.4.2. Phng php ko lin tc
Dng kim Kirchner xuyn qua mm khuu, cch nh 1,5 n 2cm, xuyn
t trong ra ngoi ch ng trnh lm tn thng dy thn kinh tr. Ko lin
tc vi lc 2,5 n 3kg. Theo di st trong tun u, khi cn c th nn h tr
bng tay. Thi gian ko lin tc 2 tun, sau chuyn sang cc phng php
bt ng thng thng.
Chp X quang kim tra: 2 ln trong tun u, sau mi tun mt ln.

Hnh 8.4. C nh khung vo thn Hnh 8.5. C nh tay gy vo khung,
ko lin tc
71
2.4.3. Phng php bt ng
i vi gy I, II v sau ko lin tc, c th bt ng bng hai np to bn
(rng 4 n 5cm, dy 0,5cm), u di c un cong theo hnh gii phu
u di xng cnh tay. C nh np bng dy dn, chn "dy ci" mm
lm dy, mt ph bng mm p vo da cho m v thong ni tip xc; cui
mi dy c nh mt on "dy c" dn thay cho nt buc. Trn np,
tng ng vi ni dy ci s ngang qua cng gn nhng mnh dy c
(bng keo dn g thng dng...) sau khi dn dy ci c nh, cc np
c lin kt vi nhau, khng b di lch hoc xc xch...
cht mi dy va , khng gy cn tr tun hon, khng lng tut.
Theo kinh nghim ca chng ti: sau khi qun chu vi, xit thm t 1 n
1,5cm l va phi.

Hnh 8.6. Cch t np v m
cho gy dui
Hnh 8.7. Cch t np v m
cho gy gp
Theo di sau khi t np: sau khi b np, bnh nhn c hng dn treo
gc cao chi gy to thun li cho tun hon tr v, gim sng n. Treo
cng tay vi khuu gp 90
0
khi i li; c th dng chn, m, tng nh,
khung... da cng tay; tt nht l treo tay khi nm (hnh 20).
Quan st theo di: sau nn chnh v c nh, cn theo di cht ch 1- 4
ngy, trnh tht buc qu cht hoc qu lng; cc im t trn mu
xng gy au, lot im t.

Hnh 8.8. Phng php treo tay khi nm
72
Thi gian bt ng t nht 3 tun tnh t ngy nn chnh, c nh.
Hng dn tp luyn phc hi chc nng chi gy (xem phn iu tr chn
thng theo YHCT).
2.3. Bin chng
Tn thng ng mch cnh tay: mch quay yu hoc mt. Cn nn ngay,
sau 30 pht khng c du hiu phc hi mch quay cn can thip ngoi khoa.
Chn p khoang: do sng cng n, mu t. Bnh nhn au nhiu, au t
nhin nh dao m, cc ngn b co rt gp li, ko dui cc ngn cng gy au
n. X tr: nu giai on sm th cn nn xng, theo di, treo gc tay cao; nu
giai on mun cn m gii p trnh mc hi chng Volmann (thoi ho x
cn c, thn kinh do thiu mu nui) li di chng nng n.
Tn thng cc dy thn kinh ngoi bin (gia, tr, quay) x tr nn sm
gii p. Thng thng lit thn kinh t hi phc sau 3 n 4 thng. Theo di,
nu s phc hi khng tin trin, cn phu thut thm d.
Gy h: iu tr phu thut hoc bo tn tu tng trng hp.
Bin chng mun: hi chng Volkmann, can lch, khuu vo trong, vim
c ct ho lm cng khp khuu.
3. Mt s trt khp thng gp
Trt khp c th xy ra cc khp: vai, khuu, hng.
3.1. Triu chng chung
3.1.1. C nng
au vng khp b trt, mt c nng v du hiu quan trng nht l "du
hiu l xo", ngha l khi a phn ngoi vi khp trt sang v tr khc, th ra li
tr v v tr c.
3.1.2. Trt khp vai
Hu ht cc trng hp trt khp vai u di lch chm ra trc v xung
di. C th minh ha 3 loi sau y:





(1) (2) (3)
Hnh 8.9. Trt khp vai v cc kiu di lch ca chm: (1) xung di;
(2) trc - di; (3) trc - trong
73
Phng php nn chnh:




Hnh 8.10. Phng php dng chn nn di lch (Hypocrat)









Hnh 8.11. Trt khp vai, chm di lch ra trc
v 4 ng tc c bn (ko, nn chnh) (L.Boehler)







Hnh 8.12. Nn trt khp vai ng dng


74







(1) (2)
Hnh 8.13. Phng php c nh sau nn chnh trt khp vai:
(1) C nh bng bng v m; (2) C nh bng ko lin tc qua da
t lng gi
1. Hy in ch cho cu ng v ch S cho cu sai
Gy u di xng quay c 4 loi /S
iu tr bo tn bng nn xng v b np /S
Gy trn li cu xng cnh tay chia lm 3 /S
iu tr gy trn li cu xng cnh tay ch yu l phu thut /S
2. in cm t thch hp vo ch trng
Bin chng mun ca gy u di xng quay
llch.gidng.
Bin chng sm ca gy u di xng quay l.c
taytrquay.
Bin chng ca gy trn li cu xng cnh tay
l..tntay..chn..khoang, tn thng.ngoi bin, gy
3. M t c mt s trt khp thng gp.

75
Bi 9
Thuc y hc c truyn dng ngoi
trong iu tr bnh da liu
(Bnh b phu)
Mc tiu
1. Hiu c nguyn tc s dng thuc dng ngoi ca y hc c truyn.
2. Nh c v ng dng c cc nhm thuc dng ngoi.
3. Nh c v ng dng c cc bi thuc dng ngoi.


1. i cng
Thuc y hc c truyn dng ngoi trong da liu chim mt v tr ht sc
quan trng, trong nhiu trng hp l quan trng nht. Cng vi s pht trin
ca y hc c truyn thuc dng ngoi trong da liu cng c nhng tin b khng
ngng, th hin bng nhng nghin cu dc l hc v s tch lu khng ngng
nhng bi thuc mi. Thuc y hc c truyn dng ngoi trong da liu ch yu
da vo i chng, tuy nhin cng c khi cn ph thuc vo nguyn nhn gy
bnh. Nhn chung thuc y hc c truyn dng ngoi trong da liu c nhng c
im sau:
Hiu qu tt: hin nay thuc y hc c truyn dng ngoi trong da liu c
mi dng m thuc y hc hin i cng c, ngoi ra n cn c thm
nhng dng nh xng, hun, cao cng.
c tnh thp: y u l nhng ch phm c ngun gc thin nhin v ni
chung rt t c tnh.
D kt hp: s kt hp ny c th l gia cc v thuc y hc c truyn vi
nhau, cng nh gia cc v thuc y hc c truyn vi thuc ty, chng c
th hp ng vi nhau pht huy tc dng, ly trng b on. y l
mt hng rt c trin vng trong lnh vc ny.
Pht trin nhanh: theo s pht trin ca khoa hc cng ngh, cc dng
thuc ngy cng phong ph, cht lng ngy cng cao.
C nhiu bi thuc c gi tr iu tr nhng cha c nghin cu y
nht l v c ch tc dng. y cng l mt trong nhng vn thu ht nhiu
nh nghin cu.
76
2. C ch hp thu
2.1. Hp thu theo kinh lc
Kinh lc l mt b phn cu thnh c th con ngi lin lc cc phn biu
l, trong ngoi, tri phi ca c th; ngoi lin quan n b phu tu l, pha
trong ni vi lc ph ng tng; hnh thnh nn mt mng li khp c th.
Nhng loi cao thuc dn vo huyt c th thng qua kinh lc m pht huy tc
dng. Th d nh: vic p thuc vo rn, c th thng qua huyt thn khuyt,
ri qua h thng kinh lc m i khp ton thn pht huy hiu qu.
2.2. Hp th qua da
Thuc y hc c truyn dng ngoi trong bnh da liu sau khi bi, dn,
xng, ngm, cc cht thuc s c khuych tn vo da ri i vo trong thng
qua nhng con ng sau: trc tip thm qua biu b, thm qua chn lng,
thm qua tuyn m, c huyt qun v mng mch hp th. nh hng n
vic hp thu thuc qua da l nhng yu t sau:
Tnh trng ca da: nu nh da lnh, nht l lp biu b cn nguyn vn th
cc cht thuc kh hp thu qua. Ngoi ra s hp thu ca thuc cn nh
hng bi dy, th ca da, tnh trng ca l chn lng. Ni chung da
bnh thng th s hp thu thuc qua rt km. Khi c bnh, nu nh lp
biu b v h b cn ton vn th s hp thu ca thuc cng ch tng -
ng nh qua da bnh thng m thi; nu nh lp biu b c tn thng
nh trong cc trng hp bong vy, lot, mc mn nc, nt n, th tnh
thm v hp thu thuc ca da tng ln rt nhiu. Hin tng sung huyt
da hoc tng tit m hi cng c li cho vic hp thu thuc.
Tnh cht ca thuc: cc thuc du c hp thu nhanh hn cc thuc n-
c, hn hp du nc cng d hp thu hn. Thnh phn ca c cht cng
gn vi thnh phn ca tuyn m th s hp thu thuc cng tt. Ni chung
trn lm sng c th thy: thuc du/nc> thuc nc/du>vaselin>du
thc vt.
Nhng nhn t khc: khi nhit tng cao th s hp thu thuc cng thun
li hn. y l c s ca vic bc ni bi thuc bng giy nilon hoc dng
my sy tc thi vo ni bi thuc tng cng s hp thu ca thuc.
3. Nhng nguyn tc c bn ca vic s dng thuc ngoi
Tc dng ca thuc ngoi khng ch ph thuc vo tnh cht ca dc vt,
liu lng, nng , cch ch thuc, dng bo ch m cn ph thuc vo bnh
tnh. Do s dng thuc ngoi da nn ch nhng mt sau:
La chn thuc: vic la chn ny da trn vic i chiu gia nhng c
im ca bnh tt vi tnh nng ca thuc. Nu nh nguyn nhn gy
bnh r rng th cn c vo bnh nguyn chn thuc (v d: bnh do da
nhim cc vi khun sinh m nn chn cc thuc thanh nhit, st trng
77
nh hong b, hong cm, t tho; nu do nm nn chn th cm b,
hong tinh; nu bnh do virus gy nn th nn chn bn lam cn, sinh
d, mc tc, hng ph; bnh gh nn chn lu hunh.
Trong i a s cc trng hp, vic chn thuc u da trn c im ca
tn thng da. Th d nhng tn thng xung huyt do vim c km theo c
lot v tit dch nn dng cc thuc thanh nhit thu lim nh long m tho,
cam tho, ng bi t, kh sm. Nu da dy th hoc c niken ho th nn
dng cc thuc nhun phu tr nga nh du u en. Nga dng cc thuc
tr nga nh long no, bc h, bng phin, thng nh t, minh phn.
La chn dng thuc: s thnh bi trong khi s dng thuc ngoi c
quyt nh khng ch da vo vic chn thuc cho ng, m cn ph thuc
rt nhiu vo vic la chn ng n dng thuc. Vic la chn khng xc
ng dng thuc khng ch lm gim tc dng ca thuc m cn c th
lm cho bnh tnh nng hn (v d nh dng thuc m trong nhng trng
hp c lot v tit dch). Nguyn tc la chn dng thuc nh sau:
+ Tn thng l ban , nt sn nn dng dng tn, thuc nc, kem.
+ Ni my ay nn dng thuc nc, ru thuc, kem.
+ Mn nc, mn m nn dng cch p t, cao mm, thuc nc, thuc du.
+ Tn thng lot, tit dch nn dng cch p t, thuc du.
+ Tn thng ng vy nn dng thuc m, thuc du.
+ Tn thng l vy da nn dng thuc m, du, kem
+ Tn thng nt n nn dng thuc m, kem, thuc du.
+ Tn thng niken ho nn dng thuc m, cao cng, cao mm, thuc du.
+ Hn na trong qu trnh iu tr cc tn thng da khng ngng thay
i, vic ng dng dng thuc cng cn phi c thay i cho ph hp.
4. Mt s v thuc thng dng ngoi
Cha nga: a phu t, bch tin b, thng nh t, bng phin, bc h,
long no, s sng t.
Thuc nhun phu: sinh a, ng quy, h ma nhn, t tho, sp ong,
hnh nhn, m ln, du vng, o nhn.
Thuc gii c: hong lin, hong b, hong cm, i hong, chi t, thanh
i, i thanh dip, t hoa a inh, kim ngn hoa, lin kiu, m x hin, b
cng anh, xa tin tho.
Thuc thu lim: thc thch cao, hot thch, l cam thch, kh phn, ng
bi, hi phiu tiu, ch xanh, thng trut, xch thnh chi, luyn long ct,
luyn mu l.
78
Thuc tr hn: can khng, ng th, bch ch, nhc qu, u, nam tinh,
xuyn tiu, khng hong, trn b, ngi dip.
Thuc sinh c: nh hng, mt dc, huyt kit, h phch, i gi thch.
Thuc hot huyt: hng hoa, tam lng, nga trut.
Thuc hu c: nha m t, mai.
Thuc st trng: kh sm, lu hong, hng hong, bch b, i phong t,
khinh phn, thu ngn.
Thuc ch huyt: tam tht, a du, trc bch dip sao en, b hong, huyt
d thn, bch cp, t tho.
Thuc t m: sinh trc bch dip.
5. Mt s bi thuc thng dng ngoi
Tht l tn:
Thnh phn: huyt kit 30g, nhi tr 6g, chu sa 3,6g, hng hoa, nh hng,
mt dc mi v 3g, bng phin mi v 0,36g.
Cch bo ch: cc v thuc tn nh, trn u.
Tc dng: hot huyt, ho .
Ch nh: cc trng hp ngoi thng c chy mu.
Cch dng: trn vi ru trng cho thnh h ri p ln ni tn thng.
Cu nht an:
Thnh phn: thc thch cao 900g, thng an 100g.
Cch bo ch: nghin nh, trn u.
Tc dng: bi nng, kh h.
Ch nh: dng trong cc vt l lot, cc l r.
Cch dng: rc ln trn tn thng hoc v thnh si ri nht vo cc l r.
Nh v b c tn:
Thnh phn: minh hng hong, bch phn mi v 100g.
Cch bo ch: nghin nh, trn u.
Tc dng: b c tiu thng, thanh nhit ch thng.
Ch nh: dng trong cc trng hp mn nht.
Cch dng: ho vi nc ch c hoc nc vt ca hnh ri p ln ni
tn thng.

79
i hong thang:
Thnh phn: i hong 15g, qu chi 20g, o nhn 30g.
Cch bo ch: nghin nh, bc vo mt ming vi ri em sc ly nc trong.
Tc dng: nhun to, dng phu.
Ch nh: dng trong bnh vy c.
Cch dng: p dch thuc ln ni tn thng.
Tam diu tn:
Thnh phn: binh lang 100g, thng trut 100g, hong b 100g.
Cch bo ch: tn nh trn u.
Tc dng: thm thp, ch dng.
Ch nh: chm, vim da.
Cch dng: khi xut tit t th rc ln ni tn thng, vo thi k bong vy
th trn vi du vng ri bi ln ni tn thng.
Cao m x hin:
Thnh phn: bt m x hin 50g, sp ong 10g, m ln 40g.
Cch bo ch: un cho tan sp ong v m, sau cho bt m x hin vo
trn u thnh cao.
Tc dng: st trng.
Ch nh: cc trng hp nm lng.
Ng bi t thang:
Thnh phn: ng bi t, phc tiu, lin phng, tang k sinh, kinh gii, mi
v 30g.
Cch bo ch: sc ly nc.
Tc dng: tiu thng ch thng, thu lim ch huyt.
Ch nh: chm giang mn, tr, sa trc trng.
Cch dng: xng hi thuc nng vo ni c bnh, sau ngm, ngy 2-3 ln
an sm cao:
Thnh phn: an sm, xch thc, mi v 60g, bch ch 30g.
Cch bo ch: 3 v trn ngm trong ru mt m, sau cho vo 180g m
ln rn nh la, lc b cn, ly m dng.
Ch nh: vim tuyn v giai on u, ban c thm nhim trn da.

80
Ngc c tn:
Thnh phn: u xanh 250g; hot thch, bch ch, bch ph t, mi v 6g.
Cch bo ch: nghin thnh bt mn.
Tc dng: vinh c nhun phu.
Ch nh: tn nhang, xm da, da kh nt n.
Cch dng: trn vi nc si thnh h ri bi ln ni tn thng.
T hong cao:
Thnh phn: kinh gii 3g, chi t 3g, ngu bng t 3g, hong lin 3g, hong
cm 3g, lin kiu 3g, bc h 3g, mc thng 3g, b hong 3g, ng tm 1,5g, cam
tho 1,5g.
Cch bo ch: nhin thnh bt mn, trn u.
Tc dng: thanh nhit t ho.
Ch nh: lot ming.
Cch dng: bi vo ni tn thng, ngy 2-3 ln.
Ru ng trng h tho:
Thnh phn: ng trng h tho 60g, ru trng 240ml.
Cch bo ch: ngm vo ru trong 7 ngy, lc b b ly ru trong.
Tc dng: b kh huyt, kch thch mc v lm en tc.
Ch nh: rng tc v tc bc sm.
Ru bch b:
Thnh phn: bch b 20g, ru cao lng 80ml.
Cch bo ch: bch b tn nh, ngm trong ru 1 thng, lc b cn ly
ru trong dng.
Tc dng: st trng gii c, khu phong ch dng.
Ch nh: gh, vim da thn kinh, m ay.
Cch dng: bi vo ni c bnh ngy 2-3 ln.
Kim hong tn:
Thnh phn: i hong, khng hong, hong b, bch ch mi loi 25g;
nam tinh, trn b, thng trut, hu phc, cam tho mi v 10g; thin hoa
phn 50g.
Cch bo ch: nhng v thuc trn tn nh, trn u.
Tc dng: thanh nhit, tr thp, tiu thng, ch thng.
Ch nh: mn nht thuc dng chng.
Cch dng: trn bt thuc vi nc vt ca hnh, mt ong hoc du thc
vt ri bi ln ch b bnh ngy t 1-2 ln.
81
Cao hong lin:
Thnh phn: hong lin 9g, ng quy 15g, hong b 9g, sinh a 30g, kh-
ng hong 9g, du vng 360g, sp ong 120g.
Cch bo ch: nhng v thuc trn tr sp ong, cho vo du vng rn nh
la cho n khi vng kh, cht b b, thm sp ong vo, un tan.
Tc dng: thanh nhit gii c, nhun to ch dng.
Ch nh: bng, mn m trn da, nt n chn tay.
Cch dng: bi hoc p ln ni c bnh ngy 1-2 ln.
Cao cha chm:
Thnh phn: thanh i 60g, bt hong b 60g, oxyd km luyn vi thch
cao 620g, du vng 620ml, vaselin 930g.
Cch bo ch: nhng v thuc trn nghin thnh bt mn, sau luyn vi
du vng v vaselin, trn u.
Tc dng: chm, vim da.
Cch dng: bi vo ni c bnh ngy 2-3 ln.
T lng gi
1. Trnh by nguyn tc s dng thuc dng ngoi ca y hc c truyn?
2. Nu cc tn thuc dng ngoi theo nhm tc dng?
3. K tn, thnh phn cch bo ch v tc dng ca 15 bi thuc dng
ngoi cha bnh da liu?
82
Bi 10
chm
(Phong chn)
mc tiu
1. Hiu v trnh by c nguyn nhn v c ch bnh sinh ca chm theo y hc
hin i.
2. Hiu v trnh by c nguyn nhn v c ch bnh sinh ca chm theo y hc
c truyn.
3. Nh c cc giai on ca chm.
4. Hiu c v trnh by c cch phn loi chm theo y hc c truyn v cch
iu tr bng y hc c truyn cho tng th.


1. i cng
Chm l mt bnh da liu thng gp vi biu hin lm sng l cc tn
thng da a dng, c xu hng xut tit, phn b i xng, d ti pht v tr
thnh mn tnh ho, cm gic nga rt d di.
Bnh ny thuc v phm tr chng "phong chn" ca y hc c truyn.
2. Bnh nguyn
Bnh nguyn ca chm tng i phc tp. C nhiu kh nng l do cc
nguyn nhn bn ngoi v bn trong tng tc vi nhau gy nn. Mi quan h
nhn qu y l tng i phc tp, ngoi ra cc yu t nh hng cng rt
nhiu. Nhng nguyn nhn ny tng i kh loi tr, khin cho bnh c xu
hng ti pht v tr thnh mn tnh.
Cc nhn t bn ngoi gm: cc m phm, hng liu, bt git v cc cht
ty ra; cc c t ca ng vt, mt s loi protien ca c, tm, sa, hoa phn,
bi nh, cc loi vi sinh vt, nh nng mt tri, lnh, ng tc ch st, gi.
Nguyn nhn bn trong gm: th cht qu mn, ri lon v chuyn ho,
ni tit, tr ngi ca hot ng thn kinh v tm thn, mt mi qu , thn
kinh cng thng, cc nhim trng, k sinh trng ng rut, gin tnh mch,
chng nhiu m hi, chng da kh.
83
3. C ch bnh sinh
C kh nng l nhng phn ng qu mn chm sinh ra trn c s kt hp
phc tp gia cc nguyn nhn bn trong v bn ngoi. Tuy nhin li c nhng
trng hp chm m dng nh khng c quan h g vi qu mn c. Ni chung
c ch bnh sinh ca chm cn cha r rt cn cn tip tc c nghin cu.
Y hc c truyn cho rng gy nn bnh ny c th do nhng nguyn nhn sau:
Do n ung khng iu , ung ru, n cay hoc tanh qu nhiu lm tn
thng n t v. T mt kin vn s lm cho thp nhit ni sinh v tr,
ng thi ngoi cm phi phong thp nhit t. Ni ngoi t tng tc vi
nhau ri tr li b phu m sinh ra bnh.
Cng c khi v c th h nhc, t b thp lm khn, khin cho c nhc
khng c nui dng ri sinh bnh.
Cng c th cn v thp nhit ut lu ngy, lm hao tn phn m huyt,
huyt h ho to ri sinh phong, to nn chng huyt h phong to, lm
cho b phu khng c nui dng m thnh bnh.
4. Cc giai on ca chm
4.1. Chm cp tnh
Tn thng a dng v c quy lut din bin nht nh. Thng bt u l
nhng ban lan to, sau pht trin thnh nt sn, ri thnh mn nc, v
ra, xut tit ri ng thnh vy. Ni chung ti mt thi im thng c vi
dng tn thng ng thi tn ti.
Tn thng c th tp trung li thnh tng vng, nhng cng c th lan
to, khng c ranh gii r rt, thm ch c th lan trn ra ton thn. Tuy nhin
v tr hay gp nht vn l u, mt, phn ngn ca t chi, m nang. Nhng
phn b ny thng c tnh i xng.
Qua giai on cp tnh vi cc triu chng vim r rt, nu c iu tr
thch ng, sau 2 -3 tun bnh s khi, nhng rt d ti pht.
Bnh nhn t cm thy nng rt v nga d di.
4.2. Chm bn cp
y l giai on trung gian gia chm cp v chm mn. Thng do chm
mn tnh khng c iu tr kp thi v thch ng.
Tn thng da nh hn so vi giai on cp tnh vi tn thng ch yu l
nt sn, vy tit v vy da l chnh, ch c mt t mn nc v lot.
4.3. Chm mn tnh
Thng do chm cp v chm bn cp khng c iu tr thch ng, ko
di khng khi v thng xuyn ti pht m thnh. Tu v tr pht bnh m
bnh cnh lm sng khc nhau, nhng u c nhng c im chung sau y:
84
Thng pht cc b ti mt v tr no nh mu tay, cng chn, nch, m
nang, m h, c ranh gii r rng, cc triu chng vim khng r rng.
Da vng b bnh b lichen ho (dy v th, cc np nhn trn da rt r), c
lng ng sc t, trn mt thng c vy da, vy mu do nhng vt gi
li. Cng c th c mt s t cc nt sn v mn nc khi gi v c xut
tit. Khi tn thng xy ra cc khp th da d b nt toc ra hoc dy
ln, gy au nhiu v nh hng n hot ng.
Din bin ca bnh c xu hng mn tnh, lc nh lc nng, khng c quy
lut nht nh, thng hay ti pht thnh cp tnh, c bit l vo nhng lc
thn kinh cng thng.
Lc bnh thng cm gic nga khng r rng, nhng trc khi ng hoc
khi thn kinh cng thng thng xut hin nhng cn nga d di.
Din bin thng gp ca chm l giai on cp tnh v bn cp vi tun
thng ht, nhng hay ti pht ri dn tr thnh chm mn tnh. Tuy nhin
cng c nhng trng hp ngay t u xut hin ngay th bn cp hoc mn
tnh.
5. Chn on phn bit
5.1. Phn bit chm cp tnh vi vim da d ng tip xc
Vim da d ng tip xc Chm cp tnh
V tr Ch yu ni tip xc vi d nguyn,
hay gp ni b l ra ngoi
Khng c v tr nht nh, thng
i xng
Tn thng Mt loi, sng rt r rng, c th
thy bng nc to
Tn thng a dng, lan to, km
theo nga nhiu
Din bin Pht bnh cp, din bin ngn ngy, khi
loi tr c nguyn nhn th thng khi
Hay ti pht ri chuyn thnh
mn tnh
Tin lng Nu khng tip xc li vi d nguyn th
khng ti pht
Rt d ti pht
5.2. Chm mn tnh cn phn bit vi vim da thn kinh
Chm mn tnh Vim da thn kinh
Bnh s Thng do chm cp v bn cp
chuyn thnh
Trc ht c nga, sau mi dn
dn c cc tn thng da
Tn thng Da dy, thm nhim, lichen ho
khng r rng, c lng ng sc t,
trn v ra tn thng c nt sn
mu xm hoc mn nc nh, sau
khi v th xut tit
Sn phng, c hnh trn hoc hnh
a gic, lichen ho r, ra tn
thng c nhng nt sn phng c
mu ging vi da bnh thng,
hoc sng, khng c mn nc
Din bin C nhng giai on cp tnh xen k
vi mn tnh
L mt qu trnh mn tnh

85
5.3. Phn bit chm vi vim da m
Mc d trong tin trin ca vim da m c th c chm ho, nhng bnh
ch yu pht u, trc ngc, phn gia ca lng, nch, m b l nhng khu
vc c tit nhiu m. Tn thng ch yu ca bnh l nhng ban trn c
ph mt lp vy da c m.
6. Phn loi theo y hc c truyn
6.1. Th thp nhit
Th ny thng gp giai on chm cp tnh.
Bnh pht cp, din bin ngn. Tn thng da v nng, ph n nhiu,
xut tit nhiu. Tm phin, ming kht, i tin to, tiu tin t v , ru li
vng. Tnh trng ny l do thp nhit cng thnh, xm phm vo b phu ri gy
nn bnh.
6.2. Th t h thp thnh
Th ny thng gp giai on chm bn cp.
Bnh ko di; tn thng da th v dy, c th c xut tit nh, thng c
vy da; ming kht, i tin khng kh hoc lng, cht li nht, li bu, c
ngn rng, ru li trng nht, mch trm hon hoc hot. Tnh trng ny l
do t h, thp thnh lm cho b phu khng c nui dng m sinh bnh.
6.3. Th huyt h phong to
Th ny thng gp giai on chm mn tnh.
Bnh din bin mn tnh; tn thng da dy, nt n, hay c vy mu; cht
li nht, ru li trng, mch trm t hoc trm hon. Tnh trng ny do bnh
lu ngy lm hao tn m huyt, huyt h phong to gy nn bnh.
7. Phng v iu tr bnh
7.1. Nguyn tc
C gng tm ra nguyn nhn ri cch ly vi n, trnh kch thch da, loi tr
cc nhim trng, iu tr tt cc bnh mn tnh ton thn nh cc ri lon
ng tiu ho, bnh k sinh trng ng rut, bnh tiu ng, gin tnh mch
Tng cng gi v sinh da, khng dng nc nng v x phng ra ni c
chm, khng dng cc thuc tr nga c tnh kch thch.
Khng c ung ru, n cc thc n cay; trnh n cc loi cua, c d gy
kch thch v nhng n kh tiu ho khc. Ch quan st mi quan h gia
n ung v bnh tnh c iu chnh cho thch hp.
Lm vic hp l, trnh lao lc v cng thng qu .
86
7.2. iu tr
7.2.1. iu tr ton thn
Th thp nhit cng thnh: thng gp th ny giai on chm cp tnh.
+ Php iu tr: thanh nhit li thp, lng huyt gii c.
+ Bi thuc Long m t can thang [1] gia gim:
Nhit thnh; gia bch mao cn, thch cao.
Nhit c thnh: gia i thanh dip.
i tin to: gia i hong.
Cng c th dng Thanh nhit li thp thang [2].
Th t h thp thnh:
+ Php iu tr: kin t, to thp, dng huyt nhun phu.
+ Bi thuc: tr thp v linh thang [3] gia gim:
Thp thnh, xut tit nhiu th gia: t gii, xa tin t.
Th huyt h phong to:
+ Php iu tr: dng huyt s phong, tr thp nhun to.
+ Bi thuc: Tiu phong tn [4] hoc T vt tiu phong tn [5] gia gim:
Thp thnh gia: xa tin t, trch lan.
Nga nhiu gia: bch tt l, kh sm.
7.2.2. Chm cu
Chm cc huyt khc tr, tc tam l, huyt hi; chm loa tai cc im:
thn, ph, ni tit, thn mn.
7.2.3. iu tr ti ch
Giai on cp tnh:
+ Khi bnh mi pht ch ti ch, sn v mn nc cha v, cha xut
tit th nn dng cc thuc n ho tiu vim, trnh kch thch. Chn
cch p t cc thuc nh thuc ra L cam thch [6], dung dch 2%
bng phin.
+ Khi cc mn nc v v xut tit nhiu th nn dng cc thuc thu
lim, tiu vim... nhm thc y da hi phc. C th sc ly nc c
p t nhng thuc sau:
Rau sam 60g.
Hong b, sinh a du mi v 30g.
B cng anh, long m tho, cc hoa, mi v 30g.
87
+ Khi c bi nhim c th thm vo nc p cc v nh xuyn tm lin,
si t, bn lam cn.
+ Khi xut tit nhiu c th dng Tam diu tn [7] hoc Tr thp tn [8],
trn vi glycerin thnh cao lng ri bi ln tn thng.
+ Giai on cui ca giai on cp tnh l giai on bong vy, nu x l
khng tt s rt d lm cho bnh ko di v chuyn thnh mn tnh. Lc
ny nn dng cc thuc bo v tn thng, trnh cc kch thch t bn
ngoi, thc y lp sng ti sinh v gii quyt tnh trng vim cn st
li. Thuc nn dng l cc bi Cao thanh lng [9], Cao hong lin [10].
Giai on bn cp: nguyn tc iu tr lc ny l tiu vim, tr nga, thu
lim. C th s dng m oxyd km, Tr thp tn [8], Tn tam diu tn
[11] luyn vi du thc vt thnh cao, du t tho 5%, du a du-oxyd
km 10%.
Chm mn tnh: nguyn tc iu tr l cha nga, c ch s tng sinh ca
biu b, tiu tr tnh trng vim thm nhim trong lp chn b. C th
chn Cao hong lin [10], cao du u en 10%- 20%.
8. Kt lun
Chm l mt bnh da liu thng gp, do hay ti pht nn din bin ko
di, mang li nhiu thng kh cho ngi bnh. Cc thuc khng histamin
khng cho c kt qu nh mong i; liu php corticoid tuy c tc dng nht
nh, nhng sau khi dng thuc thng c hin tng ti pht nng hn, li c
nhiu tc dng ph. Thuc y hc c truyn vi tc dng chng vim, tr nga,
iu tit min dch c tc dng rt tt vi vic iu tr bnh ny, khng c tc
dng ph ca cc thuc khng histamin v corticoid, khng b ti pht nng
hn. Do , vic pht huy nhng u th ca thuc y hc c truyn c th cho
nhng bi thuc c hiu qu tt, an ton l mt vic lm rt c ngha.
Ghi ch bi thuc:
[1]. Long m t can thang: long m tho, chi t, hong cm, si h, sinh
a hong, trch t, ng quy, xa tin t, mc thng, cam tho.
[2]. Thanh nhit li thp thang: long m tho, hong cm, sinh a, i
thanh dip, xa tin tho, sinh thch cao, lc nht tn.
[3]. Tr thp v linh thang: thng trut, hu phc, trn b, hot thch,
bch trut, tr linh, hong b, ch thc, trch t, phc linh, cam tho.
[4]. Tiu phong tn: ng quy, sinh a, phng phong, thuyn thoi, tri
mu, kh sm, h ma nhn, kinh gii, thng trut, ngu bng t, thch cao,
cam tho, mc thng.
[5]. T vt tiu phong tn: sinh i hong, ng quy, kinh gii, phng
phong, xch thc, xuyn khung, bch tin b, thuyn thoi, bc h, c hot,
si h, hng to.
88
[6]. Thuc ra L cam thch: l cam thch 10g, oxyt km 2g, acid carbonic
1ml, glycerine 5ml, nc ct va 100ml.
[7]. Tam diu tn: hong b, ngu tt, thng trut.
[8]. Tr thp tn: i hong 30g, hong cm 30g, hn thu thch 30g,
thanh i 3g.
[9]. Cao thanh lng: ng quy 30g, t tho 6g, i hong 4,5g, sp ong
120g, du thc vt 480g.
[10]. Cao hong lin: hong lin 20g, vaselin 80g.
[11]. Tn tam diu tn: hong b 10, hn thu thch 5g, thanh i 1g.
T lng gi
1. Trnh by nguyn nhn v c ch bnh sinh ca chm theo y hc hin i?
2. Trnh by nguyn nhn v c ch bnh sinh ca chm theo y hc c truyn?
3. K tn cc giai on ca chm?
4. Bnh nhn chm vi cc triu chng chnh nh sau:
Tn thng a dng v c quy lut din bin nht nh. Thng bt u l
nhng ban lan to, sau pht trin thnh nt sn, ri thnh mn
nc, v ra, xut tit ri ng thnh vy. Ni chung ti mt thi im
thng c vi dng tn thng ng thi tn ti.
Tn thng c th tp trung li thnh tng vng, nhng cng c th lan
to, khng c ranh gii r rt, thm ch c th lan trn ra ton thn. Tuy
nhin v tr hay gp nht vn l u, mt, phn ngn ca t chi, m nang.
Nhng phn b ny thng c tnh i xng.
Qua giai on cp tnh vi cc triu chng vim r rt, nu c iu tr
thch ng, sau 2 -3 tun bnh s khi, nhng rt d ti pht.
Bnh nhn t cm thy nng rt v nga d di.
Thuc v giai on no ca chm?
5. Bnh nhn chm vi cc triu chng chnh nh sau tn thng da nh
hn so vi giai on cp tnh vi tn thng ch yu l nt sn, vy tit v vy
da l chnh, ch c mt t mn nc v lot.
Thuc v giai on no ca bnh chm?
Bnh nhn chm vi cc triu chng chnh nh sau: thng do chm cp
v chm bn cp khng c iu tr thch ng, ko di khng khi v thng
xuyn ti pht m thnh. Tu v tr pht bnh m bnh cnh lm sng khc
nhau, nhng u c nhng c im chung sau y:
89
+ Thng pht cc b ti mt v tr no nh mu tay, cng chn, nch, m
nang, m h, c ranh gii r rng, cc triu chng vim khng r rng.
+ Da vng b bnh b lichen ho (dy v th, cc np nhn trn da rt r),
c lng ng sc t, trn mt thng c vy da, vy mu do nhng vt
gi li. Cng c th c mt s t cc nt sn v mn nc khi gi v
c xut tit. Khi tn thng xy ra cc khp th da d b nt toc ra
hoc dy ln, gy au nhiu v nh hng n hot ng.
Thuc v giai on no?
6. Bnh nhn chm vi cc triu chng chnh nh sau:
Din bin ca bnh ko di, khng c quy lut nht nh, thng hay ti
pht thnh cp tnh, c bit l vo nhng lc thn kinh cng thng.
Lc bnh thng cm gic nga khng r rng, nhng trc khi ng hoc
khi thn kinh cng thng thng xut hin nhng cn nga d di.
Thuc v giai on no?


90
Bi 11
Bnh my ay
(n chn)
Mc tiu
1. Hiu c bnh nguyn v bnh sinh ca bnh my ay theo y hc hin i v
y hc c truyn.
2. Trnh by c cc th bnh ca bnh my ay theo y hc hin i.
3. Chn on c cc th bnh my ay v cch iu tr bng y hc c truyn.


1. i cng
y l mt bnh da liu c tnh qu mn thng gp. Lm sng biu hin
bng: ni my ay to nh khng u, c th cc b nhng cng c th lan ra ton
thn, bnh pht t ngt, tin trin nhanh, bin mt cng rt nhanh v khng
li so. Bnh ny thuc v phm vi chng n chn ca y hc c truyn.
2. nguyn nhn gy bnh
Nguyn nhn gy ra chng ni my ay ny c rt nhiu, ch yu gm:
Nhng vt ht phi: phn hoa, bi xc ng vt, khi thuc, bo t nm,
mt s cht bay hi.
n: c, tm, trng sa v nhng n giu m khc.
Thuc: vaccin, huyt thanh v rt nhiu loi thuc khc.
Nhim trng: rt nhiu loi k sinh trng, vi khun, nm, virus, coxsackie
c th gy ni my ay.
Cc yu t vt l: nh nng mt tri, nhit thp, hon cnh nng m.
Yu t tinh thn: my ay hay ni vo lc lo lng, hng phn qu mc.
Nhng nguyn nhn khc: cn trng t, mt s thc vt, mt s bnh
ton thn nh bnh tng s lng tng bo, bnh bch cu v mt s
bnh ni tit.

91
3. C ch bnh sinh
3.1. Theo y hc hin i
C ch sinh bnh cho n nay vn cha c sng t hon ton. Ni chung
ngi ta cho rng bnh ny c lin quan n phn ng qu mn tp I. Do
tng bo gii phng ra histamin, lm gin cc mao mch, tng tnh thm
thnh mch, huyt tng thm qua thnh mch vo vng chn b m gy
nn ni my ay nh lm sng vn thng thy.
C mt s loi ni my ay li lin quan n phn ng qu mn typ III.
Phc hp khng nguyn khng th kch thch b th, khi ng cho qu
trnh sn sinh ra cc cht trung gian ho hc, lm cho tng bo gii
phng ra histamin ri gy nn ni my ay.
Ngoi nhng c ch trn cc yu t vt l, ho hc trc tip lm tn
thng t chc, kch thch trc tip cc tng bo, ri gy ra ni my ay.
Ngoi ra ni my ay cn c mi lin quan ti yu t di truyn.
3.2. Theo y hc c truyn
Do bm t tin thin khng y , li n phi nhng thc n tanh d gy
ng phong nh tm, c, ri gy bnh.
Hoc v n ung khng iu , khin cho v trng thc nhit; hoc v th
cht suy nhc, v kh khng kin c, khin cho c th d cm phi phong
nhit, phong hn t, t kh ut khong tu l m gy nn bnh.
Cng c th cn v nguyn vng khng c tho mn, can kh ut, mt s
tit, kh c ng, khng thng, ho thnh ho, gy tn thng m huyt,
khin cho m huyt bt tc, lm cho c th d cm phi phong hn t m
gy nn bnh.
4. Triu chng v chn on
4.1. Bnh s
Trong bnh s ngi bnh c th c tin s tip xc vi thc n, thuc kh
nghi gy d ng. C th c tin s mc bnh nhim trng, hoc bnh l nhim.
Cng nn tm tin s cc bnh d ng nhng ngi cng gia tc vi bnh nhn.
4.2. Triu chng
4.2.1. Ni my ay thng thng (common urcaria)
Nt my ay xut hin rt t nhin. Nhng tn thng ny c hnh dng,
kch thc khng ging nhau, mu hng nht hoc nh mu da, ranh gii r.
Nhiu khi nhng ban my ay ny dnh lin vi nhau thnh mt mng.
Bnh nhn cm thy nga d di, c khi c cm gic nng rt.
Tn thng thng tn ti vi gi sau th bin mt v khng li du vt
g. C khi pht li nhiu ln trong ngy.
92
Ni pht bnh thng khng c nh, c th cc b, cng c th ton thn,
ngay c nim mc cng b nh hng. Nu pht sinh nim mc ng tiu
ho, c th gy bun nn, nn, au bng. Nu nim mc ng h hp c
th gy nn kh th, trng hp nng c th nguy him cho tnh mnh.
Triu chng vch da c th dng tnh.
Cn c theo bnh trnh c th phn thnh mn tnh v cp tnh. Th cp
tnh ko di vi ngy hoc vi tun, nguyn nhn d tm ra; khi loi tr c
nguyn nhn, bnh s khi rt nhanh. Loi mn tnh thng ti pht nhiu ln,
qua nhiu thng, nhiu nm khng khi, rt kh tm ra nguyn nhn.
T chc bnh l: ph n cc b, cc lp nh v lp chn b ph n, xung
quanh mch mu thm nhim mt s t bo lympho.
4.2.2. Chng da ni vch
Chng da ni vch ngi ta cn gi l bnh my ay gi to (factition urticaria).
Da ca ngi bnh rt mn cm vi nhng kch thch c hc bn ngoi,
trn da thng khng c tn thng my ay, nhng nu dng mng tay
hoc mt vt cng khc vch ln da th sau khng lu s ni ln trn
mt da mt vch ph n theo ng vch.
Bnh ny c th gp mi la tui, khng c nguyn nhn gy bnh r rt.
C th c mi quan h ca tnh trng ny vi nhng nhim trng tim n,
bnh tiu ng, ri lon chc nng tuyn gip, thi k mn kinh.
Bnh trnh di ngn bt nh, c th di ko di vi thng hoc lu hn na.
Mt s bnh nhn, ti nhng vng b t nhiu, nh gt chn, mng, c
th pht sinh tnh trng h b b ph n. Trng hp ny gi l bnh ni
my ay do p lc (pressure urticaria).
Cng c mt s trng hp sau khi nhng vch ph n to nn bi tc
ng c gii nh trn s tn ti mt vi gi ri bin i, li xut hin nhng
tn thng my ay khc ngay ti vng c v tn ti ko di ti vi ngy.
4.2.3. Ph n do huyt qun
Chng ny cn c gi l chng ph n do thn kinh v mch mu
(angioneurotic edema), cng cn c gi l ph Quincke.
Tn thng da cc b, cp tnh, ranh gii khng r rng, mu ca da bnh
thng hoc hng, nga mc va phi.
Nhng v tr hay c tn thng l nhng ni c t chc lng lo nh mi
mt, mi, di tai; c lc cn c th thy nim mc ming, li, hu.
Bnh thng xut hin vo ban m, khi ngi bnh tnh dy th pht
hin ra.
Bnh thng xut hin cng vi bnh my ay thng thng, sau 2 - 3
ngy th mt, nhng hay ti pht ti chnh v tr c.
93
C khi cn gp nhng ri lon tiu ho nh bun nn, nn, au qun bng
do ph n nim mc ng tiu ho. Nu ph n nim mc hu hng th
c th gy kh th, thm ch c th e da tnh mng.
y l bnh di truyn bi mt nhim sc th thng. Nu bnh pht sinh
t lc tr, th sut i ngi y s mang theo.
4.2.4. My ay do nh sng
Tn thng hay gp nhng phn da h. Sau khi b chiu sng vi pht
n vi chc pht l bt u xut hin nga, ban , ri nhanh chng chuyn
thnh my ay. Thng sau vi gi th nhng tn thng ny bin mt, nhng
cng c th tn ti mt thi gian di, nht l nhng ngi b chiu sng
thng xuyn. Tuy nhin mt s ngi thng xuyn b chiu sng s thy
xut hin hin tng nhn nh sng v khng b mi my ay na.
Th nghim bng chiu tia cc tm l mt tiu chun c gi tr trong chn
on, sau mt thi gian ngn b chiu sng thy xut hin ban v my ay.
Bnh l do phn ng qu mn pht sinh di tc dng ca tia t ngoi.
Di tc dng ca tia ny, s chuyn ho da s sn sinh ra mt s cht c tnh
khng nguyn, ri t pht sinh phn ng kt hp khng nguyn khng th.
Mt c ch khc c th l do hot tnh ca nh sng t ngoi lm trc tip gii
phng cc histamin ti t chc.
4.2.5. My ay do lnh
Bnh hay thy ph n tr.
Sau khi tip xc vi lnh, vng tip xc c m tr li th xut hin nga,
ph n v ni my ay, thng th khong mt gi sau s bin mt.
Tn thng thng pht sinh ti nhng vng da h, nhng khi nng c
th lan ra c nhng vng da khc. Nhng trng hp nng khi ung
lnh c th gy ph n nim mc ming, li, hng, thm ch nim mc
ng tiu ha cng ph n ri gy au bng.
Hay km vi au u, chng mt, huyt p thp.
Nhng ngi ny khi gp nc lnh (trong b bi hoc trong nh tm) c
th b shock, thm ch t vong.
Dng nc lnh chm ln da bnh nhn, sau vi pht s thy my ay
ni ln in hnh. y l mt th nghim rt c gi tr chn on
bnh ny.
Bnh ny c tnh di truyn r rt, gen di truyn nm trn nhim sc th
thng.
4.2.6. My ay do acetylcholin
My ay hay xut hin sau vn ng mnh, khi gp nng hoc cng thng
thn kinh qu .
94
Tn thng c c trng bi nhng nt my ay c kch thc 1 n
3mm, xung quanh c ban , phn b tn mn v km theo nga.
Khi xut hin my ay hay c ra nhiu m hi. Trn nhng vng ban
xung quanh my ay li xut hin nhng my ay v tinh.
C ch ca hin tng ny l trong khi vn ng mnh, gp mi trng
nng, hoc cng thng qu mc, cc trung tm ph giao cm s gii phng
acetylcholin, cht ny s tc ng ln tng bo lm gii phng ra histamin.
5. Phn loi theo y hc c truyn
5.1. Th phong nhit
Bnh pht rt nhanh; my ay mu , nga d di, km theo pht st,
bun nn, hng sng au, bun nn, au bng, khi gp nng th bnh nng ln.
Ru li vng mng, mch ph sc. Chng ny thuc v phong nhit thc biu,
ph v khng tuyn pht.
5.2. Th phong hn
Mu ca my ay nh mu ca da bnh thng, gp gi hoc lnh th
nng thm, ming khng kht, cht li bu nht, ru trng, mch khn.
Chng ny thuc v phong hn thc biu, ph v mt tuyn thng.
5.3. Th m huyt bt tc
My ay hay ti pht, ko di khng khi, bnh hay pht v chiu v m,
tm phin, hi hp, hay cu, ming kh, li kh, mch trm t. Chng ny
thuc v m huyt bt tc, phong t thc biu.
6. iu tr bng y hc c truyn
6.1. iu tr bng thuc ung
6.1.1. Th phong nhit
Php iu tr: tn lng thu biu, tuyn ph thanh nhit.
Bi thuc: c th la chn mt trong nhng bi thuc Kinh phong
phng
[1]
, Tang cc m
[2]
, Phng phong thng thnh tn
[3]
; hoc phi hp chng
vi nhau.
6.1.2. Th phong hn
Php iu tr: tn n gii biu, tuyn ph tn hn.
Bi thuc: Ma hong phng
[4]
, hoc c v ph bnh.
6.1.3. Th m huyt bt tc
Php iu tr: t m, nhun huyt, s tn phong t.
Bi thuc: Lc v gia kinh gii, phng phong, hoc a b m phng
[5]
.
95
6.2. Chm cu
Dng cho cc trng hp my ay mn tnh.
Phng huyt: khc tr, cch du, can du, i trng du, huyt hi, tam m
giao, hp cc. Chm bnh b bnh t.
6.3. iu tr ti ch
Dng nc sc l dng ra ni c my ay.
Bi cn thuc Bch b
[6]
.
6.4. Cc bin php iu tr phi hp
C gng tm nguyn nhn trnh tip xc.
Ch iu tr cc ri lon d dy, rut, bnh k sinh trng, cc ri lon
ni tit, cc nhim trng mn tnh.
Trnh n cc thc n d gy d ng.
King ru, ch c, c ph, cc loi thc n cay nng.
Lun gi cho i tin thng.
7. Nhn xt
i vi my ay cp tnh cc thuc gii d ng ca y hc c truyn cn
cha pht huy hiu qu nhanh nh thuc Ty. Nhng nghin cu v phng
din ny vn cn t, c th l do hn ch v ng dng ca thuc y hc c
truyn. Do trc mt vi nhng trng hp my ay cp tnh c km theo
ph n nim mc ng h hp, shock nn phi hp ng Ty y trong iu tr.
i vi m ay mc trung bnh hoc nh th iu tr bng y hc c
truyn cho hiu qu tt; cn trong vic gim bt ti pht th thuc y hc c
truyn li c u th ln thng qua vic bin chng lun tr iu ho li cc
ri lon trong p ng min dch ca ngi bnh.
Ph lc bi thuc
1. Kinh phong phng: kinh gii, phng phong, cng tm, kim ngn hoa,
thuyn thoi, ngu bng t, an b, ph bnh, sinh a, hong cm, cam tho.
2. Tang cc m: tang dip, cc hoa, hnh nhn, ct cch, cam tho, bc h,
lin kiu, l cn.
3. Phng phong thng thnh tn: phng phong, kinh gii, lin kiu, ma
hong, bc h, xuyn khung, ng quy, bch thc, bch trut, chi t, i
hong, mang tiu, thch cao, hong cm, ct cnh, cam tho, hot thch.
4. Ma hong phng: ma hong, hnh nhn, can khng b, ph bnh,
bch tin b, trn b, an b, bch cng tm, an sm.
5. a b m phng: a ct b 10g, ng gia b 10g, tang bch b 10g, can
khng b 5g, i phc b 10g, bch tin b 15g, an b 15g, xch linh b 15g,
ng qua b 15g, bin u b 10g.
6. Cn thuc bch b: bch b 25g, cn 75 100ml, ngm 1 tun.
96
T lng gi
1. Trnh by cc nguyn nhn gy bnh my ay theo 3 nhm nguyn nhn
Ni nhn: .
Ngoi nhn:
Bt ni ngoi nhn:
2. in nhng ni dung thch hp vo ch trng
iu tr my ay th phong nhit:
+ Php iu tr:
+ Tn bi thuc:


iu tr my ay th phong hn:
+ Php iu tr:
+ Tn bi thuc:


iu tr my ay th m huyt bt tc:
+ Php iu tr:
+ Tn bi thuc:


3. Mt bnh nhn b my ay vi cc triu chng lm sng nh sau: bnh
pht rt nhanh, my ay mu , nga d di, km theo pht st, bun nn,
hng sng au, bun nn, au bng, khi gp nng th bnh nng ln, ru li
vng mng, mch ph sc. Chng ny thuc v phong nhit thc biu, ph v
khng tuyn pht.
Thuc v th bnh no ca y hc c truyn:
+ Phong nhit:
+ Phong hn:
+ m huyt bt tc:
97
Bi 12
tr
mc tiu
1. Phn bit c cc dng ca tr ni.
2. Trnh by c cc triu chng v cch iu tr bnh tr theo y hc c truyn.


1. i cng
Bnh tr l mt tp hp cc biu hin bnh l c lin quan n nhng thay
i ca thnh mch v ca cc m tip xc nng mng mch hu mn trc
trng.
Bnh tr c t l ngi mc rt cao (chim ti 35-55% dn s) do nhng yu
t gy bnh ch yu sau:
Ri lon lu thng tiu ha: ta bn, a chy, c thai.
S suy yu ca t chc nng (thoi ha keo ca cc dy chng c nng
hu mn).
Ch n: ung nhiu ru
Ni ging (ngi Do Thi b tr nhiu hn).
Mt s ngh: phi ng lu, th may, li tu , mt s mn th thao (ci
nga) hoc thi quen sng tnh ti.
Mt s bnh: l, vim i trng
2. phn loi tr
2.1. Tr ni
Tr ni l nhng bi tr nm trong c rng lc: c Morgagnie) v chia lm
4 .
1: tr ch to trong lng ng hu mn, khi i tin tr khng sa ra ngoi
hu mn.
2: bi tr sa ra ngoi hu mn khi i i tin, sau t co ln.
3: bi tr sa ra ngoi hu mn khi i i tin, sau i ngoi phi ly tay
y bi tr vo hu mn v bi tr khng sa ra ngoi khi i li hay gng sc.
98
4: bi tr sa thng xuyn ngoi hu mn hoc y vo hu mn kh,
khi i li hoc gng sc bi tr d tt ra ngoi hu mn.
2.2. Tr ngoi
Tr ngoi l nhng bi tr nm ngoi c rng lc. y l loi tr c ph
bi da.
2.3. Tr hn hp
Tr hn hp l nhng bi tr nm va trong va ngoi c rng lc.
3. Bin chng ca bnh tr
Tc mch tr ngoi.
Tr sa, nght, tc mch, thng l bin chng ca tr ni giai on 2,3.
Bnh tr c th iu tr bng phng php ni khoa, th thut hay phu
thut. Ch nh iu tr ty theo giai on pht trin ca bnh, hon cnh v
nguyn vng ca bnh nhn, kinh nghim ca thy thuc, trang thit b ca c s.
4. iu tr bng phng php ni khoa
4.1. Th huyt (tng ng vi tr ni 1, 2)
Triu chng: khi i tin c mu ti km theo phn. Mu c th khng
nhiu (thm giy v sinh, ti ln cc phn tng git) hoc nhiu nh ct
tit g.
Php iu tr: lng huyt ch huyt.
Phng dc: thng dng 1 trong cc bi thuc c phng sau:
Bi 1: He gic a du hon
Ch xc 60g Hong cm sao en 80g
a du sao en 80g a hong sao en 80g
He gic sao vng 160g Kinh gii sao 80g
Quy v 40g
* Tn bt trn mt lm hon, to bng ht ng ng ln, mi ln ung 12g
lc i, ngy 2 ln.
Bi 2: Lng huyt a hong thang
ng quy 4g Hong b 6g
He hoa 4g Thanh b 4g
Thc a 4g Tri mu 6g
Sc ung mi ngy 1 thang
99
Bi 3: He hoa tn
Cam tho 20g ng quy 40g
Ch xc 40g Hu phc 40g
He hoa 80g mai 20g
Thng trut 40g Trn b 40g
Tn bt, mi ln dng 20g, sc vi nc ung lc i.
Chm cu: trng cng, th liu, i trng du, tc tam l, tam m giao,
tha sn, hp cc.
4.2. Th thp nhit (tng ng vi bin chng ca tr)
Triu chng lm sng: vng hu mn au tit nhiu dch, tr sa ra ngoi
au khng y vo c, c th c cc im hoi t trn b mt tr, i
tin to.
Php iu tr: thanh nhit li thp, hot huyt ch thng.
Phng dc: s dng mt trong cc bi thuc c phng sau
Bi 1: Tn cu phng phong thang
Bch trut 6g Thng ma 8g
Chch tho 4g Trch t 12g
i hong 4g Trn b 8g
o nhn 12ht Si h 8g
Hong b 12g Tn cu 12g
Quy thn 12g
Sc ung ngy 1 thang.
Bi 2: Tn cu bch trut hon
Bch trut 40g Ht b kt 20g
Ch thc 20g Quy v 40g
o nhn 40g Tn cu 40g
a du 12g Trch t 20g
Tn bt lm hon ung 8 - 12g/ngy.
Bi 3: ch tr s 9 hm nc si ung 50g/ngy.
Chm cu: dng cc huyt nh trong th huyt .
4.3. Th kh huyt u h
Tng ng vi tr ngi gi, tr lu ngy gy thiu mu.
100
Triu chng lm sng: i tin ra mu lu ngy, hoa mt, tai, sc mt
trng bt, ru li trng mng, ngi mt mi, on hi, mch trm t.
Php iu tr: ch kh thng , b huyt, ch huyt.
Phng dc: c th s dng mt trong cc bi thuc c phng sau
Bi 1: B trung ch kh thang
ng sm 16g Thng ma 8g
Hong k 12g Si h 12g
ng quy 8g Cam tho 4g
Bch trut 12g Trn b 6g
Sc ung ngy 1 thang.
Bi 2: T qun t thang gia v
Nhn sm 8g Bch bin u 8g
Bch trut 8g Hong k 8g
Phc linh 8g Cam tho 8g
Sc ung ngy mt thang.
Chm cu: trng cng, tc tam l, tam m giao, huyt hi, t du, thn
du; dng b php.
5. iu tr tr bng th thut
5.1. Tim chai x bi tr
Cht gy x chai c th l persulfat st, acid carbonic 10- 20%, du oliu,
cn 90
o
hoc dung dch phenol 5% hoc huyt thanh nng.
Ch nh: tr ni 2 - 3.
5.2. Tht tr bng vng cao su
Ch nh: tr ni 2 - 3.
5.3. Thuc lm hoi t rng tr (kh tr tn)
Thch tn (bch ph ) 20g Thn sa 8g
Bch phn (phn chua) 80g Hng hong 8g
Lu hong (dim sinh) 8g
Tn bt rc vo tr.
Ch nh: tr ni 2 - 3.

101
6. iu tr tr bng phu thut
C th l iu tr tm thi (cha bin chng nh mu t) hay iu tr tit
cn (iu tr bnh tr). Phu thut c dng nhiu nht hin nay l phu
thut bng phng php Milligan Morgan, Longo.
Hin nay vic kt hp gia y hc hin i v y hc c truyn iu tr
bnh tr mang li nhiu kt qu tt. V d nh bnh nhn sau khi c phu
thut ct b tr c kt hp vi ngm ra hu mn bng bt ngm tr c
thnh phn l cc v thuc ng y th vt thng au, mau lin, t chy mu.
T lng gi
Chn cu tr li ng nht bng cch khoanh trn vo ch ci u cu
Cu 1: Du hiu chnh phn bit cc ca tr ni l
a. i tin ra mu ti km theo phn
b. C bi tr sa ra ngoi hu mn khi i i tin
c. C bi tr sa ra ngoi hu mn hay khng v tnh cht sa ca bi tr khi
i i tin
Cu 2: iu tr bnh tr bng dng c thng p dng vi
a. Tr 1,2 hoc 3
b. Tr 4
c. Cc bin chng ca tr
Cu 3: Hy khoanh trn vo ch cho cu ng v ch S cho cu sai:

Php iu tr thch hp cho tr th huyt l lng huyt
ch huyt
/S
Bi thuc B trung ch kh thang dng trong trng hp
bnh tr th thp nhit l thch hp
/S
Bnh tr ch c th iu tr bng phu thut /S
102
Bi 13
r hu mn
(Giang lu)
Mc tiu
1. Nm vng quan nim, phn loi, bnh sinh bnh nguyn r hu mn.
2. Hiu v nu c cc triu chng v iu tr bng ung thuc y hc c truyn
i vi r hu mn.
3. Hiu v nu c cc phng php iu tr ti ch bng y hc c truyn i vi
r hu mn.


1. i cng
R hu mn l mt bnh kh ph bin vng hu mn thng ng sau
tr. Bnh do p xe vng hu mn hoc tr vim m x l khng tt sinh ra.
Bnh hay gp nam gii, c bit t thi Hyppocrate (cch y 500 nm trc
Cng nguyn). Vit Nam c i danh y Tu Tnh v Hi Thng Ln
ng m t v c nhiu bi thuc iu tr.
R hu mn theo y hc c truyn cn c tn giang lu, tr lu (r do tr)
hoc tr sang.
2. Bnh sinh, bnh nguyn
Trong cc y vn u thng nht nguyn nhn ch yu l thp nhit ut
kt giang mn lm cho kh huyt vn hnh khng thng xng hoc c th kh
huyt h sn cho nn thp nhit ut kt, kt hp vi kh huyt h v khng
thng xng, nung nu m sinh ra sng, c m v nui dng km nn xut
hin lot thnh l, dn dn khot su thnh ng gy nn r hu mn.
3. Phn loi
Da vo bnh sinh, bnh nguyn chia r hu mn c cc th sau:
Th thp nhit.
Th m h ni nhit.
Th trung kh bt tc.
Th kh huyt lng h.
103
4. Chn on r hu mn theo Y hc hin i
Vng hu mn c l r chy nc vng hoc nc m, s lng l r c th
c 1-2 hoc 3 l.
Bm hi hoc xanh methylen xc nh c l r trong v ng r.
5. Phng php iu tr
Theo y hc c truyn c 2 nguyn tc iu tr phi kt hp vi nhau l:
iu tr ton thn (ni tr) v iu tr ti ch (ngoi tr).
5.1. iu tr ton thn
Ngi ta thng da vo th bnh iu tr.
5.1.1. Th thp nhit
Triu chng: bnh mi mc hoc t cp; ti l r sng, nng, , au,
chy nc vng hoc m c, st nng, ru li vng nht, cht li ,
mch hot sc.
Chn on:
+ Bt cng: thc nhit.
+ Nguyn nhn: thp nhit.
Php iu tr: thanh nhit tr thp, gii c, bi nng, sinh c.
Bi thuc: Thc l tiu c tn
Sinh hong k 12g ng quy 12g
To gic thch 12g Bch trut 12g
Kim ngn hoa 16g Phc linh 16g
Ct cnh 12g ng sm 16g
Bch ch 8g Bch thc 12g
Xuyn khung 8g
5.1.2. Th m h ni nhit
Triu chng: bnh mc lu ngy, ngi gy, da mi kh, lng quyn ,
st v chiu, trong ngi ho nng, i tin to, tiu tin vng, l r khng
nng , chy dch m long hoc t dnh, li ru vng kh, cht li ,
mch v lc hoc t sc.
Chn on:
Bt cng: h nhit
Nguyn nhn: m h.
Php iu tr: dng m thanh nhit, bi nng sinh c.
104
Bi thuc: Thanh ct tn gia gim
Thch cao 8g Ngn si h 6g
Mit gip 12g Hong lin 8g
a ct b 12g Cam tho 4g
Tri mu 12g Tn giao 8g
Gia: ng quy 8g, hong k 12g, thng trut 10g.
5.1.3. Th trung kh bt tc
Triu chng: ngi gy, mt mi, c nho, l r thm t, chy dch nhn,
khng sng nng , n t, ru li vng, cht li nht bu, mch trm t.
Chn on:
+ Bt cng: l h.
+ Nguyn nhn: kh huyt h.
Php iu tr: b kh ch huyt, bi nng sinh c.
Bi thuc: Bt trn gia v
ng sm 12g Thc a 12g
Bch trut 10g ng quy 10g
Cam tho 16g Xuyn khung 12g
Bch linh 12g Bch thc 12g
Gia: hong k 12g, to gic thch 8g, kim ngn 12g.
5.2. iu tr ti ch
Trong y hc c truyn c nhiu v thuc, bi thuc iu tr v cc cch iu
tr bnh giang lu.
5.2.1. Cch tht l r
i nh Minh, Trung Quc: dng si c di lun qua 2 l ng r, ri
dng thuc thanh nhit kh h sinh c, iu tr na thng si c tt ra l
khi, cch ny sau ny s dng trong tht m l r.
Dng 7-8 si ch lun xuyn l r, mi ngy tht mt si sao cho si cui
va tht ht ch l r.
5.2.2. Cch kh h sinh c
Kinh nghim gia truyn 1 (ng lang Tr, Thu Nguyn, Hi Phng): dng
thch tn ch thnh que, t vo ng r cho n khi ng r b ph hu
hon ton.
Tai bin: st cao, vng hu mn sng ty, rt d nhim c, do thch
tn khng c dng (Vin Y hc c truyn VN nghin cu).
105
5.2.3. Cch ngm ra
Dng l tru khng ti, sc c, ngm vng r.
Theo i danh y Tu Tnh: dng phn nga trng, gi nt vi mui, mi
th 1/2 em sao nng, p vo l r cho n khi khi th thi (cch ny
cha nghin cu).
Ni chung cc cch cha ti ch gii thiu trn hin nay khng s dng
c, do vy ngy nay ngi ta dng tht hoc m ca y hc hin i v dng
thuc ni tr ca y hc c truyn.
Xin gii thiu mt phng php iu tr kt hp y hc c truyn vi y
hc hin i c kt qu tt ( ti nghin cu ca bc s CKII Phm Vn Sn)
nh sau:
Thuc ngm:
L tru khng 50g
Phn phi 5g
Cho 2 lt nc un si ngui, ngm vng r hng ngy.
Thuc ung: bi Thc l tiu c
Hong k 10g Phc linh 12g
ng quy 10g Bch trut 10g
Ngu tt 10g ng sm 12g
Xch thc 10g Kim ngn hoa 10g
Sc ung ngy 1 thang
Tht ng r: dng que thm d a vin bao cao su (OK) lun qua l r v
buc. Trc khi buc tht cn rch da theo ng r chng au, vin
cao su sau 10-12 ngy t rng, ming l r h; nu lin bc cu th dng
gy t, ct lc, sau ngm v ung thuc trung bnh 25 ngy l khi (kt
qu khi 97%, 3%, khng khi 0%). Phng php ny c th ng dng
rng ri, nht l tuyn c s.
6. Kt lun
iu tr r hu mn quan trng vn l ti ch, loi b ng r bng phu
thut hoc tht m ng r c th kt hp vi thuc ngm, thuc ung bng y hc
c truyn c l l phng php hu hiu nht.
T lng gi
1. Anh (ch) hy trnh by phng php iu tr r hu mn bng ung
thuc y hc c truyn.
2. Anh (ch) hy trnh by phng php iu tr ti ch r hu mn bng y
hc c truyn.
106
Bi 14
Mn nht
(Tit inh)
Mc tiu
Trnh by c triu chng v cc phng php iu tr bnh mn nht theo y
hc c truyn.


1. i cng
Bnh mn nht l mt bnh nhim khun ngoi da, thng gp phn ln
l do t cu vng. Y hc c truyn gi mn nht l tit. Bnh pht tp trung
mt s v tr trn c th hay ri rc khp ngi, d ti pht. Nht thng mc
tp trung vng gy, mng v nch.
2. nguyn nhn
Bnh phn ln l do nhit gy ra.
Nhng yu t c lin quan do v sinh da km, nga gi, da b kch thch do
bi ha cht, c xt nhiu ln, tinh thn cng thng, lao lc qu mc, mc bnh
tiu ng, c th suy yu.
3. triu chng lm sng
Nht mi mc hi nga, sng, cng au; sau to dn, nng, au v c
m; km theo l pht st, ming kht, i tin to bn, tiu vng , ngc y,
chn n, li ru vng nhy, mch hot sc. Sau khi chy ht m th ng
vy, lin da.
4. phng php iu tr
4.1. Giai on sng au
Php iu tr: thanh nhit gii c, hot huyt tiu vim.
Bi thuc:
+ Thuc dng ngoi: dng 1 -2 v thuc sau
B cng anh L rau sam
L ph dung L dip c
Gi nt vi mui, p vo mn nht ngy hai ln.
107
+ Thuc dng ung trong: bi Gii c thang
B cng anh 20g Huyn sm 20g
H th 12g K u nga 12g
Hong ng 12g K huyt ng 12g
L n 12g Th phc linh 20g
Sn tr 12g V cy go 20g
L mng tay 12g Si t 20g
Sc ung ngy mt thang.
Chm: chm cc huyt n lu, h c h, hp cc, cc huyt a th xung
quanh mn; dng t php.
4.2. Giai on ha m
Php iu tr: thc c, bi nng.
Bi thuc:
+ Thuc dng ngoi: p cho v m
Rc ry
L xoan
Mui
Lng bng nhau, gi nh trn u ngy p hai ln.
+ Thuc dng trong:
Bi thuc: Ni thc tiu c tn
Bch ch 40g Cam tho 20g
Ct cnh 40g ng quy 20g
Hong k 60g Ngn hoa 60g
Lin kiu 80g Nhn sm 60g
Phng phong 40g Xuyn khung 40g
Tn bt cho thm nc vo nu, lc b b, ung.
4.3. Giai on v m
Giai on ny c th c km theo c th suy nhc.
Php iu tr: kh h, sinh c, b ch kh huyt.
Bi thuc:
+ Thuc dng ngoi: dng cao dn ht m v ln da, gm
C ry di 100g Sp ong 30g
Ngh gi 50g Nha thng 30g
Du vng 300ml
Cc vng 1 con t tn tnh
108
Cch ch v dng: cho du vng, ngh, ry un si n khi ngh, ry teo
li, gn b b, cho sp ong vo un tan, cho bt cc v nha thng khuy tan
u, ly 1 git nh vo mt ci a khng le ra l c.
Ra sch mn nht bng nc l tru khng v kinh gii, pht cao vo 1
ming giy c l chc thng gia v dn ln nht.
+ Thuc ung trong:
Bi thuc Ni b hong k thang
Bch thc 10g Vin ch 8g
Nhc qu 2g Phc linh 10g
Cam tho 4g Xuyn khung 8g
Hong k 12g Quy thn 12g
Nhn sm 12g Thc a 12g
Mch mn 12g
Sc ung ngy mt thang.
5. phng bnh
King cc cht cay nng, du m, cc cht tanh.
Phng tr bnh tiu ng kp thi (nu c).
V sinh da tt.
Trnh bi cc loi thuc du m.
T lng gi
1. in t thch hp vo ch trng
Bnh mn nht thuc chng. ca y hc c truyn.
2. Chn cu tr li ng nht bng cch khoanh trn vo ch ci u cu
Cu 1: Phng php iu tr thch hp nht trong giai on sng au ca
bnh mn nht l
a. Thanh nhit lng huyt
b. Thanh nhit gii c
c. Thanh nhit tr thp
Cu 2: iu tr c hiu qu bnh mn nht theo y hc c truyn th
a. Dng cc thuc y hc c truyn p ngoi hoc bi ln nht.
b. Kt hp cc thuc y hc c truyn p hoc bi ln nht vi cc bi
thuc y hc c truyn ung trong.
c. Dng cc bi thuc y hc c truyn ung trong.
109
Bi 15
si tit niu
(Thch lm)
Mc tiu
1. Bit chn on v phn loi si tit niu theo YHH v YHCT.
2. Nm vng ch nh iu tr theo y hc c truyn.
3. Bit vn dng trn lm sng iu tr si tit niu theo YHCT.


1. i cng
Si tit niu bao gm c si thn, si niu qun, si bng quang v si niu
o. Y hc c truyn gi si tit niu l sa lm, thch lm hoc ct lm.
Si tit niu gp tt c cc la tui, theo Rev frat (1976) si tr em chim
50% trc 5 tui v 30% trc 3 tui. Si tit niu c tnh cht a phng nh
chu , chu Phi; cn chu u gim r rt. Vit Nam min trung du hay gp
hn vng ng bng. Trung Quc vng Qung ng, H Nam hay gp hn.
Y hc hin i: nguyn nhn ca si rt phc tp, hin nay mt s nguyn
nhn bit r rng cn mt s cha bit r cho nn vn iu tr vn cha c
phng php iu tr c hiu, nht l loi si oxalat m Vit Nam hay gp
nht.
2. Bnh sinh, bnh nguyn
2.1. Theo y hc hin i
Si tit niu l bnh ton thn nhng biu hin ti ch h thng tit
niu, do s mt cn bng ca mui khong v th keo trong nc tiu. Do vy,
v nguyn nhn gm c cc loi sau:
Thiu vitamin A: nhng t bo thng b h tit niu bong ri to thnh
nhn si, sau cc mui khong bm vo thnh si.
Vim nhim: xc cht cc vi trng v cc t bo cht lng ng trong nc
tiu to thnh nhn v thnh si.
Tch t nc tiu lu: gy lng ng cc thnh phn mui sinh ra si.
Nguyn nhn thng do d dng h tit niu, li i tiu, nm lu trn ging.
110
Nng nc tiu tng: do lng nc a vo t hoc n nhiu cc thc
n, ung tng phosphat v calci nh ung t nc, n nhiu cua, c, c,
nc c nhiu mui khong.
Cng tuyn ph gip trng: gy ri lon chuyn ho phosphat v calci
lm tng phosphat.
Cc yu t khc: a l, kh hu, gen.
Tuy vy tm nguyn nhn r rng gy ra si tit niu th kh. Theo Frat
(1976) tng kt 50% khng r nguyn nhn, 25% do d dng tit niu, 25% do
chuyn ho b ri lon.
2.2. Theo y hc c truyn
Thn c 2 loi: thn m ch huyt v thn dng ch kh. Nu thn kh
y th nc t thn thy xung bng quang mi c kh ho m bi tit ra
ngoi c d dng. Nu thn kh h th khng kh ho bng quang c, thp
ngng tr h tiu, ho t tn dch (thu thp) lm cho cc tp cht nc tiu
kt thnh si (sa hoc thch). Si lm thng tn huyt lc gy i ra mu, si
ng li bng quang v thn lm kh tr m gy au. V vy an Kh tm php
ni: Si pht sinh l do thn kh h lm cho bng quang thp nhit, ho chng
t thu thp, cc cht cn b nc tiu lng ng sinh ra si.
Nh vy bnh sinh, bnh nguyn v phn loi ca si tit niu c lin
quan vi nhau c biu th s :















111

























S : Nguyn nhn sinh bnh v phn loi ca si tit niu
3. phn loi si tit niu
3.1. Theo y hc hin i
Da vo thnh phn cu to si m chia lm nhiu loi.
n ung, lao ng, thp
hn, thp nhit, tinh thn
Thn kh h
Kh ho bng quang
tht thng
Bng quang
sinh nhit
Trong nc tiu tp cht
b chng ct
Hnh thnh si
C nng tr ngi
Ni thp nh tr, ngoi
thp xm nhp
Kh tr,
huyt h
Bng quang
thp nhit
Tn thng huyt lc
Loi kh kt
Loi thp nhit
112
3.1.1. Si calci
C 2 loi l phosphat calci v oxalat calci. Cc loi si ny hay gp
nhng ngi bnh:
Cng calci niu khng r nguyn nhn.
Toan chuyn ho ng niu xa nguyn pht.
Cng ph gip trng.
Do bnh nhn bt ng lu.
Nhim c vitamin D.
3.1.2. Si oxalat
Loi si ny do hai nguyn nhn ( Vit Nam hay gp):
Bnh oxalose (cng oxalat niu), c 2 loi:
+ Oxalat niu nguyn pht l do bnh di truyn, d gy suy thn do si
ti pht, cha c phng php iu tr c hiu.
+ Oxalat niu ti pht trong oxalat niu khng cao, c th km theo
acid uric niu v calci niu.
Cng oxalat niu trong ri lon rut non, hay gp trong bnh Crohn,
bnh ct on hi trng.
3.1.3. Si cystin, xanthins, glucin urat
Nguyn nhn do thiu hp th loi cystin v cc acid amin kim khc nh
lysin, arginin.
3.1.4. Si hn hp
Loi si ny c cn quang.
3.2. Theo y hc c truyn
Da theo nguyn nhn c ch sinh bnh m chia ra lm hai loi:
Loi kh kt: l loi kh tr, huyt . Do thn kh h, bng quang thp
nhit, nhit chng t tp cht trong nc tiu m hnh thnh si, si
ngn cn lm cho kh c bng quang bt li. V vy gy nn kh tr huyt
, tiu tin kh v au.
Loi thp nhit: do thn h gy kh ho bng quang tht thng m sinh
nhit thp, c th do si lm tr nc tiu hoc do thp ngoi c th xm
nhp sinh ra thp nhit, nhit lm cho huyt lc bc lon gy i mu.
4. Triu chng v chn on
4.1. Theo y hc hin i
au tht lng lan xung bng quang, niu o, au tng ln khi nhy,
nu si di ng nhiu gy cn au qun thn.
113
i kh, i but, i rt.
i mu cui bi l si bng quang, nu i mu ton bi l si thn.
Chp X quang khng chun b (cn tht i trng k trc khi chp) ch thy
si cn quang.
Siu m c th thy cc loi si.
4.2. Theo y hc c truyn
4.2.1. Loi kh kt
Thng triu chng ton thn khng r rt.
au nh bng di v tht lng.
Tiu tin ra mu, i kh.
Li ru hi vng, cht li .
Mch huyn khn.
4.2.2. Loi thp nhit
Thng c st, au tht lng bng di.
Tiu tin kh, nng rt, c khi au.
i mu, c khi c m.
Li ru nht vng hoc trng nht.
Mch sc hot hay huyn sc (loi si th thp nhit).
5. Chn on phn bit
5.1. iu tr cn au qun thn
Triu chng: thng xut hin sau khi chy nhy, i xa. Bnh nhn t
ngt au d i vng h tht lng c khi gy tc bng b i.
Bin chng: do kh tr qu mc sinh ra huyt gy nn au.
Php iu tr: ph kh, hot huyt.
Thuc ung: sc ung
Mc hng 20g
dc 20g
Chm cu: chm t, c th in chm cc huyt
+ Th chm:
Thn du Tam m giao
Bt liu Tc tam l
114
+ Nh chm:
Huyt vng thn Bng quang
Niu qun Thn mn
+ Thy chm bng thuc novocain, lidocain (1ng x 10ml), vo huyt trn
hoc dng thuc gim au, gin niu qun nh atropin 0,5mg +
morphin 50-100mg.
5.2. iu tr si theo ni khoa
5.2.1. Ch nh
Kch thc si 1cm niu qun.
Trn phim si tng i nhn.
Bnh nhn mc bnh 5 nm.
Nhiu si, m hoc tn si khng ht.
Chng ti pht.
Cng nng ca thn bnh thng hoc tn thng nh, si thng mt bn.
Bnh nhn khng chu ni phu thut v tui cao, ton trng suy yu.
5.2.2. Phng php iu tr v thuc ung
a. Th kh tr
Php iu tr: hnh kh li tiu, thng lm, ho si.
Bi thuc:
Bi thuc bi xut si: Thch v tn gia gim
Thch v 3 tin Tang bch b 3 tin
Mc thng 2 tin Phc linh 3 tin
Xa tin t 3 tin Chi t 3 tin
Hot thch 4 tin Kim tin tho 3 tin
Cam tho 1,5 tin
Nu iu tr lu si khng ra c th gia: xuyn sn gip, b hong, ng
linh chi.
Nu thn dng h th gia thm: ph t, nhc qu, b ct ch; thn m h
th gia thm: n trinh t, hn lin tho, k t, thc a.
+ Bi thuc tn si:
Mit gip 10 - 40g Hot thch 20 - 40g
d 20 - 40g Thng trut 12 - 40g
Kim tin tho 40 - 80g H kh tho 12 - 20g
Bch ch 12 - 20g
115
+ Bi tn si tng hp dng cho ngi gi yu:
Ch xc 12g Hu phc 12g
Kim tin tho 40g Xa tin 40g
Thanh b 12g Trch t 12g
Ngu tt 12g Tam lng 20g
Nga trut 20g Bch ch 12g
b. Thn h thy (tng ng thn nc ca YHH)
D cng nng ca thn km do si hoc sau khi dng bi si hoc m ly
si cng c th cha bng y hc c truyn
Phc bn t 40g Thc a 16g
Th ty t 12g H th 20g
Bch gii t 12g Tang phiu tiu 12g
B ct chi 12g Bch ch 12g
Quy bn 12g Hong tinh 12g
Ngu tt 12g Bch mao cn 12g
Thng trut 20g Sinh hong k 40g
c. Loi thp nhit
Php iu tr: thanh thp nhit, thng lm, bi tn si.
Thuc iu tr:
+ Bi thuc xut si:
Xa tin 12g Kim tin tho 16g
dc 4g a inh 12g
Hot thch 10g Tang bch b 8g
B cng anh 16g Thch v 12g
Chi t 8g Mc thng 16g
Hu phc 10g Cam tho 6g
Phc linh 12g
Thuc tn si: bi Bt chnh tn gia gim
Kim tin tho 16g Hot thch 12g
Ngu tt 16g i hong 4g
Nh hng 08g Bin sc 12g
Xa tin 16g K t 12g
Mc thng 12g
116
2.3. Phng php iu tr h tr
2.3.1. Ung nhiu nc
Trong thi gian iu tr phi bo o lng nc vo c th t 1500ml -
3000ml.
2.3.2. Vn ng
Ty theo sc kho m phi vn ng nhiu t nh nhy dy i vi si
thn, chy i vi si bng quang.
2.3.3. iu chnh pH nc tiu (pH=5-7)
Si urat: hn ch n tht, dng loi mui lotin, lm nc tiu kim tnh
bng ung thm bicarbonat.
Si oxalat: hn ch n cua, c, c.
Si phosphat: hn ch n trng, sa, lm nc tiu toan tnh bng n
ung chanh, cam.
Chng nhim trng.
6. Kt lun
iu tr si tit niu bng phng php y hc c truyn c kt qu nhng
phi theo di chc nng ca thn v c ch nh ng.
Ung thuc y hc c truyn phng bnh l phng php tt nht.

T lng gi
1. Hy trnh by triu chng chn on v phn loi si tit niu theo
YHCT v YHH.
2. Hy trnh by ch nh iu tr si tit niu theo YHCT.
3. Hy trnh by phng php iu tr si tit niu th kh tr bng YHCT.
4. Hy trnh by phng php iu tr si tit niu th thp nhit bng YHCT.


117
Phn 2
Bnh hc
Sn - ph khoa

PGS. TS. L Th Hin

PGS. TS. L Th Hin

PGS. TS. L Th Hin







118
Chng 1
i cng
Bi 16
c im sinh l ca ph n
Mc tiu
Nu c c im sinh l v kinh nguyt v thai sn.


1. Kinh nguyt
Ph n trn di 14 tui th bt u thy kinh, mt thng thy 1 ln.
Ngi xa cho rng ph n thuc v m nhng nguyn kh ng vi mt
trng. Mt trng c 30 ngy c mt ln trn, do vy kinh nguyt cng 1 thng
thy 1 ln v thng xuyn ng hn nn gi l kinh nguyt hay cn gi l
nguyt tn (ng hn).
Sch T vhi:
Con gi 7 tui thn kh thnh, thay rng, tc di.
14 tui c thin qu, nhm mch thng, thi xung mch thnh, nguyt s
di thi hn, hu nng c t (kinh nguyt n ng hn v c kh nng c con).
21 tui thn kh thng bng, mc rng khn.
28 tui gn xng cng cp, tc di ht sc, thn th kho mnh.
35 tui mch dng minh suy, da mt bt u nm, tc bt u rng.
42 tui tam dng mch suy phn trn, da mt nhn, tc bt u bc.
49 tui mch nhm h, mch xung suy km, thin qu kit, mch tc
thiu m thn khng thng na, hnh th suy tn, ht kh nng sinh .
1.1. Thn kh
Thn kh l gc ca tin thin, l ngun ca sinh ho. l bm th ca
tin thin to thnh bi s kt hp tinh huyt ca b m, c tc dng thc y
qu trnh sinh trng v pht dc ca c th.
119
1.2. Thin qu
Thin qu l loi vt cht mi sinh ra khi chc nng sinh l ca con ngi
hon thin. Chc nng ca thin qu l lm cho nhm mch thng, thi
xung mch thnh, to ra kinh nguyt n, lm tinh kh trn y nam.
Tip l lun y hc c truyn cho rng kinh nguyt v thai sn lin quan
n hai mch xung - nhm.
1.3. Mch xung
Mch xung thuc kinh dng minh v, l ch cc kinh mch hi t, l b
cha huyt. Khi b huyt trn y kinh s ra ng hn.
1.4. Mch nhm
Mch nhm ch bo cung, thng qun cc mch m trong c th con ngi.
Vng Bng ni: Mch xung l b cha huyt, mch nhm ch v bo
thai. Hai mch xung - nhm nng ta h tr cho nhau tt th y l ngun
sui ca kinh nguyt v thai sn.
C kinh nguyt ch yu do hai mch xung - nhm, song cng c lin quan
n 5 tng. V: kinh nguyt do huyt bin ho m tm ch huyt, can tng
huyt, t thng nhip huyt, thn tng tinh ch tu, huyt li do tinh tu ho
ra. Nh vy khi 5 tng iu ho, huyt mch lu thng th b huyt lun y
lm cho kinh nguyt iu ho.
Ngi ph n kho mnh bnh thng th c 28 ngy c kinh 1 ln (tr
khi c thai v cho con b) gi l sinh l bnh thng. C trng hp 2 thng
c kinh 1 ln (tnh nguyt), 3 thng c kinh 1 ln (c kinh), mt nm thy kinh
1 ln (t nin), sut i khng c kinh m vn c thai (m kinh), sau khi c thai
n k kinh vn ra cht t (khch kinh), l s khc thng v sinh l, khng
phi bnh tt.
V lng kinh mi k khong 50-100ml, cng c ngi nhiu hn ngi t
hn song khng qu nhiu hoc qu t gi l bnh thng. Thi gian thy kinh
thng 3-7 ngy. Mu kinh lc u nht sau m hn, cui cng li nht,
khng ng.
Ph n mi bt u thy kinh v thi k tin mn kinh c nhng biu
hin khc thng nh sau:
Lc u mi thy kinh c th khng u v chu k, nu trong ngi khng
c bnh g khc th khng cn cha.
Thi gian tin mn kinh c giai on ri lon kinh nguyt km theo tnh
tnh cu gt, mt ng, au u, au lng, nhc mi chn tayNu khng
c g nghim trng th khng cn phi cha.
2. Thai sn
Sch Linh khu c ghi: Lng thn tng tc, hp nh thnh hnh. Ngha
l hai thn chung c nhau hp li m nn con ngi, vt cht chung c y
l tinh cha v huyt m. Ph n sau khi th thai, v sinh l c mt s thay i
c bit:
120
Trc ht l tt kinh.
m o tit ra nhiu cht dch.
Mu da b ngoi m o sm li.
Bu v dn dn to ln, nm v thm li, c mt s ht ni ln.
Thi gian c hin tng m nghn: thch n ca chua, bun nn; sau
4 thng sn ph thy thai my ng; n cui thi k hay c hin tng i dt
v b i tin; sau 280 ngy l n thi k khai hoa n nhy. Sinh l hin
tng sinh l bnh thng. C nhn hnh dung s sinh l da chn th
trc ming a.
Ngy u sau khi sinh thng c pht st, s rt, m hi, mch tr hon
l do khi sinh hao tn nhiu kh huyt, nu khng pht trin nng hn th
khng coi l hin tng bnh l.
Sau khi sinh vi ngy trong m o c chy ra cht dch gi l huyt hi
(c huyt, c l), c ngi au bng di tng cn nh, nu khng phi au d
di th sau vi ngy s khi, cng khng coi l hin tng bnh l.
Sau khi sinh c nm ngh ti ch (nm ch, c) ng 100 ngy. Ngoi vic
cho con b v khng thy hnh kinh, ton b thn th s hi phc li bnh thng.
3. Cc mch Xung, Nhm, c, i c quan h vi ph khoa
Trng yu nht l hai mch xung v nhm v hai mch ny l ngun sui
ca kinh nguyt v thai sn.
Cc mch xung, nhm, c, i u khi u t huyt hi m ri chia ra 3
nhnh. Mch Xung nhm ni lin vo d con chu s rng buc ca mch i.
V th bn mch xung, nhm, c, i cng lin quan nh hng vi nhau gy
thnh h thng c quan h trc tip n sinh l ca ph n.
Mch xung - nhm y , thnh vng th thn th kho mnh, kinh
nguyt iu ho, th thai v sinh n bnh thng. Nu mch xung - nhm b
tn thng c th gy ra bnh ph khoa.
Mch i th rng buc ly cc mch gn gi ly mi quan h ln nhau.
Nu cng nng y khng iu ho th 3 mch xung, nhm, c b nh hng
sinh ra bnh i h, v sinh.
T lng gi
1. Trnh by c im sinh l kinh nguyt theo YHCT.
2. Thn kh l g? Thin qu l g?
3. Trnh by c im sinh l v thai sn theo YHCT.
4. Hy in vo ch trng cm t thch hp
Mch xung, mch nhm l ngun sui ca.
Mch xung, nhm, c, i u xut pht t.
C nhn ni: Sinh l da.ming a
121
Bi 17
Bnh nguyn bnh sinh theo YHCT
ca bnh ph khoa
Mc tiu
1. Trnh by c cc nguyn nhn gy bnh ph khoa theo hc c truyn.
2. Trnh by c c ch sinh bnh ph khoa theo y hc c truyn.


1. Nguyn nhn
Nguyn nhn sinh bnh i vi ph khoa cng ging nh ni khoa l do
ngoi nhn, ni nhn v bt ni ngoi nhn nhng khi vn dng vo bnh ph
khoa cn ch nhng c im sau.
1.1. Nguyn nhn bn ngoi
Ch yu do hn, nhit v thp. Ph n ly huyt lm ch; huyt gp nhit
th lu thng, gp hn th ngng tr; nhit nhiu qu lm huyt i sai ng
gy chng bng lu; hn nhiu qu lm huyt ngng tr khng lu thng gy
thng kinh, b kinh, trng h; thp nhiu qu thng gy bnh i h.
1.2. Nguyn nhn bn trong
Tht tnh lin quan n 5 tng, nh hng n kh huyt. Cc bnh ph
khoa phn nhiu l huyt. Kh l ch th ca huyt, huyt nh kh vn
hnh, hai mt ny lin quan cht ch vi nhau. Khi tht tnh kch thch phn
nhiu lm hi kh, kh khng iu ho th huyt khng iu ho, mi bnh t
sinh ra.
1.3. Bt ni ngoi nhn
Ham vic bung the l mt nguyn nhn quan trng gy ra bnh ph n.
V mi ln giao cu kh huyt b pht ng ti a, gy tn hi n mch xung-
nhm, can v thn b h yu, tinh huyt b tiu hao, tt nhin s nh hng
n kinh i, thai sn.
Sch Ni kinh c ghi: Bnh huyt kh l v lc tui tr mt huyt qu
nhiu hoc n nhu say sa ri hnh phng lm cho kh kit, can huyt tn
thng cho nn kinh nguyt mt ngun m khng hnh.
122
Sch Ch bnh nguyn hu lun c ghi: ang lc hnh kinh m giao
hp th mch mu b co li khng ra kinh. Huyt kinh b li gy nn chm
kinh, b kinh.
V vy m Chu an Kh ch trng hn ch tnh dc phng bnh.
2. C ch sinh bnh
2.1. Kh huyt khng iu ho
Ph n ly huyt lm cn bn. Cc bnh kinh, i, thai sn u lin quan
mt thit vi huyt, huyt phi hp vi kh. S thng, ging, hn, nhit, h,
thc ca huyt u do kh; cho nn kh nhit th huyt nhit m sc bm, kh
hn th huyt hn m sc xm; kh thng th huyt nghch m vt ra (xut
huyt), kh hm xung th huyt i xung gy bng huyt.
V vy nguyn nhn no nh hng n kh huyt u lm cho kh huyt
khng iu ho, gy cc bnh v kinh, i, thai, sn.
2.2. Ng tng khng iu ho
Ph n ly huyt lm cn bn, m ngun sinh huyt l t, thng soi ch
huy huyt l tm, tng tr huyt l can, phn b huyt nh ph, nui dng
huyt do thn nhun ti khp ton thn. Nu tm kh suy yu, huyt dch
khng y th d sinh kinh nguyt khng u, kh c con. Nu can kh ut
kt th huyt khng tr v can gy chu k kinh khng u, bng lu.
Nu t h lm huyt h hoc kh h h hm gy nn rong kinh, rong
huyt, i h, b kinh. Nu ph kh h khng vn tng c huyt lm huyt
kh, dch tiu hao; hoc ph kh ng di sn gy chng th dc, au ngc
(tc bn). Nu thn h tn gy chng bng lu, v sinh, non.
Bt k nguyn nhn no nh hng n cng nng ca 5 tng u c th
lm kh huyt khng iu ho v gy nn cc chng bnh ca ph khoa.
2.3. Mch xung - nhm tn thng
Hai mch xung v nhm c quan h mt thit n sinh l v bnh l ca
ph n. Hai mch ny phi tip nhn kh huyt, cht dinh dng ca 5 tng
mi pht huy c tc dng. Ph n m kh huyt c iu ho, 5 tng c
yn n th mch xung trn y, mch nhm thng li. Khi c nhn t nh
hng trc tip hay gin tip n mch xung - nhm u c th gy nn bnh
ph khoa.
T lng gi
1. Anh (ch) hy trnh by cc nguyn nhn gy bnh ca bnh ph khoa
2. Anh (ch) hy trnh by c ch sinh bnh ca bnh ph khoa
123
Bi 18
c im v Chn on bnh ph khoa
(T chn)
Mc tiu
Vn dng c t chn trong chn on bnh ph khoa.


1. Vng chn (nhn)
Nhn thn, sc, ton trng ging nh ni khoa. Cn ch trng nhn li
vi cc c im sau:
Cht li ti l chng huyt nhit.
Cht li nht l chng huyt h.
Cht li trng nht l kh huyt h.
2. Vn chn (nghe, ngi)
Mu kinh khm thi l nhit, tanh l hn, hi l huyt .
Kh h khm thi l nhit, khm hi nh cc cht l thp nhit kt
thnh c.
3. Vn chn (hi)
3.1. Hi v kinh nguyt
Hi tui bt u thy kinh ln u, chu k kinh, s ngy c kinh, lng
kinh, mu sc, tnh cht, mi v ca mu kinh; au lng, au bng v cc
chng khc km theo. Nu hnh kinh c au bng di, c n l chng thc;
cn au m m thch xoa thch chm nng l chng h. C cm gic bng
di nng tc khi sp hnh kinh l kh tr; cn c au tc ngc, ng ming l
can kh ut tr. Khi hnh kinh c ph v a lng l t h, hnh kinh xong au
bng l huyt h. Nu kinh trc k, lng nhiu ti, mt , kht, thch
mt, s nng, thng l nhit; cn kinh sau k, lng t, nht, thch m, s lnh
thng l hn.

124
Nu khng c kinh 2 thng, bun nn, thch n chua, n km, mt mi l
c thai. Nu khng c kinh nhiu thng, mt bch, chng mt hoa mt, tim p
mnh, th yu, n t, da kh, li khng c thai l b kinh.
3.2. Hi v i h
Ch mu sc, lng, mi ca i h. Nu mu trng lng nhiu, mi
mt, n km l t h thp tr. Nu mu vng hoc xanh c, dnh hi v nga
m h l thp nhit. Nu c mu nh mu c, ra lin tc, hi hi thng l
nhit ut kinh can.
3.3. Hi v cha
Hi s ln cha , s ln sy thai, no thai; sau cng hi v tnh trng
thai nghn, sinh . Nu ly chng nhiu nm khng c cha hoc sinh ri,
sau khng c cha na, thng c au mi tht lng, hoc c thai song sy
lin tip l thn h, hai mch xung - nhm b tn thng. Nu nhiu ln,
mt mu nhiu thng l do kh huyt khng .
4. Thit chn (bt mch)
Ch bn loi mch: mch kinh nguyt, mch c thai, mch kh h, mch
v sinh.
4.1. Mch kinh nguyt
Sp c kinh mch thn bn phi ph hng hoc ring mch thn hot,
km theo ming ng, trng bng.
ang hnh kinh: mch thn bn phi ph hng hoc mch quan hi
huyn, hoc mch thn hai bn hi ph.
Kinh trc k lng nhiu (do nhit xung, nhm): mch huyn hot sc.
Kinh trc k, lng t (do m h, huyt nhit, huyt thiu): mch t sc.
Kinh sau k, lng t (h hn, huyt hi bt tc): mch trm tr.
Kinh khng u, can t h tn c mch quan hai bn h yu. Kh h h
hm, mch trm t.
Kinh b (kh huyt h): mch xch vi sp; (kh h m thp): mch trm hot.
Bng lu: mch h i huyn sc l tin lng bnh thng, mch ph
hng sc l tin lng xu.
4.2. Mch kh h
Kh h nhiu trng hoc vng; nu thp nhit mch bn tri huyn sc,
bn phi trm t c lc; nu m thp nh tr: mch bn tri hot i c lc.
Kh h nhiu, long (thn dng h) mch trm tr vi nhc, c bit
mch hai mch xch.
125
4.3. Mch c thai
Mi c thai: mch hot hoc mch thn bn phi v xch hai bn hot li.
Phng sy thai: su b mch trm hon sp hoc mch xch hai bn u
yu, l kh huyt h yu cn phng sy thai, non.
Sp : thai y thng tui, mch c th ph sc, tn lon hoc trm t
hot, km theo au bng lan ra ct sng.
4.4. Mch v sinh
Bng di thng xuyn lnh, mch xch vi nhc sp.
4.5. Mch sau khi
Bnh thng phi l hon ho; khng nn l hng i, huyn.
T lng gi
1. Anh (ch) hy trnh by c im bnh l ca cc loi mch trong ph khoa?
2. Anh (ch) hy trnh by c im v vn chn trong bnh ph khoa?
126
Bi 19
Bt cng
Mc tiu
Vn dng c bt cng trong chn on bnh ph khoa.


1. Hn
1.1. Phong hn
T chn: sc xanh nht, au bng di, gp lnh au tng, chn tay lnh,
u gy cng au, eo lng mi, s lnh, a lng, li trng, mch trm
khn.
Ph khoa: kinh nguyt sau k, mu tm en, b kinh, thng kinh, bng
di lnh au.
1.2. Hn thp
T chn: sc mt xanh, mt hi thng vng, s lnh u hi chng au,
mi lng mnh nng, au khp xng, ngc y tc, n t, bng lnh, a
chy, tiu tin t, hai chn ph, ru li trng nhn, mch trm tr.
Ph khoa: kinh ra sau k, mu tm nht, kinh tng i nhiu, kh h nhiu.
2. Nhit
2.1. Thc nhit
T chn: sc , s nng, hay cu gt, kht nc, tm phin, to bn, ng
t, tiu tin vng, t ra m hi, ni lm nhm, cht li , ru li kh,
mch hng i hoc hot sc.
Ph khoa: kinh ra trc k, mu sm, kinh ra nhiu hoc thnh bng
huyt. Nu c thai sinh ra chy mu (thai lu).
2.2. H nhit
T chn: sc mt vng nht, hai g m , st hm hp, ra m hi trm,
da kh, u chong, hng kh, tim hi hp, bn trong nng, lng bn tay
nng, t ng, nm m nhiu, tiu tin vng, to bn, cht li khng c
ru, mch h t sc.
127
Ph khoa: kinh nguyt trc k, kinh c dnh mu vng nht, kinh hi t
hoc hi nhiu (hoc bng huyt, hoc rong kinh, hoc thnh kh h),
khi c thai hay ng thai hoc thai d sy, d bin thnh h lao.
2.3. Thp nhit
T chn: sc mt vng hoc vng, u chong, mnh my nng n, li
kh bn, tm phin, ng t, n khng ngon, bng y trng, tiu tin
vng t, ru li vng, mch hot sc.
Ph khoa: kinh nguyt ra trc k, kinh c dnh, mu vng c ; kh h
vng trng hoc hi, ra nhiu ; c thai d non ra huyt.
3. H chng
3.1. Kh h
T chn: sc mt nht, s lnh, chong vng, tim hi hp, on hi, ting
ni nh, lng i au mi mm yu, i tin lng, tiu tin lun, cht li
nht, mch h nhc.
Ph khoa: kinh nguyt ra di hoc ra sm, ra nhiu sc kinh nht, c
th bng huyt rong kinh, kh h nhiu, c thai d non hoc sau khi
d bng huyt hoc sa d con.
3.2. Huyt h
T chn: sc mt vng hoc trng hoc vng a, da kh, mnh gy yu,
chng mt, nhc u, tim hi hp, chn tay t di hoc co rt, c khi st
tng cn, eo lng mi, xng au, to bn, hng kh, ming ro, cht li
nht, ru li lm m, mch h t.
Ph khoa: sc kinh nht, hnh kinh au bng, s lng kinh gim dn,
tin ti v kinh, c thai d ng thai hoc d non, sau khi sn dch t
v hi, d chong.
3.3. m h
T chn: sc mt kh trng, hai g m , mnh gy yu, da kh, chng mt,
tai, hng kh, li ro, rng lung lay, tim hi hp, ng t, tm phin, lng
bn tay nng, eo lng v i nhc, gt chn au nhc, ng m, to bn, tiu
tin t , li hay nt n, khng ru hoc lm m, mch t sc.
Ph khoa: kinh nguyt ra trc k, c th gy rong kinh, kinh t c th
thnh b kinh, kh h trng hay mu vng, c thai d ra huyt, non,
sau khi d gy h lao, ho ra mu.
3.4. Dng h
T chn: sc mt trng xm, h mt qung en, s lnh, chn tay lnh, eo
lng au, mt mi, tim hi hp nh trng ngc, n km, lng bng gi lnh,
i dt; nu nng th sn i, a chy, cht li nht, ru li mng, mch trm
tr nhc.
128
Ph khoa: kinh nguyt phn nhiu ko di, mu nht, kinh ra t, bng au
lm rm, c khi ra kh h nhiu, khi c thai thng mi eo lng, d non.
4. Thc chng
4.1. Huyt
T chn: sc mt tm, mi ming xanh xm, ming kh khng mun ung
nc, ngc bng y trng, nhc u hay qun, to bn, cht li hi
tm, c nhiu im ban xanh tm, mch trm sc hoc trm hot.
Ph khoa: ri lon kinh nguyt, phn nhiu kinh sau k, mu tm, nhiu cc,
bng di cng tc, khng thch xoa, trc khi hnh kinh au tng, huyt ra
au, c th b kinh hoc bng huyt, sau khi sn dch ko di.
4.2. Kh ut
T chn: sc mt xanh xm, tinh thn bc dc, u cng tc, au na u,
tm phin, tc ngc, hi, n ung km, au bng c lc trng bng, ru
li mng, mch huyn sc.
Nu kh ut ho nhit: sc mt xanh vng, c lc ng, c lc nng,
au mng sn, au u, tm phin, hay th di, ng hay m, cht li ,
ru li vng.
Ph khoa: kinh nguyt ri lon, sc tm, lng t, bng di au, au lan
ra hai mng sn, v au, trng bng, ra kh h nhiu, nu c thai bng
hi nng, lc bng au nhiu.
Nu trng hp ut ho nhit th hnh kinh ra trc k, kh h ra mu
vng ; sau khi d bun nn, trn trc, vt v
4.3. m thp
T chn: mt trng bu, ngi bo, u nng m, ming nht, m
long, kh th, khc ra m, tc ngc, bng trng, tim hi hp, kh on,
n km, mt mi, i tin lng, ru li trng, mch trm hot.
Nu km theo nhit th sc mt hi , li nht, tm phin hoc m
man kinh git, m c, tim hi hp, to bn, tiu tin t, ru li trng nht,
mch hot sc.
Ph khoa: kinh nguyt ko di, lng kinh nhiu, sc kinh nht, kh h
nhiu; khi c thai mnh nng, ho, ph.
Nu m nhit : kinh nguyt sc , kh h vng, d b t phin, sn git
hoc sau khi d b bng huyt.
129
T lng gi
1. Trnh by vng chn trong ph khoa.
2. Trnh by vn chn trong ph khoa.
3. Trnh by vn chn trong ph khoa.
4. Trnh by thit chn trong ph khoa.
5. Hy khoanh trn vo ch cho cu ng, ch S cho cu sai
Kinh nguyt nhiu, sc ti l hn /S
Kinh nguyt sau k, lng t l nhit /S
Kh h trng, ngi mt mi l nhit /S
Kh h vng, hi, nga l hn /S



130
Bi 20
nguyn tc iu tr bnh ph khoa
Mc tiu
1. Trnh by c 4 nguyn tc c bn trong iu tr bnh ph khoa.
2. Hiu c nguyn tc chung iu tr mt s chng bnh ph khoa.


1. Cc nguyn tc c bn
Ph khoa cng nh cc khoa khc, trc tin phi nm vng cc nguyn
tc c bn (tr bnh phi tm gc bnh tr). l php bin chng lun tr m
ngi thy thuc cn nm vng ra phng thc tr liu cho tht hp l.
Tuy nhin do ngi ph n c quan h sinh l v tn thng n phn huyt,
thng nh hng n chc nng ca tm, t, can, thn, dn ti tn thng 2
mch xung - nhm m sinh ra bnh thuc kinh, i, thai, sn. V vy cn ch
n c im sinh l v bnh l ca nhiu giai on khc nhau iu ho kh
huyt, iu ho t v, s can kh v dng can thn.
1.1. iu ho kh huyt
Ph n ly huyt lm ch, huyt thng bt tc kh thng hu d. Bt
c nguyn nhn g nh hng n kh huyt u c th lm ri lon kh huyt
v gy nn bnh.
V vy trc tin phi iu ho kh huyt. Nu kh nghch th phi ging
kh, kh ut th phi khai ut hnh kh, kh lon th phi iu kh l kh, kh
hn th phi n dng tr kh, kh nhit th phi thanh kh tit nhit, kh h
h hm th phi thng dng ch kh, ng thi phi tr thm thuc ho huyt,
b huyt. Nu huyt hn nn n, huyt nhit nn thanh, huyt h nn b,
huyt tr nn thng, ng thi phi tr thm thuc hnh kh b kh.
1.2. iu ho t v
T v l gc ca hu thin, l gc ca qu trnh sinh ho. Nu t v b ri
lon, ngun sinh ho b yu i th d gy bnh v kinh nguyt, thai sn. Trong
trng hp nu iu ho c t v th s khi bnh.
Trong phng php iu ho cng phi cn c vo bnh tnh khc nhau
nh h th b, tch th tiu, hn th n, nhit th thanh. c bit i vi ph n
ht kinh th thn kh suy nhc, kh huyt u h nn cn nh vo thu cc
ca hu thin, khi y nn b t v b gc sinh ho ca n.
131
1.3. S can kh
Can ch v tng huyt, tnh ca n thch s tit, iu t. Khi can kh
bnh ho th huyt mch lu thng, huyt hi nh tnh. Khi can kh b ut, mt
chc nng iu t s gy nh hng n kinh, i, thai, sn (nht l ph n
giai on tin mn kinh hay gp chng trng ny). V vy trong iu tr cn s
t can kh l chnh.
1.4. B can thn
Thn l gc ca thin nhin li ch v tng tinh kh, do n l ng lc
pht dc v sinh trng ca c th. Ngi ph n c sinh kh sung tc, k l
mch nhm - mch xung thng thnh mi c kh nng c kinh v c thai. Ngc
li khi thn tin thin bt tc th c th sinh ra bnh tt. V th b thn kh
cng l mt trong nhng nguyn tc quan trng trn phng din tr bnh ph
khoa. Ngoi ra can li l con ca thn (thu sinh mc) li nh thn thu tu
dng. Nu thn m bt tc d lm can dng vng ln m sinh ra bnh. Khi
nn t dng can thn tr bnh.
Can v thn l gc ca xung - nhm, khi can thn h s lm tn thng
n xung - nhm; ngc li khi mch xung - nhm b tn thng cng lm nh
hng n tng can v tng thn. Trn lm sng cc chng nh b kinh, bng
lu, i h, ng thai phn ln l do can thn suy nhc, xung - nhm tn
thng m gy ra. Dng can thn chnh l b ch xung - nhm, ngun gc
thnh th lu li thng thng nh m khi bnh.
2. nguyn tc chung iu tr mt s chng bnh
2.1. iu tr bnh kinh nguyt
Nu c bnh no gy nn ri lon kinh nguyt th phi cha bnh
trc ri mi n iu kinh sau.
Mun iu kinh cn phi l kh v kh l soi ca huyt. Kh hnh th
huyt hnh, kh ngng th huyt tr, kh nhit th huyt nhit, kh hn th
huyt hn. L kh trong iu kinh thng ly l kh khai ut l chnh. Thuc
dng khng nn dng qu nhiu thuc phng hng v n lm hao kh (trm
hng, hng ph, trn b, ch xc) ng thi phi phi hp vi thuc dng
huyt.
V d: can kh ut phi s can l kh (dng si h, bch thc, hng ph);
nu can kh nghch th phi bnh can tc phong (dng cu ng, thin ma).
T v l ngun gc bi b ca kh huyt, huyt nh hng trc tip n
kinh nguyt. Nu t h hay gy ri lon kinh nguyt, v vy phi b t v
iu kinh.
Thn l gc ca xung - nhm, lin quan n kinh nguyt. Nu thn h gy
nh hng n kinh nguyt cho nn phi b thn iu kinh.
132
2.2. iu tr bnh i h
Bnh i h do thp nhit gy ra, ch yu l do t h khng vn ho c
thu thp gy nn thp thnh. Thp ut tch lu ngy gy nn thp thnh; nu
thp tch t li mch i, kt mch nhm s thnh cht dch chy ra ngoi
m o thnh i h, lu ngy thp ho thnh nhit, thp nhit ho thnh
trng (nga).
Trong iu tr cn b t ho thp l chnh, km thm s can l kh. Nu
thp nng phi t thp nhit, nu bnh lu ngy phi dng php c sp; khng
nn dng thuc thanh nhit ho thp qu d hao tn tn dch, cng khng
nn dng thuc t nhun c sp qu nhiu d gy thp tr. Nu c trng phi
thanh nhit, gii c, st trng.
2.3. iu tr bnh thai nghn
ngi ph n bnh thng huyt khng , kh thng c d, nay
huyt li tp trung nui thai nn cng thiu. Huyt thiu d thng m, m h
sinh ni nhit. Do trong khi mang thai sn ph thng b nhit. Nhng bnh
thng gp trong khi mang thai l ng thai, au bng, ra huyt, a i. Trong
iu tr cn ch dng huyt, thanh nhit kt hp thm thuc b thn.
Khi c thai khng nn dng cc thuc hnh kh, hot huyt, ph huyt,
thuc t h, thuc gy c.
Ngoi vic dng thuc cn ch king giao hp vo 3 thng u v 3
thng cui; king n cc cht cay nng, kch thch; cn gi cho tinh thn c
vui v, thanh thn.
2.4. iu tr bnh hu sn
Khi cha nguyn kh b tiu hao nhiu, do sau nu khng bit gi
gn sc kho s d b sinh bnh hu sn. Bnh hu sn thng c h, c thc, c
hn, c nhit. Trong iu tr nu h th b, thc th t, hn th n, nhit th thanh.
Bnh sn hu ch yu dng thuc b kh, b huyt. Nu cn gii ut th
cng khng nn dng thuc lng to; nu nhit khng nn dng ko di cc
thuc hn lng (d gy ngng tr) m nn dng cc thuc dng m thanh
nhit; nu hn khng nn dng thuc tn to (qu cay, qu nng) m nn dng
thuc bnh thng.

133
T lng gi
1. Trnh by nguyn tc iu ho kh huyt trong iu tr bnh ph khoa.
2. Trnh by nguyn tc iu ho t v trong iu tr bnh ph khoa.
3. Trnh by nguyn tc s can kh trong iu tr bnh ph khoa.
4. Trnh by nguyn tc b can thn trong iu tr bnh ph khoa.
5. Khoanh trn vo ch cho cu ng, ch S cho cu sai:
Ph n ly huyt lm ch /S
Trong iu kinh khng nn dng nhiu thuc phng hng /S
iu tr thai nghn khng nn dng nhiu thuc hot huyt /S

















134
Chng 2
iu tr mt s bnh ph khoa
Bi 21
Kinh nguyt khng u
Mc tiu
1. Trnh by c triu chng cc th bnh trong ri lon kinh nguyt.
2. Nu c phng php iu tr cc th bnh theo y hc c truyn.


Kinh nguyt khng u hay cn gi l ri lon kinh nguyt bao gm kinh
trc k, kinh sau k v trc sau khng nh k; lng kinh c th nhiu hoc
t, mu sc mu kinh cng thay i.
1. Kinh nguyt trc k
Phn nhiu do nhit gy ra (nhit thc, nhit h) nhng cng c khi do
kh gy nn.
1.1. Do huyt nhit
Do n cay nng, cm nhit t lm huyt i sai ng, thy kinh trc
k v lng kinh ra nhiu.
Triu chng: kinh nhiu, mu ta, mu cc, sc mt , mi kh, d
gin cu gt, thch mt, s nng, nc tiu , ru li vng, mch hng
thc hoc hot sc.
Php iu tr: thanh nhit lng huyt, iu kinh.
Phng:
Bi 1: Cm lin t vt thang
Hong cm 12g Hong lin 8g
ng quy 12g Sinh a 12g
Xuyn khung 8g Bch thc 12g
Sc ung ngy mt thang, ung 5- 10 thang.
135
Bi 2: Thanh ho m (Cnh nhc ton th)
Sinh a 12g Hong cm 12g
Xch thc 12g Mch mn ng 12g
an b 2g Thch hc 10g
Bch linh 12g
Sc ung ngy 1 thang, trc k kinh 7 ngy.
Chm cu: chm t cc huyt: khc tr, tam m giao, quan nguyn, thi xung.
1.2. Do h nhit
m huyt km, ho vng, nhit lm kinh ra trc k nhng lng t.
Triu chng: lng kinh t, mu v khng c cc, sc mt khng nhun,
hai g m , hoa mt chng mt, trong ngi nng, phin nhit, ng
khng yn, cht li , ru vng kh, ming l lot, mch t sc.
Php iu tr: dng m thanh nhit.
Phng:
Bi 1:
Sinh a 16g Huyn sm 12g
Sa sm 12g ch mu 16g
R c tranh 12g R cy rau khi 12g
Bi 2: Lng a thang
Sinh a 40g A giao 12g
Huyn sm 40g a ct b 12g
Bch thc 20g Mch mn 20g
Sc ung ngy mt thang, ung 5 - 10 thang.
Chm cu: chm b cc huyt tam m giao, quan nguyn.
1.3. Kh h
C th suy nhc dinh dng km, lm nh hng n mch xung - nhm
gy nn kinh nguyt trc k v s lng kinh nhiu.
Triu chng: kinh ra trc k, s lng nhiu, sc mt trng nht, tinh
thn u oi, hi hp, th ngn, ngi ni, eo lng v i mi, bng di sa
xung, cht li nht, ru mng t, mch h nhc v lc.
Php iu tr: b kh, c kinh.
Phng:
136
Bi 1: B trung ch kh
ng sm 20g ng quy 12g
Hong k 20g Si h 12g
Bch trut 12g Chch tho 4g
Thng ma 12g Trn b 8g
Bi 2: B kh c kinh hon
ng sm 20g Sa nhn 4g
Bch linh 12g Bch trut 12g
Hong k 12g
Sc ung ngy mt thang, ung 10-15 thang.
Chm cu: chm b cc huyt: tc tam l, tam m giao, quan nguyn, kh hi.
2. Kinh nguyt sau k
Kinh nguyt sau k a s do h hn, nhng cng c khi do huyt hoc
m tr.
2.1. Do hn
Do ni thng (h hn) hoc ngoi cm phong hn (thc hn) gy ra.
H hn: kinh chm lng t, mu nht hoc xm en, long, sc mt
trng, mi nht, thch nng, s lnh, tay chn lnh, bng au lin min,
chm nng d chu, chng mt, th ngn, mi lng, mch trm tr v lc.
Do phong hn: chn tay lnh, s rt, ru li mng, mch trm khn.
Php iu tr:
+ Do h hn: n kinh, tr hn
Bi thuc:
Thc a 12g Xng b 8g
Xuyn khung 10g ng sm 12g
Can khng 8g H th 10g
Ngi cu 12g
+ Do phong hn: n kinh, tn hn
Bi 1:
Qu chi 8g Ngh en 8g
Ngu tt 12g Gng ti 3 lt
ng sm 12g Xuyn khung 8g
Ngi cu 8g
137
Bi 2: n kinh thang
Qu tm 4g Nga trut 8g
an b 8g Bch thc 8g
ng sm 12g Xuyn khung 8g
Ngu tt 12g Cam tho 4g
ng quy 12g
Sc ung ngy mt thang, ung 10-15 thang.
Chm cu: cu cc huyt tam m giao, quan nguyn, kh hi, qui lai.
2.2. Do huyt
Do huyt (thc) hoc huyt h (h) gy ra.
2.2.1. Do huyt
Triu chng: kinh ra sau k, lng t, mu tm en, c cc, sc mt tm
xm, bng di trng, c n, ngc bng y trng, to bn, nc tiu t
v , li xm, mch trm.
Php iu tr: hot huyt, kh , iu kinh.
Phng:
Bi 1:
Sinh a 12g ch mu 16g
Xuyn khung 8g o nhn 8g
K huyt ng 16g Ut kim 8g
Bi 2: T vt o hng
Sinh a 12g Hng hoa 6g
Bch thc 12g o nhn 8g
Xuyn khung 8g
Sc ung ngy mt thang, ung 10 -15 thang.
2.2.2. Do huyt h
Triu chng: kinh nguyt sau k, kinh long, sc mt trng, mt mi hi
hp, on hi, ngi ni, mng tay chn nht, da kh, u chong, mt hoa,
ng t, cht li nht, khng c ru, mch t sc hoc h t.
Php iu tr: b huyt, iu kinh.
Phng:
138
Bi 1:
Thc a 12g an sm 8g
Long nhn 12g H th 8g
Xuyn khung 8g ch mu 12g
Trn b 6g K t 12g
Nu kh huyt u h: b kh huyt (bi Thp ton i b).
Bi 2: Thp ton i b
Bch trut 12g Nhc qu 4g
Bch thc 12g Thc a 8g
ng sm 12g Hong k 12g
Xuyn khung 8g Phc linh 8g
Cam tho 4g Xuyn quy 8g
Sc ung ngy 1 thang, ung 10-15 thang.
Chm cu: chm b cc huyt tam m giao, quan nguyn, huyt hi,
cch du.
2.3. Do m thp
Triu chng: kinh nguyt sau k, sc nht dnh, c th nhiu hay t, ngc
bng trng, thng bun nn, n km, ming nht v nht, ru li
trng nht, mch trm hot.
Php iu tr: kin t, tiu m.
Phng:
ng sm 12g Bn h 8g
d 12g Trn b 8g
Hoi sn 12g Hng ph 8g
Bch trut 12g Ch xc 6g
Sc ung ngy mt thang, ung 10-15 thang.
2.4. Do kh ut
Triu chng: kinh ra t, bng di trng au, tinh thn khng thoi mi,
ngc sn y tc, hi, mch huyn sc.
Php iu tr: hnh kh, gii ut, iu kinh.
Phng:

139
Bi 1: dng bi Tiu dao thang
Si h 12g Cam tho 4g
Trn b 6g Gng ti 4g
Bch trut 12g Bch thc 8g
ng quy 6g Bc h 4g
Phc linh 8g
Sc ung ngy mt thang, ung 7-10 thang.
Nu hnh kinh au bng nhiu th gia hng ph 6g, o nhn 4g; nu
nhit nhiu gia an b, chi t thanh nhit.
Bi 2:
Hng ph ch 12g Thanh b sao 12g
Ch xc sao 12g Ngh vng sao 20g
Sc ung ngy 1 thang, ung 3-5 thang.
Chm cu: chm t cc huyt tam m giao, huyt hi, hnh gian, ni quan.
3. Kinh nguyt khng nh k (lc c kinh sm, lc c kinh mun)
3.1. Th can kh ut kt
Triu chng: ri lon kinh nguyt khng nh k, lng kinh ra t, sc ,
sc mt xanh xm, tinh thn ut c. Khi hnh kinh v cng, thng kinh
trc khi hnh kinh, au lan ra mn sn, hi, to bn, au lng, mch
huyn sc.
Php iu tr: s can, l kh, gii ut.
Phng: dng bi Vit cc hon
Thng trut 8g Thn khc 6g
Hu phc 8g Si h 12g
Hng ph 8g Xuyn khung 12g
Ch xc 8g Chi t 8g
Sc ung ngy mt thang, ung 7-10 thang.
Chm cu: chm t cc huyt tam m giao, huyt hi, hnh gian, ni quan.
3.2. Do t h
Triu chng: kinh ra khng nh k, lng t, sc nht, mt vng, chn
tay ph, tinh thn mt mi, thch nm, tay chn khng m, chng mt hi
hp, bng trng, ming nht, n khng ngon, a chy, ru li trng,
mch trm tr.
140
Php iu tr: b t iu kinh.
Phng:
Bi 1:
Hoi sn 16g To nhn 8g
Long nhn 8g an sm 12g
ng sm 16g Ngu tt 12g
d 16g Bch trut 8g
Bin u 12g
Bi 2: Qui t thang
ng sm 12g Hong k 12g
Bch trut 12g Long nhn 10g
Phc linh 12g ng quy 12g
To nhn 10g Vin ch 04g
Mc hng 06g Cam tho 04g
Sc ung ngy mt thang, ung 10-15 thang.
3.3. Do can thn h
Triu chng: kinh ra khng nh k, sc kinh long, sc mt m ti, tai,
chng mt, au mi lng, i tiu nhiu, i tin lng, mch trm nhc.
Php iu tr: b can thn, c xung - nhm.
Phng:
Bi 1:
Thc a 12g H th 12g
ng sm 16g Th ty t 12g
an sm 12g Ngu tt 12g
Hoi sn 12g
Bi 2: a kinh thang
Thc a 12g Phc linh 8g
Bch thc 12g Si h 12g
ng quy 8g Hc gii tu 12g
Th ty t 8g Hng ph 8g
Hoi sn 12g
141
Sc ung ngy mt thang, ung 10-15 thang.
Chm cu: chm b cc huyt tam m giao, tc tam l, quan nguyn, kh
hi, a c.
T lng gi
1. Trnh by triu chng kinh nguyt trc k th huyt nhit.
2. Trnh by triu chng kinh nguyt trc k th h nhit.
3. Trnh by triu chng kinh nguyt trc k th kh h.
4. Trnh by phng php iu tr ri lon kinh nguyt sau k.
5. Trnh by phng php iu tr kinh nguyt khng nh k th can kh
ut v th can thn h.
6. Khoanh trn vo ch cho cu ng, ch S cho cu sai:
Kinh nguyt sau k l do nguyn nhn nhit /S
Kinh nguyt khng nh k l do tm h /S
142
Bi 22
Rong kinh
(Kinh lu)
Mc tiu
1. Nm c nh ngha v nguyn nhn ca rong kinh, rong huyt theo y hc
hin i v y hc c truyn.
2. Phn bit c rong kinh v rong huyt.
3. Bit chn on v iu tr rong kinh, rong huyt bng y hc c truyn.


1. i cng
1.1. nh ngha
Theo YHH: rong kinh l hin tng kinh ko di trn 7 ngy, lng
kinh c th nhiu hoc t (kinh nhiu gi l a kinh (bng kinh), kinh t gi
l thiu kinh).
Theo y hc c truyn: rong kinh c gi l bng lu (bng: c ngha l l,
ta nh ni l, huyt ra cp tc (cp); lu: ch huyt ra nh git, ta nh nh
dt (hon)).
1.2. Nguyn nhn
1.2.1. Theo y hc hin i
Rong kinh c nng: do ri lon ni tit thng gp trong tui dy th v
rong kinh tui tin mn kinh.
Thc th: do u x t cung, t vng trnh thai.
1.2.2. Theo y hc c truyn
Nguyn nhn gy bnh ch yu do mch xung - nhm b tn thng gy
nn. Trn lm sng chia lm 2 th: h v thc.
H:
+ Kh h: do lao ng qu sc hoc n ung khng iu lm t kh v
ph kh b tn hi. Kh h khng ch qun c huyt gy bng lu.
+ Dng h: kh h lu ngy nh hng n dng kh ca h nguyn,
mnh ho suy km, khng n m c t cung, khng gn gi c s
iu ho ca xung - nhm m gy bnh.
143
+ m h: do sinh gy mt huyt hoc phng dc qu lm huyt hao
tn, mch xung - nhm khng c nui dng m sinh bnh.
Thc:
+ Huyt nhit: do tm ho vn vng hoc n phi cht cay nng, nhit
ng trong y huyt i xung.
+ Huyt : sau khi sinh hoc sau hnh kinh, huyt hi ngn tr trong
lm chn huyt li m tn huyt khng quy c kinh.
+ Kh ut: do tnh ch ut c lm can kh ut kt, can mt chc nng iu
t, kh nghch ln nn huyt khng i theo kinh c.
1.3. Phn bit rong kinh v rong huyt
Ging nhau: u ra huyt m o.
Khc nhau:
+ Rong kinh c chu k.
+ Rong huyt khng c chu k v thng do nguyn nhn thc th gy ra
nh sy thai, st rau, cha ngoi t cung, ung th t cung, polyp c t
cung, vim c t cung.
2. Phn loi v cch cha bnh
2.1. Theo y hc hin i
Trc ht cn xc nh nguyn nhn iu tr:
Nu rong kinh do ri lon ni tit: dng ni tit progesteron v oestrogen
tim 5-7 ngy.
Nu cng kinh: nguyn nhn ngi ta hay ch n qu sn nim mc
t cung, do iu tr c th no nim mc t cung.
Nu do thc th phi gii quyt nguyn nhn thc th.
2.2. Theo y hc c truyn
2.2.1. Th do huyt nhit
Triu chng: kinh ra nhiu m a, sc hng, mnh nng, kht nc,
hoa mt chng mt, li , kh, ru vng, mch hot sc.
Php iu tr: thanh nhit, lng huyt, ch huyt.
Phng:
Bi 1: Thanh nhit c kinh thang
Quy bn 12g Hong cm 12g
Mu l 12g a du 12g
144
A giao 12g Tng l thn 12g
Sinh a 12g Ngu tit 12g
Tiu sn chi 12g Cam tho 4g
a ct b 12g
Bi 2: Ng sen sao vng 40g
C nh ni sao vng 40g Trc b dip sao vng 40g
L huyt d sao vng 40g Chi t sao en 20g
Sc ung ngy mt thang, ung 7- 10 thang.
2.2.2. Th t h
Triu chng: rong kinh ko di, ngi mi mt, mu nht, n t, th
nhiu, chn tay lnh, kh tiu, y bng, cht li nht, c hn rng,
mch t nhc v lc. Nu bng huyt nhiu c th xy xm, mch mun
tuyt.
Php iu tr: b t kh cm mu.
Phng:
Bi 1: bi B trung ch kh thang
Hong k 12g Nhn sm 12g
ng quy 12g Thng ma 8g
Si h 12g Bch trut 12g
Trn b 8g Cam tho 4g
Sc ung ngy mt thang, ung 7-10 thang.
Bi 2: dng c sm thang (nu bnh nng)
Nhn sm 12g
Nu dng ng sm th phi 100g
Sc c ly nc ung ngay.
Bi 3: dng bi Quy t thang (nu c tm t h) xem bi rong kinh.
2.2.3. Th thn h
Triu chng: huyt ra khng dt, sc nht, lnh bng di, thch xoa
nng, lng au, hoa mt, chng mt, li nht, mch trm nhc
Php iu tr: b thn, iu ho xung - nhm, ch huyt.
Phng:

145
Bi 1: dng bi Lc v gia v (nu thin v thn m h)
Thc a 12g Sn dc 10g
Sn th 10g Trch t 10g
Phc linh 12g an b 12g
A giao 12g Ngi dip 12g (sao en)
Trc b dip 12g (sao en)
Bi 2: Giao ngi thang (nu thin v thn dng h)
Xuyn khung 12g ng quy 12g
Bch thc 12g Thc a 12g
A giao 12g Ngi dip 8g
Sc ung ngy 1 thang vi nc gng, i to.
2.2.4. Th huyt (do t vng)
Triu chng: huyt ra dy da khng cm, sc en, c cc, au bng di,
n vo kh chu, cht li c m huyt, mch trm sp.
Php iu tr: hot huyt, hnh .
Phng:
Bi 1: T vt o hng
ng quy 12g Thc a 12g
Xuyn khung 12g o nhn 8g
Bch thc 12g Hng hoa 8g
Sc ung ngy mt thang trong 3- 5 ngy, sau c th ung tip bi Quy t.
Bi 2: Tht tiu tn (cc phng)
B hong 8g
Ng linh chi 8g
Sc vi ru v nc tiu tr em, ung 2 ln trong ngy.
iu tr bng lu bng chm cu: chm t huyt on hng (k ngn tay
2-3 o ln 0,5 thn); chm b huyt tam m giao, quan nguyn, kh hi,
vng ni tit loa tai.
T lng gi
1. Trnh by phng php iu tr rong kinh th t h?
2. Trnh by phng php iu tr rong kinh th huyt
146
Bi 23
Rong huyt
(Huyt lu)
Mc tiu
1. Hiu c nh ngha v phn loi rong huyt theo y hc c truyn
2. Bit ch nh iu tr rong huyt theo y hc c truyn
3. Bit phng php iu tr rong huyt theo y hc c truyn


1. theo y hc hin i
1.1. nh ngha
Theo YHH: rong huyt l hin tng ra huyt ng m o, hn lon v
thi gian v s lng. Thng khng phi hnh kinh m ra huyt, nhng cng
c trng hp rong kinh ri dn n rong huyt v ngc li rong huyt ri dn
n rong kinh.
1.2. Nguyn nhn
Thng do nguyn nhn thc th nh: vim lot c t cung, polyp c t
cung, ung th c t cung, st rau, sy thai..
Ngoi ra cng c mt s bnh ton thn gy nn nh: tng huyt p, suy
tim, cng tuyn gip, Hemogenie
1.3. iu tr
Phi iu tr theo ng nguyn nhn.
2. Theo Y hc c truyn
Rong huyt cng c xp v chng bng lu ca YHCT. Nguyn nhn
ch yu do tn thng xung nhm. Lm sng chia lm 2 loi h v thc vi
nhiu th khc nhau. Phng php iu tr c 2 loi: iu tr bng thuc v
iu tr bng chm cu.
2.1. iu tr bng thuc
2.1.1. Thc chng
Do huyt nhit, thp nhit, huyt , kh ut.
147
a. Huyt nhit
Do tm ho vng hoc n phi cay nng, nhit phc xung - nhm
gy bc huyt vng hnh.
Triu chng: t nhin ra huyt m o, lng nhiu, mu , ngi nng,
kht nc, u chong, ng khng yn, cht li , ru li vng, mch
hot sc.
Php iu tr: thanh nhit, lng huyt, ch huyt.
Phng:
Bi 1:
Sinh a 16g A giao 8g
Huyn sm 12g Tng l thn 8g
a ct b 8g Chi t sao 8g
K t 8g C nh ni 16g
Bi 2: Thanh nhit c kinh thang
Trch quy bn 20g A giao 12g
Mu l 12g Sinh a 16g
a ct b 10g Sn chi 12g
Hong cm 12g a du 12g
Tng l thn 12g Ngu tit 12g
Cam tho 4g
Sc ung ngy 1 thang, ung 7-10 thang.
b. Huyt : thng rong huyt sau no thai, t vng trnh thai.
Triu chng: t nhin ra huyt nhiu hoc ra dm d khng cm, sc tm
en, c cc, bng di au, c n, khi huyt ra cc ri th bt au, mch
trm sc.
Php iu tr: thng , ch huyt.
Phng:
Bi 1: T vt o hng (trnh by rong kinh)
Bi 2:
ch mu 20g Huyt d 6g
o nhn 10g Bch tho sng 4g
Ut kim 8g C nh ni 16g
Nga trut 8g
Sc ung ngy 1 thang, ung 7-10 thang.
148
c. Thp nhit: gp trng hp rong huyt do nhim khun.
Triu chng: rong huyt nhiu, mu ta, dnh nht. Nu nng v thp
th sc mt vng, ming dnh nht, tiu tin t, a chy, ru trng nht,
mch nhu hot. Nu nng v nhit th mnh nng t m hi, tm phin,
i tin to, tiu tin , cht li , ru li kh nht, mch trm sc.
Php iu tr: thanh nhit, to thp.
Phng:
+ Nu thin v nhit dng bi Hong lin gii c thang
Hong cm 12g Hong b 12g
Hong lin 12g Chi t 10g
+ Nu thin v thp th dng bi iu kinh thng dng tr thp thang
Khng hot 8g Thng ma 12g
Si h 8g Co bn 10g
Thng trut 8g Mn kinh t 12g
Hong k 12g c hot 12g
Phng phong 8g ng quy 16g
Cam tho 4g
Sc ung ngy 1 thang, ung 7-10 thang.
d. Kh ut
Triu chng: t nhin ra huyt hoc ra dm d khng dt, c huyt cc,
bng di au lan hai bn mng sn, hay gin, th di, ru li dy,
mch huyn.
Php iu tr: iu kh, gii ut
Phng:
Bi 1:
Hng ph 8g Ch xc 6g
Bch trut 8g C nh ni 16g
ng sm 12g Thc a 12g
Xuyn khung 8g C nn 12g
Bi 2: Khai ut t vt thang
Thc a 8g Bch trut 12g
Bch thc 8g ng sm 12g
ng quy 8g Hong k 8g
149
Xuyn khung 8g a du 8g
Hng ph 8g B hong 8g
Sc ung ngy 1 thang, ung 7-10 thang
2.1.2. H chng
a. Kh h: do lao ng nhiu, lo ngh qu , dinh dng km nh hng
n kh t lm nh hng n chc nng thng nhip huyt ca t.
Triu chng: t nhin ra huyt nhiu hoc ra t mt khng ngng, mu
nht, ngi mt mi, on hi, ngi ni, khng mun n, i tin lng,
s lnh, t ra m hi, li nht, ru li mng, mch h nhc.
Php iu tr: b kh lim huyt.
Phng:
Bi 1: B trung ch kh hoc Quy t thang gia thm:
Huyt d 6g
tc ct 12g
Mu l 12g
Bi 2: C bn ch bng thang
Thc a 12g Hong k 12g
ng sm 12g Thn khng 8g
Bch trut 12g
Sc ung ngy 1 thang, ung 10-15 thang
b. Dng h
Do kh h lu ngy lm tn thng dng kh ca mnh mn ho (thn
dng) m gy ra t cung b h hn khng iu ho c mch xung - nhm.
Triu chng: bng huyt v rong huyt lu ngy, sc mt vng nht hoc
xm, bng di lnh, ngang rn lnh au, thch chm nng, au eo lng,
s lnh, ru li trng nht, mch trm tr.
Php iu tr: n b thn dng.
Phng: Giao ngi thang thm ph t, thn khng, cao sng hu
Thc a 16g Ngi cu 12g
Xuyn khung 8g Ph t ch 8g
Xuyn quy 8g Thn khng 8g
Bch thc 12g Cao sng hu 12g
A giao 8g
Sc ung ngy 1 thang, ung 10-15 thang.
150
c. m h: m h gy tn dch v m huyt gim st lm tn thng ti
mch xung - nhm nn rong huyt.
Triu chng: bng huyt, rong huyt nhiu, mu sm, ngi gy yu,
u chong, tai, ming kh, hng ro, tm phin, lng au, lng bn tay
nng, m ng khng yn, cht li , ru li trng, mch h t sc.
Php iu tr: b m, lim huyt.
Phng:
Bi 1: Lc v gia tc ct, long ct, mu l
Thc a 12g an b 8g
Sn th 8g tc ct 12g
Hoi sn 12g Long ct 16g
Trch t 8g Mu l 12g
Phc linh 8g
Bi 2: Nu m h lu ngy gy huyt h dng bi Giao ngi thang thm
cc thuc b m.
Thc a 12g Ngi cu 8g
Bch thc 10g Quy bn 8g
Xuyn khung 8g Thch hc 8g
Xuyn quy 8g N trinh t 8g
A giao 12g
Sc ung ngy 1 thang, ung 10-15 thang.
d. Cha rong huyt sau
Cn loi tr cc trng hp rong huyt do st rau, sang chn, ri cn c
vo ton th trng ca sn ph v mt h, thc, hn, nhit cha.
Nu h dng bi Thp ton i b thm a giao, tc on, thng ma, sn th
Bch trut 16g Xuyn khung 8g
Phc linh 12g Hong k 8g
Cam tho 6g Nhc qu 4g
ng sm 12g A giao 8g
Thc a 12g Thng ma 8g
Bch thc 10g Tc on 12g
ng quy 8g Sn th 8g
151
Nu do gin d qu dng bi Tiu giao thm chi t, sinh a
Si h 8g Trn b 6g
Bch thc 8g Bc h 8g
Bch linh 8g Sinh khng 3 lt
Bch trut 8g Chi t sao 8g
Cam tho 4g Sinh a 4g
Sc ung ngy 1 thang, ung 7-10 thang
Nu do huyt dng bi Pht th tn phi hp vi bi Tht tiu tn
Bi Pht th tn:
Xuyn khung 12g
ng quy 18g
Bi Tht tiu tn:
B hong 4g
Ng linh chi 4g
Sc ung ngy mt thang, ung 7-10 thang.
2.2. Cha rong kinh rong huyt bng chm cu
Dng cc huyt kinh nhm v kinh t, nu thc nhit dng php t
khng cu, nu h hn th chm b v cu.
Huyt chnh: quan nguyn, tam m giao, n bch.
Nu thc nhit thm: kh hi, bch hi.
Nu t kh h thm: tc tam l.
Nu chy mu nhiu: cu kh hi, bch hi.
Chm loa tai vng tuyn ni tit, t cung, bung trng.


152
T lng gi
1. in vo ch cho cu ng, ch S cho cu sai
Rong kinh l hin tng kinh ko di trn 7 ngy /S
Rong kinh ging hon ton vi rong huyt /S
Rong kinh, rong huyt YHCT gi l i h /S
2. Hy in cm t thch hp vo ch trng
Rong kinh c 4 th, l:.
Rong huyt c 3 th, l
3. Nu cc huyt chm cu trong iu tr rong kinh.
153
Bi 24
au bng kinh
(Thng kinh)
Mc tiu
1. Nm c nh ngha v phn loi thng kinh.
2. Nm c cc th bnh v phng php iu tr thng kinh bng YHCT.


1. i cng
1.1. Theo y hc hin i
1.1.1. nh ngha
Thng kinh l hnh kinh au bng, au xuyn ra ct sng, lan xung hai
i, lan ra ton b bng, km theo c th au u, cng v, bun nn, thn
kinh bt n nh.
1.1.2. Phn loi
C 3 loi thng kinh:
Thng kinh nguyn pht: xy ra sau tui dy th (hay ni ng hn l
ngy vng kinh u tin c th phng non).
Nguyn nhn thng do c nng nh: cc mch mu t cung co tht gy
thiu mu, t cung co bp qu mnh, ngng au thp, tnh trng d xc ng.
Thng kinh th pht: xy ra sau nhiu nm hnh kinh khng au (cn
gi l thng kinh mun, thng kinh mc phi).
Nguyn nhn thng do thc th nh: t cung sau, cht c t cung, u x
t cung.
Thng kinh mng: y l th c bit, nguyn nhn cha r.
1.2. Theo y hc c truyn (nguyn nhn v th bnh)
Th kh tr, huyt : do tnh ch khng th thi lm cho can kh ut tr
dn n huyt gy au, hoc do hn kh kt bo cung lm huyt khng
vn hnh m gy au.
Th kh huyt h: c th suy yu, kh huyt h, mch xung - nhm b ri
lon gy au.
154
2. iu tr thng kinh
2.1. Theo y hc hin i
Phng php iu tr thng kinh theo YHH rt rng ri v phong ph
do tnh cht a dng ca nguyn nhn gy bnh, (t cc thuc gim au n
phu thut).
Thuc gim au: c 2 nhm
+ Nhm gy m mng, gy ng nh morphin, codein, pethidin.
+ Nhm gim au, h nhit nh pyrazolon v cc ch phm.
iu tr bng hormon: progestin trong iu tr lc ni mc t cung nhm c
ch phng non v c c tc dng gim au tc ng ln tm l ngi bnh.
Nu trng hp thng kinh qu nng dng thuc khng kt qu c th ch
nh phu thut cotte (ct m ri thn kinh trc xng cng): t dng.
2.2. Theo y hc c truyn
2.2.1. Th huyt h
Triu chng: sau khi hnh kinh ri au bng lin min, lng kinh t sc
nht, sc mt trng a vng, mi nht, ngi gy, chng mt, hoa mt, hi
hp, t ng, i tin to, li nht khng ru, mch trm h t.
Php iu tr: b huyt, ch kh.
Phng: dng bi Bt trn thang lm ch
ng sm 12g Xuyn khung 8g
Chch tho 4g Bch thc 12g
Bch trut 12g ng quy 12g
Phc linh 12g Thc a 12g
Sc ung ngy mt thang, ung trong 3 chu k kinh lion.
Nu thn km khng nui dng c can th nn b thn iu can; dng
bi iu can thang
Sn dc 12g
Sn th 12g (chng chn, b ht)
Ba kch 8g (sao mui)
Bch thc 8g (sao ru)
ng quy 8g (sao ru)
Cam tho 4g
Sc ung ngy mt thang, ung trong 3 chu k kinh lin tc.

155
2.2.2. Th kh tr, huyt
Triu chng: au bng trc khi c kinh v sau khi c kinh, thch xoa
bng, lng kinh t, km theo tc ngc sn, trng bng, th di d chu,
li c m huyt , mch huyn.
Php iu tr: nu kh tr nn thun kh hnh tr.
Phng: Gia v dc thang
dc 16g Hng ph 8g
Sa nhn 8g Cam tho 4g
Mc hng 4g
Sc ung ngy mt thang, ung trong 3 k kinh lin.
2.2.3. Th thc hn
Triu chng: au bng trc khi hnh kinh v gia lc hnh kinh, lng
kinh t, mu thm c cc, ngi gai rt, s lnh, li c im huyt,
ru trng, mch hot hoc ph khn.
Php iu tr: n kinh, tn hn.
Phng: dng bi Ng th du thang
ng quy 12g T tn 4 g
Nhc qu 4g Co bn 4g
Ng th 12g Can khng 4 g
an b 12g Mc hng 4g
Bn h ch 8g Phc linh 8g
Mch mn ng 8g Cam tho 4g
Phng phong 8g
Sc ung ngy mt thang, ung trong 3 chu k kinh lin.
Chm cu: quan nguyn, tam m giao, t du.
2.2.4. Th h hn
Triu chng: sau khi hnh kinh au bng lin min, thch xoa nn, tay
chn lnh, lng mi, ru li trng, mch trm tr.
Phng: dng bi n kinh thang
Ng th 12g Xuyn khung 8g
ng quy 12g Bch thc 8g
Nhn sm 8g Qu chi 8g
156
Bn h 8g A giao 10g
Mch ng 8g
Sc ung ngy mt thang, ung trong 3 chu k kinh.
2.2.5. Th huyt nhit
Triu chng: au bng trc lc hnh kinh, kinh trc k, lng nhiu sc
hng, mt , ming kh, mch huyn sc hoc hot sc.
Php iu tr: thanh nhit lng huyt, hot huyt.
Phng: dng bi Sinh huyt thanh nhit thang
ng quy 12g o nhn 8g
Xuyn khung 12g Hng hoa 4g
Bch thc 12g Mc hng 4g
Sinh a 16g Hng ph 8g
an b 8g Chch tho 4g
Sc ung ngy mt thang, ung trong 3 chu k kinh lin.
T lng gi
1. Nu nh ngha thng kinh.
2. Trnh by triu chng, phng php iu tr thng kinh th huyt nhit
bng YHCT.
3. Trnh by triu chng, phng php iu tr thng kinh th huyt
bng YHCT
4. Trnh by triu chng, phng php iu tr thng kinh th thc hn
bng YHCT.
5. Trnh by triu chng, phng php iu tr thng kinh th h hn
bng YHCT.
157
Bi 25
B kinh, v kinh
(Trn huyt)
Mc tiu
1. Trnh by c quan nim v kinh theo YHH v YHCT.
2. Trnh by c triu chng v phng php iu tr v kinh theo th bnh
bng YHCT.


1. theo y hc hin i
1.1. nh ngha
V kinh l hin tng khng c kinh nguyt qua mt thi gian quy nh.
Thi gian y l 18 tui i vi v kinh nguyn pht, 3 thng nu tng c
kinh u, l 6 thng nu c kinh khng u.
Ngi ta cn phn bit v kinh sinh l (xy ra trong thi k c thai, thi
k cho con b) v v kinh bnh l.
1.2. iu tr
Gy vng kinh nhn to theo trnh t: giai on u ch c oestrogen, giai
on sau c c oestrogen v progesteron ging nh vng kinh t nhin.
2. theo Y hc c truyn
Trn thc t lm sng y hc c truyn ch cha loi v kinh th pht v
chng b kinh, do 2 nguyn nhn chnh:
Do phn huyt gim st gm: kh h, huyt h, lao tn, v nhit.
Do phn huyt b tr gm: phong hn, kh ut, m tc, huyt lm
kinh huyt khng vn hnh gy b kinh, v kinh.
2.1. Kh huyt h tn
2.1.1. Do huyt h: hay gp ngi thiu mu
Triu chng: kinh nguyt vi thng khng c, sc mt vng a, hoa mt
chng mt, nhc u, hi hp, n km, ngi gy, da kh, cht li nht,
mch t sc.
158
Php iu tr: b kh huyt.
Phng:
Bi 1: ng sm 12g Thc a 12g
Bch trut 12g H th 12g
Hoi sn 12g K huyt ng 12g
d 12g Ngu tt 12g
K t 12g ch mu 16g
Bi 2: Dng bi T vt o hng
Xuyn khung 10g Bch thc 12g
ng quy 16g o nhn 12g
Thc a 12g Hng hoa 10g
Sc ung ngy 1 thang, ung 20- 30 thang.
2.1.2. Do t kh h
Triu chng: b kinh vi thng, sc mt vng, tinh thn mi mt, u
chong, hi hp, th gp, km n, chn tay lnh, i tin lng, cht li
nht, ru li trng, mch trm.
Php iu tr: kin t, ch kh, sinh huyt.
Phng: dng bi B trung ch kh thang gia gim
ng sm 12g Bch trut 12g
Hong k 12g ng quy 12g
Thng ma 12g Si h 12g
Trn b 12g an sm 12g
Ngu tt 12g Bch thc 12g
Hoc dng bi Quy t thang gia gim
ng sm 12g Bch linh 12g
Bch trut 12g Cam tho 12g
Hong k 12g ng quy 12g
To nhn 10g Mc hng 6g
Vin ch 4g Thc a 12g
Bch thc 12g Xuyn khung 8g
Sc ung ngy 1 thang, ung 10-15 thang.
159
2.1.3. Do can thn m h
Triu chng: b kinh vi thng, ngi gy cm, sc mt trng, g m ,
lng bn tay bn chn nng, ming kh, tm phin, t ng, cht li ,
ru li vng, mch t sc.
Php iu tr: t b can thn, hot huyt.
Nu h lao (lao phi) thm b ph m.
Phng: dng bi Lc v gia v
Thc a 12g Sn dc 12g
Sn th 12g Trch t 10g
Phc linh 12g an b 12g
Trch lan 12g Ngu tt 12g
ch mu 12g o nhn 10g
Nu c ph m h th dng bi Kip lao tn
Bch thc 12g Bn h ch 12g
Hong k 12g Phc linh 12g
Cam tho 4g ng quy 12g
Ng v t 10g Sa sm 12g
Agiao 12g Thc a 12g
Sc ung ngy 1 thang, ung 15-20 thang.
2.1.4. Do v nhit: do nhit tch trung tiu, khng dn xung lm tn thng
tn dch gy nn b kinh.
Triu chng: b kinh, sc mt vng, hai g m , tm phin, nng ny,
ming ng, hng kh, ngi gy, cht li , ru li vng kh, c khi
lot ming, mch t sc.
Php iu tr: tit nhit, tn m.
Phng: dng bi Ngc trc tn
Xuyn khung 10g ng quy 12g
Thc a 12g Bch thc 12g
i hong 4g Mang tiu 4g
Cam tho 4g
Sc ung ngy 1 thang, ung 15-20 thang hoc c th lm thuc hon ung.

160
2.2. Do huyt
2.2.1. Do phong hn: do phong hn xm nhp vo mch xung v nhm gy
b kinh.
Triu chng: b kinh, bng di lnh, au, chn tay lnh, bun nn, ru
li trng, mch trm khn.
Php iu tr: n kinh tn hn, hnh kh hot huyt.
Phng:
Bi 1:
Qu chi 6g T ngnh 10g
Bch ch 8g an sm 12g
Xuyn khung 10g Ut kim 8g
Ngu tt 12g Nga trut 10g
Bi 2: Lng phng n kinh thang
ng quy 12g Ngu tt 12g
Xuyn khung 10g ng sm 12g
Bch thc 12g Cam tho 4g
Nga trut 12g an b 12g
Qu chi 4g
Sc ung ngy 1 thang, ung 7-10 thang.
2.2.2. Do can kh ut
Triu chng: b kinh, tnh ch ut c, hay cu gt, phin to, sc mt
vng, ngc sn y tc, hi, cht li , ru li vng, mch huyn.
Php iu tr: l kh th ut, iu kinh.
Phng:
Hng ph 8g Nga trut 12g
Trn b 8g Ut kim 8g
Xuyn khung 12g dc 8g
T ngnh 8g Ngu tt 12g
Sc ung ngy 1 thang, ung 10-15 thang.
2.2.3. Do huyt , huyt ngng
Triu chng: b kinh, au vng h v, c n, sc mt ti, ming kh nhng
khng mun ung, mch trm sc.
161
Php iu tr: hot huyt, ho .
Phng:
Bi 1: ch mu 12g o nhn 10g
Ut kim 12g Ngu tt 12g
To gic thch 8g Hng ph 8g
Bi 2: Thng tin
ng quy 12g Huyn h 10g
Hng hoa 10g Xch thc 12g
Xuyn khung 10g Hng ph 8g
Sc ung ngy 1 thang, ung 10-15 thang.
Chm cu
+ Ti ch: chm b cc huyt quan nguyn, kh hi, khc ct.
+ Ton thn: chm tam m giao, huyt hi, thn du, can du, t du.
+ Nh chm: chm vng t cung v ni tit.
T lng gi
1. Hy in cm t thch hp vo ch trng
V kinh l hin tng.quy nh.
Thi gian y lv kinh nguyn pht,..c kinh u,
..c kinh khng u.
2. Hy in vo ch cho cu ng, ch S cho cu sai
V kinh th huyt h, php iu tr l b kh huyt /S
iu tr v kinh khng nn chm cu /S

162
Bi 26
i h
Mc tiu
1. Nm c i cng v i h theo YHH v YHCT.
2. Nu c triu chng v phng php iu tr i h bng YHCT.


1. i cng
1.1. Theo y hc hin i
Bnh thng m o ph n tit ra dch nhy trong, khng hi, c tc
dng nhu nhun m o, gi cho pH ca m o mc 4,5 (toan) vi khun
gy bnh khng pht trin (glucogen chu tc dng trc tip ca trc khun
Doderlein m o bin thnh acid lactic lm mi trng m o tr nn toan
nn vi khun khng pht trin c).
Cht dch c tit ra t cc tuyn c t cung, nim mc t cung, biu
m m o di tc dng ca ni tit.
Trong trng hp thiu nng ni tit, kh h t, hay b vim m o v dn
n v sinh.
Trong nhim khun ng sinh dc kh h ra nhiu, bn, hi, nga.
Tc dng ca kh h:
Bo v m o khi vim nhim.
Hng cho tinh trng i v pha t cung.
Phn nh s pht trin ca ni tit.
Phn nh tnh trng ca vim nhim ng sinh dc.
Di tc dng ca estrogen cc cht protein kt tinh to thnh hnh nh
dng x (phn nh tnh trng rng trng v phng non), thng p
dng iu tr v sinh.
1.2. Theo y hc c truyn
Theo Ni kinh i h bao gm 2 ngha:
163
Ngha rng: gm tt c cc bnh kinh i, thai sn v cc bnh ny u
pht sinh phn di lng qun (i l dy tht lng qun, h l di).
Ngha hp: trong m o c dch chy xung lai rai gi l i h. Bao gm
bch i, xch i, hong i, hc i, thanh i, ng sc i, bch dm
(ging di tinh nam gii), bch trc (vim ng tit niu).
i h thuc m dch. Trong c th m dch do t vn ho, thn b tng,
lin quan n xung nhm. Khi t vn ho tt, thn kh thnh, xung - nhm iu
ho, i mch kin c th m dch c tc dng nhu nhun m h v m o
tn tn thng nhun, bn phi bnh gi.
Nu thn kh bt tc, t vn ho km hoc nhm mch h yu, i mch
bt c gy kh h ra nhiu, sc mu c tnh cht thay i gi l bnh i h.
2. Nguyn nhn gy bnh i h
2.1. Ni nhn
Do t h thp nh tr.
Do can kh ut, nhit theo kinh can dn xung xung - nhm.
Do thn h, xung - nhm thng tn gy nn i h.
2.2. Ngoi nhn
Do phong hn thp nhit nhn lc bo cung h yu xm nhp vo gy nn
bnh i h.
2.3. Bt ni ngoi nhn
Do cha , phng dc qu , no sy nhiu ln.
3. iu tr
3.1. Th do t h
Triu chng: i h nhiu, trng long nh nc, khng hi, au lng, tr-
ng bng, da vng nht, tinh thn mt mi, chn tay lnh, i tin to,
cht li nht, mch trm nhc.
Php iu tr: kin t, tr thp.
Phng: dng bi Hong i thang
Bch trut 12g Sa tin t 8g
Hoi sn 12g Thng trut 8g
ng sm 12g Trn b 8g
Bch thc 12g Cam tho 4g
Si h 12g Bch gii t sao 4g
164
Hoc dng i php lp phng
ng sm 12g Hoi sn 12g
d 12g Bch trut 12g
Thng trut 8g Hong b 8g
Khim thc 12g Hng ph 8g
Cam tho 4g
Sc ung ngy mt thang, ung 10-15 thang.
3.2. Th do thn h
Triu chng: i h nhiu, mu vng, mt mi, au lng, mi gi, tiu
tin nhiu ln, lnh bng di, cht li nht, ru li trng dy, mch
trm t.
Php iu tr: b thn, c xung nhm.
Phng:
Nu thn dng h dng bi Bt v.
Nu thn m h dng bi Lc v tri b hoc bi Th cu k thang
H th 12g Cu k t 12g
Th ty t 12g Tang phiu tiu 12g
Xch thch chi 12g Cu tch 12g
trng 12g Thc a 12g
Hoc hng 4g Sa nhn 4g
Sc ung ngy mt thang, ung 10-15 thang.
3.3. Th do can ut
Triu chng: i h l mu c, nhy dnh, kinh nguyt trc sau khng
nh k, u ut, ngc sn y tc, ming kh ng, tiu tin vng, cht
li , mch huyn hot.
Php iu tr: iu can, gii ut, thanh nhit.
Phng: dng bi Long m t can thang
Long m tho 12g ng quy 12g
Bch thc 12g Si h 12g
Trch t 10g Mc thng 10g
Sa tin 8g Cam tho 4g
Sc ung ngy mt thang, ung 10-15 thang.
165
3.4. Th do thp nhit
Triu chng: i h nhiu, mu vng nh m, hi, nga m h, m o,
tiu vng, cht li , ru li vng, mch hot sc.
Php iu tr: thanh tr nhit thp.
Phng: dng bi Ch i hong
Tr linh 12g Nhn trn 12g
Phc linh 12g Xch thc 12g
Sa tin 10g an b 12g
Trch t 10g Chi t 12g
Hong b 8g Ngu tt 12g
Sc ung ngy mt thang, ung 10-15 thang.
Hoc c th dng bi Long m t can thang.
T lng gi
1. in vo ch cho cu ng, ch S cho cu sai
Kh h c tc dng bo v m o /S
Kh h phn nh s pht trin ca ni tit /S
Kh h phn nh tnh trng vim nhim ng sinh dc /S
i h thuc m dch /S
2. in vo ch trng cm t thch hp
i h bao gmng sc i.
Nguyn nhn gy ra i h l..v bt ni ngoi nhn.
3. Trnh by triu chng v phng php iu tr i h th t h.
4. Trnh by triu chng v phng php iu tr i h th thn h.
5. Trnh by triu chng v phng php iu tr i h th can ut.
6. Trnh by triu chng v phng php iu tr i h th thp nhit.


166
Bi 27
Vim lot c t cung
(m sang)
Mc tiu
1. Trnh by c biu hin bnh l c t cung.
2. Trnh by c phng php iu tr vim lot c t cung bng y hc c truyn.


1. i cng
1.1. Theo y hc hin i
Vim lot c t cung l bnh vim nhim ng sinh dc, t l gp kh cao
(80%) trong bnh ph khoa, ph bin hay gp trong tui hot ng tnh dc.
Nu pht hin bnh sm, iu tr tch cc s khi hn v trnh c nhng bin
chng xu nh vim tc ng dn trng, vim phn ph, ung th c t cung.
Vim c t cung: c 2 hnh thi vim c t cung l vim trong c t cung
v vim ngoi c t cung.
L tuyn c t cung: l tn thng trong biu m tr ca ng t cung
pht trin v thay th biu m lt ca mt ngoi c t cung b hu hoi.
V i th nhn l tuyn nhng tn thng lot, nu lm nghim php
thm acid acetic 3% s thy tn thng mu trng, c nhng ht nh
chm nho.
Lao v ung th c t cung: din lot lao v ung th thng khng u, sn
si, chm vo d chy mu. chn on xc nh cn phi lm t bo
hc hoc sinh thit.
Nguyn nhn: thng do ly qua ng tnh dc, nhim khun sau cc
th thut nh t vng, bm hi vi trng, no sy thai, sau , thiu v sinh
khi giao hp, khi hnh kinh.
1.2. Theo y hc c truyn
Vim lot c t cung c m t trong chng m sang (m l trong, sang
l nht, l lot).
167
Nguyn nhn: do can kh ut kt, do t h hoc do ngoi nhn gy nn
thp nhit h tiu. Thp lu ngy dn n sinh lot, lot lu dn n sinh
trng (nga).
2. iu tr
2.1. Theo y hc hin i
Phi xc nh mm bnh v nguyn nhn gy bnh.
Nu do vi khun thng: kh h vng nh m, c th ln t mu, m o
, c t cung vim .
t thuc khng sinh phi hp vi estrogen: thng dng colposeptin va
c tc dng st khun va c tc dng estrogen, mi ngy t mt vin vo m
o trong 20 ngy lin tc.
Nu vim do lu: kh h c trng hoc xanh c, phi iu tr c nam gii.
Nu vim do Gardnerella vaginalis (l loi Gram (m) hnh que): kh h
nhiu, hi, c, nga, c t cung vim lot, soi ti kh h s thy nhiu
trc khun gy bm th dng ampicillin 2g/ngy hoc amoxicilin 1g/ngy
trong 10 ngy.
Ngoi dng khng sinh c th vn dng thm t in c t cung, p lnh
c t cung.
2.2. Theo y hc c truyn
t thuc ti ch chia lm 3 giai on:
Giai on u: gim tit dch v dn sch tn thng
t bt kh h (kh l khc, b; h l cht bn, hi), thnh phn gm:
L m qu L mng tay
Ng bi t Bch cp
Bng sa Phn phi
Giai on 2: chng vim (khi mt lot ch cn vim )
t bt tiu vim, thnh phn gm:
L mng tay
Hong b
Hong ng
Giai on 3: ti to t chc
t bt sinh c, thnh phn gm:
Ngh vng Mu l
168
Hong b Ng bi t
L cam thch (oxyd km)
Cc loi thuc t ny u c sn xut ti Khoa dc Bnh vin Y hc
c truyn Trung ng.
Ch :
+ Thuc t c lm di dng bt m bo PH ca m o (4,5) mi
ngy t 10g, c th t lin tc hoc cch ngy.
+ Thi gian t thuc: ph thuc vo tn thng, khng nht thit phi
qua 3 giai on.
+ Khi c kinh khng t thuc.
+ Ngoi thuc t ti ch c th dng thuc ung trong theo bin chng.
+ Nhng trng hp t thuc v ung thuc ca y hc c truyn khng
c kt qu phi kt hp vi y hc hin i.
T lng gi
1. Hy in vo ch cho cu ng, ch S cho cu sai
Vim lot c t cung c m t trong chng m sang /S
YHH thng dng khng sinh t ti ch /S
Khng nn t in c t cung /S
Vim c t cung c th bin thnh ung th c t cung /S
2. Trnh by phng php iu tr vim lot c t cung theo YHCT.
169
Bi 28
Vim m o
(m dng)
mc tiu
1. Trnh by c cc nguyn nhn gy vim m o.
2. Trnh by c triu chng v phng php iu tr vim m o theo y hc c
truyn.


1. theo Y hc hin i
Vim m o l mt trong cc bnh ph khoa thng gp, tuy khng lm
nh hng n tnh mng nhng gy kh chu, nh hng n sinh hot ca
ngi ph n. Bnh gp nhiu la tui sinh .
1.1. Nguyn nhn
Do nm Candida albicans, trng roi Trichomonas v tp khun (cn gi l
vim m o khng c hiu).
1.2. Triu chng
Ni bt l nga, nng rt m h m o, kh h nhiu hoc t v ra nhiu
hn trong nhng ngy trc kinh. Nu do nm th kh h trng c nh vng
sa, nu do Trichomonas kh h trng long v nhiu bt. Khm lm sng thy
m h, m o ph n, vim , trng hp nng c th c tn thng c vng
tng sinh mn v i bn.
1.3. Xt nghim
Ly kh h cng sau soi ti tm nm, Trichomonas, tp khun.
Trong trng hp do nm hoc Trichomonas th phi khm ton thn tm
nm ng tiu ho, khoang ming, hu mn, mng tay, mng chn v b phn
sinh dc ca ngi chng.
1.4. iu tr
Nu do nm: dng thuc khng nm nh
+ Nystatin vin 100000UI, t m o ngy 1 -2 vin/ngy, dng trong 14 ngy.
170
+ Miconazol hoc clotrimazol vin t m o 200mg, 1 vin/ngy, dng
trong 3 ngy.
+ Hoc clotrimazol 500mg t 1 liu duy nht.
Hoc fluconazol vin 150mg ung 1 vin duy nht, khng cn iu tr cho
bn tnh, khng cn iu tr cho nhng ph n xt nghim c nm nhng
khng c triu chng lm sng.
Nu vim m o do trng roi: cn phi iu tr cho c v, chng v bn
tnh. C th dng 1 trong nhng phc sau:
+ Metronidazol 2g hoc tinidazol dng liu duy nht.
+ Metronidazol vin 250mg x 3 vin /ngy, ung 3 ln, cch nhau 8 gi,
ung 7 ngy.
Nu vim m o vi khun:
+ Phc s dng metronidazol nh iu tr vim m o do trng roi,
khng cn iu tr cho bn tnh.
+ Clindamycin 1,5-3g/ngy, ung chia 4 ln, cch nhau 6 gi/ln.
+ Amoxicilin 250-500mg/ln, ung 3 ln, cch nhau 8 gi/ln.
2. theo Y hc c truyn
Vim m o c m t trong chng m dng (m l trong, dng l nga).
2.1. Nguyn nhn
Thp nhit khu tr h tiu: do t h khng vn ho c thp, thp lu
ngy ho nhit, thp nhit dn xung h tiu lu ngy sinh trng, dng (nga).
Nhit ut kinh can: do tnh ch tc gin lm thng can, can ut sinh
nhit, nhit ut kinh can dn xung xung - nhm gy nn bnh.
2.2. Th bnh
2.2.1. Th thp nhit
Triu chng: nga ca mnh, kh h nhiu, c bt mu vng hoc nh m,
bn chn, mt ng, ming ng, tc ngc, au lng, tiu vng, i tin
to, mch hot sc.
Php iu tr: thanh nhit, tr thp.
Phng:
Bi 1: dng bi T gii thm thp thang gia thng trut
T gii 12g Sinh d 20g
Hong b 12g Xch thc 12g
171
an b 16g Trch t 12g
Hot thch 12g Thng tho 6g
Thng trut 8g
Sc ung ngy 1 thang, ung 5-7 thang.
Bi 2: dng bi an chi tiu dao:
an b 12g Si h 12g
Sn chi 8g Bch thc 12g
ng quy 12g Bch trut 8g
Phc linh 12g Bc h 4g
i to 12g Gng ti 3lt
Sc ung ngy 1 thang, ung 5-7 thang.
2.2.2. Th nhit ut kinh can
Triu chng: nga ca mnh, u ut, d cu gin, bn chn, ng t, mm kh
ng, i tin to, nc tiu vng, cht li , ru li vng, mch hot sc
Php iu tr: t can, thanh nhit.
Phng: dng bi T can thang
Long m 8g Sinh a 8g
Si h 8g Trch t 8g
ng quy 8g Mc thng 8g
Sa tin t 8g Chi t sao 8g
Hong cm 8g Cam tho 4g
Sc ung ngy 1 thang, ung 5-7 thang.
Ngoi thuc ung, cn dng thuc t ti ch cng c tc dng rt tt.
Hin ti Khoa ph Bnh vin Y hc c truyn Trung ng ang s dng
bt t tiu vim B, thnh phn gm: hong b, l mng tay, lu hunh. Cc v
thuc trn sy kh, tn mn, m bo PH ca m o (4,5). Mi ngy t 1
ln 10g vo m o, t 5-7 ngy, c th t lin tc hoc cch ngy.
3. D phng
Ngi ph n lun gi gn v sinh hng ngy, cn ch n mt s thun
li gy vim m o.

172
4. tin trin v bin chng
Cc nhim khun m o c th gy vim tiu khung, dn n nguy c
cha ngoi t cung, v sinh. Mt s trng hp c th gy sy thai, non hoc
tr thiu cn.
T lng gi
1. Hy in ch cho cu ng, ch S cho cu sai
Vim m o thng do nm, trng roi, tp khun /S
Vim m o bt buc phi iu tr cho c bn tnh /S
Vim m o theo YHCT chia lm 3 th lm sng /S
2. Hy in vo ch trng cm t thch hp
Php iu tr ca th thp nhit l..
Php iu tr ca th thp nhit kinh can l
3. K c triu chng ca vim o theo YHH.
4. K c nhng bin chng ca vim m o.
173
Bi 29
Vim phn ph
(Trng h)
Mc tiu
1. Trnh by c i cng vim phn ph theo YHH v YHCT.
2. Trnh by c triu chng, nguyn nhn gy bnh, php iu tr vim phn
ph theo YHCT.


1. i cng
1.1. Theo y hc hin i
Nguyn nhn: thng xy ra sau , no, sy, hnh kinh, hoc c th sc
khng gim, nhim trng ngc dng, qua ng mu (t gp 2%), lao
sinh dc, bin chng quai b.
Triu chng:
+ C nng: au vng h v, thng au c hai bn h chu, au lin tc,
c khi au tng cn d di, c th c st, mch nhanh.
+ Thc th: nn bng thy au vng h v. Thm m o: c khi n cnh
t cung, t cung di ng hn ch, khi vim cha lan to s nn thy vi
trng cng thnh mt khi, n au. Khi vim lan to th cc b phn
xung quanh dnh vi vi trng thnh khi n, n vo rt au, khi
thnh bng s c phn ng.
Chn on:
+ Chn on xc nh: da vo tin s c b cc bnh ly nhim qua
ng tnh dc hoc nhim khun sau th thut bung t cung v cc
triu chng au vng h v, st, c khi n cnh t cung, n au.
+ Chn on phn bit vi: vim rut tha, vim phc mc tiu khung, u
nang bung trng xon, cha ngoi t cung.
iu tr: iu tr ni khoa l chnh
+ Ngh ngi.
+ Khng sinh.
174
+ Nng cao th trng.
+ L liu php: chiu tia hng ngoi.
+ iu tr ngoi khoa t ra khi c ti m khu tr v sau khi iu tr tch
cc bng khng sinh khng .
1.2. Theo y hc c truyn
c m t trong chng trng h.
Trng: l khi tch t ca huyt. Huyt thuc m, tnh cht ca m l
chm, lng nn au c nh ti ch.
H: l khi tch t ca kh. Kh thuc dng, tnh cht ca dng l ni v
ng nn au khng c nh.
iu tr: chia lm 4 th (1 th cp tnh v 3 th mn tnh).
2. Phng php iu tr theo y hc c truyn
2.1. Vim phn ph cp
2.1.1. Th nhit c
Nguyn nhn:
Ch yu do nhit c. Y hc c truyn cho rng sau khi hnh kinh hoc
sau th bo cung h yu, nhit t nhn xm phm vo bo cung, chnh t
tranh chp, dinh v bt ho m gy nn bnh.
Triu chng: st, au bng di, c n, kh h vng hi, ngi mt mi,
au u, ming kh khng mun n, nc tiu vng t, i tin to hoc
lng, cht li , ru li vng, mch hot sc.
Php iu tr: thanh nhit gii c, hnh kh hot huyt.
Phng: dng bi Ngn lin hon
Kim ngn hoa 12g an b 12g
Lin kiu 12g Xch thc 12g
Chi t 12g d 12g
Xuyn luyn t 10g Huyn h 10g
Nu phn ph n nhiu gia: o nhn 8g, hng hoa 8g.
Nu c biu chng gia: kinh gii 10g, phng phong 10g, bch ch 8g.
Nu chng bng gia: mc hng 4g, hng ph 6g.
Nu kh h nhiu hi gia: hong b 8g, nhn trn 12g.
2.12. Th thp nhit
Triu chng: thng l t cp ca vim phn ph mn tnh. Ngi bnh c
th c st ko di, mt mi, au bng di, kh h nhiu mu vng, hi, au
lng, tiu tin vng, i tin to, cht li , ru vng, mch hot sc.
175
Php iu tr: ph , tn kt, tr thp nhit.
Phng: dng bi Tiu tch tn
Tam lng 12g Nga trut 12g
o nhn 10g an sm 12g
an b 12g Xch thc 12g
Huyn h 10g d 12g
Nu au lng gia thm tc on 12g, tang k sinh 12g.
2.2. Vim phn ph mn tnh
Do vim phn ph cp iu tr khng trit , c th biu hin cc b
nh tc ng dn trng, nc vi trng dn n v sinh. Y hc c truyn
chia lm 3 th.
2.2.1. Th kh tr, huyt
Triu chng: au h v khng c nh, trng bng, kh h ra nhiu, km
theo ri lon chc nng t v, kinh nguyt khng u, thng kinh.
Php iu tr: l kh, hnh tr, hot huyt, ho .
Phng: dng bi T vt o hng, hoc i php lp phng nh sau
ng sm 12g K huyt ng 12g
Trn b 8g Ch xc 8g
Hng ph 6g Xuyn khung 10g
Xch thc 12g d 12g
Sc ung ngy 1 thang, ung 10-15 thang.
2.2.2. Th hn ngng, kh tr
Nguyn nhn: do hnh kinh hoc sau , sy c dm ma li nc hoc, n
cht sng lnh qu , hn t xm nhp vo bo cung, huyt b hn ngng
li gy au.
Triu chng: au tc bng di, lnh bng di, thch chm nng, au
lng nht l hai bn xng hng, kinh nguyt sau k (lng t, c cc)
kh h nhiu long, cht li nht, c im huyt, ru li trng, mch
trm tr.
Php iu tr: n kinh tn hn, hnh kh hot huyt.
Phng: dng bi Tiu phc kh thang
B hong 6g Ng linh chi 6g
ng quy 12g Xch thc 12g
176
Mt dc 6g Tin h 10g
Qu tm 4g Tiu hi 4g
Bo khng 4g
Sc ung ngy 1 thang, ung 10-15 thang.
3. Cc phng php iu tr kt hp
3.1. Chm cu
Chm b cc huyt: quan nguyn, kh hi, quy lai, t cung, tam m giao,
huyt hi, thn du, bt liu; cu i vi th hn ngng, kh tr.
3.2. Tht thuc vo hu mn
Thuc tht gm:
B cng anh 12g K huyt ng 12g
Hng hoa 8g o nhn 8g
Tam lng 10g Nga trut 10g
Nu trng bng: b tam lng, nga trut; thm hng ph 8g, huyn h 12g.
Nu phn ph n cng thm nh hng 4g, mt dc 4g.
Mi thang sc k ly 100ml nc thuc, lc qua vi mn 2 ln, gi m
36- 37 , tht chm vo hu mn cch ngy. Trc khi tht thuc phi tht
tho phn.
T lng gi
1. Hy in cm t thch hp vo ch trng:
Vim phn ph thng xy ra sauquai b.
iu tr bng cc bin phpngoi khoa khi cn thit.
Trng l ..ca huyt.
H l ca kh.
2. Trnh by triu chng, nguyn nhn, php iu tr vim phn ph th
nhit c.
3. Trnh by triu chng, nguyn nhn, php iu tr vim phn ph th
thp nhit kt.
4. Trnh by triu chng, nguyn nhn, php iu tr vim phn ph th
kh tr huyt .
5. Trnh by triu chng, nguyn nhn, php iu tr vim phn ph th
hn ngng kh tr.
177
Bi 30
Da sy thai
(ng thai, thai lu)
Mc tiu
1. Trnh by c nh ngha, chn on ng thai theo YHH.
2. Trnh by c triu chng, nguyn nhn, php iu tr cc th bnh theo YHCT.


1. theo y hc hin i
1.1. nh ngha
Do sy thai l giai on u ca sy thai. Trong giai on ny trng cn
sng cha b bong khi nim mc t cung, nu c iu tr sm th c th gi
c thai.
1.2. Triu chng
C nng: chm kinh, ra mu l triu chng ch yu. Mu ti hoc
en, thng ln dch nhy, au lng, tc nng bng di, au bng (nu
au c cn co th d b sy thai).
Thc th: khm m o thy c t cung cn di v ng kn, t cung to
tng ng vi tui thai.
1.3. Chn on phn bit
Triu chng Do sy Cha ngoi TC Cha trng Thai lu
Chm kinh + + + +
Nghn ++ -
Ra mu , t , nhiu Mu c ph,
ko di
en
au bng D di,
HA tt

Khm TC tng ng
tui thai
TC, BT v cng
au
TC to hn tui
thai
TC nh hn
tui thai
Xt nghim hCG (+) hCG (+) hCG (++) hCG (-)
178
1.4. X tr
Ngh ngi, bt ng.
Thuc chng co bp t cung: spasmaverin 0,04g x 2-4 ng/ngy tim bp.
Nu au nhiu v ra mu: spasmaverin 0,04g x 2-4 ng/ngy tim bp.
Lactacringer + spasfon 0,02gx 1-2 ng truyn tnh mch.
Amoxicilin 2g/ngy x 5-7 ngy ung.
Thuc ni tit: utrogestan 100mg x 2-4 vin ung hoc t m o
2ln/ngy
Microfolin 0,05mg x 1vin/ngy hoc provames 2mg x 1vin/ngy ung.
Trng hp thai km pht trin hoc tin s sy thai lu dng pregnyl
1500v x 1 ng tim di da cch ngy.
Thi gian iu tr: thuc gim co dng n khi ht triu chng au bng.
Thuc ni tit iu tr ti a cho n khi thai ht 13 tun.
Nu sy thai cn kim tra bung t cung trnh st rau.
2. theo Y hc c truyn
Tu theo chng bnh c cc tn gi nh sau:
ng thai.
Nu c tin s sy thai gi l hot thai.
C thai au bng gi l t thng.
C thai ra mu gi l thai lu.
C thai nn nhiu gi l c tr.
2.1. Nguyn nhn
Sch Ng khoa kinh lun c ghi: c thai m thai khng yn l v xung -
nhm mch u h, thai ph khng vng. Cng c khi do ung ru, dm dc
qu m thai ng khng yn; c khi do vp ng m thai ng; c khi do kh
gin m tn thng can, kh ut kt khng th thi lm huyt mch khng yn
hoc ung cc thuc king k gy ng thai; cng c khi ngi m c bnh m
ng thai.
2.2. Th bnh v iu tr
2.2.1. Th kh huyt h
Triu chng: c thai mi lng, tc nng bng hoc au bng m , chng
mt, mt mi, da kh, khng ra mu hoc ra t, ming nht khng mun
n, mch trm hot.
179
Bin lun: do thai ph vn yu hoc khi mang thai c bnh lm cho kh
huyt h, xung - nhm vn khng vng chc, khng gi c kh huyt;
hoc do t kh h khng vn ho c thu cc nn sinh huyt km, xung
nhm yu nn thai khng c nui dng.
Php iu tr: b kh, dng huyt, an thai.
Phng: dng bi Thai nguyn m
ng sm 12g Thc a 12g
ng quy 12g trng 8g
Bch thc 12g Trn b 8g
Bch trut 12g Cam tho 4g
Sc ung ngy mt thang, ung 10-20 thang.
Hoc dng bi Bt trn gim xuyn khung; gia a giao, ngi dip, tc on.
Nu thin v huyt h dng bi Giao ngi thang (T vt gia a giao, ngi dip).
2.2.2. Th huyt nhit
Triu chng: c thai m ra huyt ri r, sc ti, mt , mi , lng bn
tay nng, ming kh, tiu tin vng t, li , ru li vng, mch hot sc.
Bin lun: thai ph vn m h ho vng hoc n nhiu cht cay nng,
nhit phc xung - nhm lm huyt i sai ng khng nui dng thai.
Php iu tr: thanh nhit, lng huyt, dng huyt, an thai.
Phng: dng bi Bo m tin
Sinh a 12g Tc on 12g
Hoi sn 20g Cam tho 4g
Hong b 8g Bch thc 20g
Thc a 12g Hong cm 12g
Nu ra mu nhiu gia: c mc sao, a giao nng.
Nu au lng nhiu gia: c gai, tang k sinh.
Sc ung ngy mt thang, ung 7-10 thang.
2.2.3. Th thn h
Triu chng: thai ng khng yn, ra mu, au lng, au bng, chng
mt, au u, tai, tiu tin nhiu ln, ngi gy, mt xm, ru mng,
cht li nht, mch trm hot mch xch yu.
Bin lun: do thn tin thin km, thn kh h yu, tnh dc thi qu, no
sy nhiu ln lm nh hng xung - nhm, do khng gi c thai.
180
Php iu tr: b thn an thai.
Phng: dng bi B thn an thai m
Thc a 12g Cu tch 12g
Tang k sinh 12g ng sm 12g
Th ty t 12g Bch trut 12g
A giao 12g Ngi dip 6g
trng 12g ch tr nhn 8g
Hoc bi Thi sn bn thch: gm bi Bt trn gia sa nhn 4g, hong cm
10g, tc on 12g.
Hoc Bi th thai hon:
Th ty t 20g Tang k sinh 20g
Tc on 0g A giao 20g
Sc ung ngy mt thang , ung 7-10 thang.
2.2.4. Th can kh ut
Triu chng: tinh thn ut c, ngc sn y tc, hi, n km, nn, au
u, au bng, c th ra mu ti, mch huyn hot.
Bin lun: do tnh ch ut c thng can, lm can kh ut kt khng th
thi, kh nghch ln lm ngc sn y tc, thai ng khng yn.
Php iu tr: s can gii ut, l kh, an thai.
Phng: dng bi T t m
T ngnh 8g ng quy 12g
i phc b 8g Xuyn khung 8g
ng sm 12g Thng bch 4g
Bch trut 12g
2.2.5. Th do ngoi thng
Triu chng: sau khi ng vp, thai ng khng yn, au bng, mi lng, c
th ra mu m o.
Php iu tr: iu kh, dng huyt, an thai.
Phng: dng bi Tiu phm tr cn thang
ng quy 12g Tr ma cn 20g
Bch thc 12g A giao 12g
Nu au lng gia thm: trng 10g, tc on 10g, tang k sinh 12g.
181
Hoc dng bi An thai m
Thc a 16g Bch thc 12g
Hong k 12g Tc on 12g
ng quy 12g Hong cm 8g
Hng ph 8g Ngi dip 8g
Xuyn khung 8g ng sm 12g
trng 10g Cam tho 4g
Ch :
+ Nhng v thuc king dng khi c thai: thuc ph huyt, thuc t h,
thuc c nh thu ngn, thch tn, mang tiu, ba u, o nhn, ngu
tt, hng hoa, tam lng, nhc qu cc thuc c tnh nng.
+ Thuc cn thn khi dng: quy v, xuyn khung, tang k sinh.
T lng gi
1. Hy in vo ch cho cu ng, ch S cho cu sai:
Da sy thai l giai on u ca sy thai /S
Trong giai on ny thai cn sng /S
Cn chn on phn bit vi cha trng, thai lu.. /S
ng thai cn phi iu tr kp thi /S
2. Trnh by triu chng, nguyn nhn, phng php iu tr ng thai
th huyt h.
3. Trnh by triu chng, nguyn nhn, phng php iu tr ng thai
th thn h.
4. Trnh by triu chng, nguyn nhn, phng php iu tr ng thai
th can kh ut kt.
5. Trnh by triu chng, nguyn nhn, phng php iu tr ng thai
th ngoi thng.
182
Bi 31
Nn ma khi c thai
(c tr)
Mc tiu
1. Trnh by c nh ngha, nguyn nhn gy c tr theo YHH v YHCT.
2. Bit chn on, iu tr cc th bnh theo YHCT.


1. Theo y hc hin i
1.1. nh ngha
Sau khi tt kinh, thai ph thng c tng tit nc bt, bun nn, nn o,
bo cho ngi ph n bit mnh c thai. Nu du hiu nghn tng ln nh h-
ng n sinh hot gi l chng nn ma. Nu tnh trng nn nng hn c nh
hng ti sc kho gi l bnh nn nng.
Nu thai ph c nn, ph hai chi di, tng huyt p, protein niu l tnh
trng nhim c thai ngn cn phi theo di v iu tr cht ch.
1.2. Nguyn nhn
Hin nay cha r nguyn nhn. C nhiu gi thuyt cho rng:
Do trng (nng hCG tng gy nn).
Do do d ng (thai l protein l i vi c th m).
Do tiu ho (c nhng tn thng c ng tiu ho).
1.3. iu tr
iu dng: nn thai ph nm phng yn tnh, thong, khng c mi
thc n, nh sng va , ch n ngui t gy nn.
Thuc iu tr:
+ Thuc chng nn, gim tit dch nh atropin, toclopamid.
+ Thuc khng histamin tng hp nh prometazin sunphat.
+ Thuc vitamin B6.
183
2. theo Y hc c truyn
Da vo nguyn nhn v chia lm 5 th bnh.
2.1. Th kh huyt khng iu ho
Triu chng: chm kinh, nn ma khng mun n, vng u, mt mi,
thch nm, lnh lng, mch trm (mch xch yu).
Bin lun: khi mang thai kh huyt tp trung nui dng thai lm phn
huyt gim, phn kh tng nn kh huyt khng iu ho, kh ca xung -
nhm nghch ln gy nn bnh.
Php iu tr: iu kh huyt, iu ho m dng.
Phng: Qu chi thang
Qu chi 6g Sinh khng 3 lt
Bch thc 12g i to 2 qu
Cam tho 4g
Sc ung ngy 1 thang.
2.2. Th v nhit
Triu chng: nn cht ng, cht chua, tm phin, ng km, tiu tin
vng, i tin to, li , ru li vng mng, mch hot sc.
Bin lun: ngi dng vn thnh, khi mang thai ng mch khng
thng, huyt ca kinh tc ko theo tinh huyt ut li, u kh xung ln v
thnh v nhit.
Php iu tr: thanh v, ging nghch.
Phng: dng bi c thanh hon
Hong lin tn mn, h hon nh ht vng, mi ln ung 20-30 ht.
2.3. Th t v h nhc
Triu chng: n km, ngc y cng, thch xoa, mt mi, a lng, li nht,
mch h.
Bin lun: ngi t v h yu, khi mang thai thc n dn kh ca tinh
nghch ln, v h nn khng ging c.
Php iu tr: kin t, ho v.
Phng: dng bi Qut b trc nh thang
Nhn sm 12g Mch ng 8g
Trc nh 8g Xch linh 12g
184
Qut b 8g T b dip (sao) 12g
Bn h 8g Sinh khng 3 lt
i to 3 qu
Sc ung ngy mt thang, ung 7- 10 thang.
Nu thin v hn: kin t n v; dng bi: Can khng ng sm bn h hon:
Can khng 1 phn
Bn h ch 2 phn
ng sm 2 phn
Tn bt mn, ngy ung 10g chia 3 ln.
2.4. Th m m
Triu chng: nn, m di, ngc y khng mun n, mm nht, ru li
trng, mch trm hot.
Bin lun: c th vn c m thp, sau khi mang thai huyt ngng tr li,
kh nghch ln, m m theo kh i ln.
Php iu tr: tr m, ging nghch.
Phng: Bn h phc linh thang
Bn h 8g
Sinh khng 6g
Phc linh 8g
Sc ung ngy mt thang, ung 7- 10 thang.
Nu thin v nhit: dng bi Hong lin n m thang
Hong lin 8g Bn h ch 8g
Trn b 6g Phc linh 8g
Cam tho 4g Trc nh 8g
Ch xc 8g
Nu thin v hn th dng bi Lc qun t thang gia gim.
2.5. Th can v bt ho
Triu chng: nn nc trong hoc nc chua, au sn, y bng hi,
th di, u ut, cng u, chng mt, ru i trng mng hoc hi vng,
mch huyn hot.

185
Bin lun: ngi vn u ut hoc cu gt thng can, can khng s tit
c kh lm cho kh phm v.
Php iu tr: iu ho can v.
Phng: c can ho v m
T dip 8g Trc nh 12g
Hong lin 8g Trn b 6g
Bn h ch 10g
Sc ung ngy mt thang, ung 7-10 thang.
T lng gi
1. Hy in vo ch cho cu ng, ch S cho cu sai:
C 3 gi thuyt nguyn nhn gy c tr /S
Nn ch n ch iu dng trong iu tr /S
YHCT chia 3 th bnh /S
2. Trnh by triu chng, nguyn nhn, phng php iu tr c tr th
kh huyt khng iu ho.
3. Trnh by triu chng, nguyn nhn, phng php iu tr c tr th v nhit.
4. Trnh by triu chng, nguyn nhn, phng php iu tr c tr th t
v h nhit.
5. Trnh by triu chng, nguyn nhn, phng php iu tr c tr th
m m.
6. Trnh by triu chng, nguyn nhn, phng php iu tr c tr th
can v bt ho.
186
Bi 32
Ph khi c thai
(T thng)
Mc tiu:
1. Trnh by c nguyn nhn c ch gy bnh.
2. Trnh by c triu chng, nguyn nhn, phng php iu tr th bnh.


1. i cng
Bnh thng giai on cui ca thi k thai nghn, thai ph thng c ph
nh chi di. Nu ph nhiu khng t ht, ngi nng n, i khng li l bnh
ph khi c thai. Theo y hc c truyn bnh thng do cc nguyn nhn sau:
1.1. T h
T dng h khng vn ho thu thp, lm cho thu thp trn vo c
nhc, chn tay.
1.2. Thn dng h km
Thn dng km khng lm m c t dng, mt khc khng tin hnh
kh ho bng quang lm cho thu dch trn ra ngoi.
1.3. Thu thp
Khi mang thai kinh huyt ng b li, nay c nc dng li s to nn
s tranh chp gia nc v huyt, lm cho nc trn ra ngoi.
1.4. Kh tr
Khi mang thai ng vn chuyn ln xung b tr ngi gy nn kh tr
thnh ph.
2. Cc th bnh
2.1. Th t h
Triu chng: ph mt, mt, t chi, sc vng, mt mi, ngi ni, chn tay
lnh, y bng khng mun n, i tin lng, tiu t, cht li nht, ru
mng, mch trm nhc.
187
Php iu tr: kin t, hnh thy.
Phng:
Bi 1: ng sm 12g Bch trut 12
d 12g Hoi sn 12g
Mc thng 8g i phc b 8g
Bi 2: Ton sinh bch trut tn
Bch trut 12g Trn b 8g
Phc linh b 12g i phc b 8g
V gng 8g
Mi ngy ung 1 thang, ung 5-10 thang.
2.2. Th thn dng h
Triu chng: ph mt, ph chn, sc mt xm ti, hi hp, th ngn, chn
tay lnh, lng lnh, au lng, y bng, cht li nht, mch tr.
Php iu tr: n thn, hnh thu.
Phng: dng bi Chn v thang
Bch linh 12g Bch trut 12g
Bch thc 12g Sinh khng 8g
Ph t ch 8g
Nu a i th dng bi Thin l ng thang
Bch trut 20g ng quy 12g
Bch linh 16g Bch thc 12g
Mi ngy ung 1 thang, ung 5-10 thang.
2.3. Th kh tr
Triu chng: bn chn ph trc, ph lan ln i, i li kh khn, u ut,
chng mt, au u, ngc sn y tc, n t, ru li vng dy, mch
huyn hot.
Php iu tr: l kh, hnh tr.
Phng:
Bi 1: Hng ph 8g Trn b 8g
Cam tho 4g dc 8g
Sinh khng 4g Mc qua 8g
T t 8g
188
Bi 2: B trung ch kh thang hp Ng b m
Hong k 12g Phc linh b 8g
Bch trut 12g ng sm 12g
ng quy 12g V gng 8g
i phc b 8g Tang bch b 6g
Thng ma 10g Si h 10g
Trn b 8g Cam tho 4g
Mi ngy ung 1 thang, ung 5-10 thang.
2.4. Th thu thp
Triu chng: chn tay v mnh ph thng, sc trng nht, au u, hoa
mt, tim p hi hp, lng gi mi, b tiu tin, i tin lng, ru li
trng nhn, mch trm hon.
Php iu tr: thng kh, hnh thu
Phng: Phc linh o thu thang
Phc linh 12g Binh lang 12g
Tr linh 12g Sa nhn 12g
Mc hng 8g Trch t 10g
Bch trut 12g Trn b 8g
Mc qua 12g i phc b 8g
Tang bch b 8g T ngnh 8g
Nu a i th dng bi Thin l ng thang
Bch trut 20g ng quy 12g
Phc linh 16g Bch thc 12g
Mi ngy ung 1 thang, ung 5-10 thang.
C th dng 1 con c chp 5 lng, b rut, un vi 20g trn b ly nc ct,
ri un vi nc thuc ung lc i.

189
T lng gi
1. in cm t thch hp vo ch trng
T dng h..thp, lm cho.c nhc, chn tay.
Thn dng h..t dng.
Khi mang thailm nc trn ra ngoi.
2. Trnh by triu chng, php iu tr t thng th t h.
3. Trnh by triu chng, php iu tr t thng th thn dng h.
4. Trnh by triu chng, php iu tr t thng th kh tr.
5. Trnh by triu chng, php iu tr t thng th thu thp.

190
Bi 33
Vim tc tia sa, vim tuyn v
(Nh ung)
Mc tiu:
1. Trnh by c nguyn nhn gy tc tia sa, vim tuyn v theo y hc hin i
v y hc c truyn.
2. Trnh by c phng php iu tr vim tc tia sa theo y hc c truyn.


1. theo y hc hin i
1.1. Tc tia sa
Tc tia sa c th gp trong bt c thi im no trong giai on no cho
con b. Tuy nhin hay gp nht l trong tun l u tin. Khong 15% ph n
cho con b b cng v. Cc yu t thun li l tr b t, b yu, ngi m b
au khi nt u v, khi cai sa.
Biu hin lm sng: ton b v b cng, cng tc, i khi c st.
iu tr: chm nng v, tip tc cho tr b. C th dng oxytoxin tim
bp 4 n v chia 2 ln mi ngy (v oxytoxin lm co t bo c biu m
ng dn sa v tng sa ra ngoi). Phi iu tr tht tt trnh vim
tuyn v v p xe v.
1.2. Vim tuyn v
C th hiu vim tuyn v gm vim bch mch v (nh) v vim ng dn
sa (nng)
Biu hin lm sng: st cao, v c cc nhn cng v au, nch c hch
n au. Nu nng vt sa ln ming gc quan st thy c nhng mnh
nh vng nht chng t c m trong sa (du hiu budin).
iu tr: chm nng ti ch, gim au paracetamol 3g/ngy. Tng cng
cho tr b (10 - 12 ln/ngy), sau khi b phi vt sch sa, c th dng
oxytoxin tim bp. Nu sau 24 gi cc du hiu khng mt i nn dng
khng sinh c tc dng lin t cu nh rovamyxin trong thi gian 15 ngy
phi hp vi thuc chng vim, cn vt sa b i. Nn ly sa xt nghim
tm vi khun gy bnh.
Vim tuyn v c th cha khi hoc tin trin thnh p xe v.
191
2. theo Y hc c truyn
2.1. Nguyn nhn
Do kh ut v do con b m sinh ra.
Chu an Kh cho rng: v thuc kinh dng minh, nm v thuc kinh
quyt m. Ngi m khng bit cch iu dng hoc gin d qu mc
lm cho kh trong quyt m khng thng nn sa khng ra c.
So Th Bnh Nguyn cho rng: n nng ra m hi, khi cho con b l
v ra ngoi nn d b phong t xm nhp gy nn chng v sng, v th
m d sinh ra chng nh ung.
2.2. iu tr
Php iu tr chung: thanh nhit, gii c, hot huyt, li sa.
Trong iu tr ngi ta thng chia ra cc giai on iu tr.
2.2.1. Lc mi pht
Triu chng: v au, sng ty, s vo c cc cng, n au, mt , ngi
pht st, au tc ngc, au lan ra cc khp, khng c m hi, ru li
trng mng, mch ph khn.
Php iu tr:
Dng thuc ung: Kinh gii ngu bng thang
Kinh gii tu 12g B cng anh 12g
Lin kiu 8g Phng phong 8g
Ngu bng t 12g To gic thch 4g
Kim ngn hoa 8g Si h 12g
Trn b 8g Hng ph 8g
Hong cm 8g Cam tho 4g
Sc ung ngy mt thang, ung 3- 5 thang.
Bn ngoi xoa Hng ph bnh (Y hc tm ng)
Hng ph tn bt 40g
X hng 12g
Hai v trn ln vo nhau, 50g b cng anh sc ly nc b b, ly nc
ho vi thuc, un si c ri p vo v au mt ln/ngy trong 1- 3 ngy.
Hoc dng phng php p hnh: dng c c hnh nguyn r, gi nt
p ln v b au.
Chm t: cc huyt ti ch v kin tnh, thiu trch, hp cc.
192
2.2.2. Giai on sp v m hay v
Triu chng: mnh lnh, ht st, v mm, au nhc sp v m hoc v.
Phng: dng bi Thn hiu qua lu tn gia xuyn sn gip, ng sm,
hong k
Qua lu 40g ng quy 20g
Sinh cam tho 20g Mt dc 8g
Hng ph 4g
Sc b b, cho thm 1 chn nh ru lu nm ung 3 ln/ngy (sau ba n).
2.2.3 Giai on kh huyt h
Triu chng: sc mt xanh, ngi mt mi, thch ng, vng v au t hn
trc nhng vn sng, cng, mch h t.
Phng: dng bi Thc l tiu c tn (Y tn kim gim)
Nhn sm 8g Xuyn khung 8g
Sinh hong k 8g Kim ngn hoa 12g
Bch trut 8g To gic thch 4g
Bch thc 8g Bch ch 4g
ng quy 8g Ct cnh 8g
Sc ung ngy mt thang x 3- 7 thang (ung xa ba n).
Chm cu: thiu trch, nh cn, hp cc, tc tam l, t du v cc huyt
ti ch.
Vim tc tia sa cng nh vim tuyn v l bnh cp tnh, cn phi iu
tr tch cc, kp thi trnh gy p xe v. Ngoi vic dng thuc y hc c
truyn cn ch v sinh v hng ngy, c bit trc khi cho b, ch ngh
ngi dinh dng cho ngi m, tinh thn phi thoi mi lc quan.
T lng gi
1. Hy in vo ch cho cu ng, ch S cho cu sai
Vim tc tia sa gp bt c thi im no ca cho con b /S
Vim tuyn v d thnh p xe v /S
Vim tc tia sa YHCT gi l nh ung /S
Vim tc tia sa cn iu tr tch cc /S
2. Trnh by triu chng, phng php iu tr nh ung giai on mi
pht bng YHCT.
3. Trnh by triu chng, phng php iu tr nh ung giai on sp v m
bng YHCT.
4. Trnh by triu chng, phng php iu tr nh ung giai on kh huyt h
bng YHCT.
193
Bi 34
Thiu sa
(Khuyt nh)
Mc tiu
1. M t c cc triu chng thiu sa theo YHH.
2. Trnh by c triu chng v phng php iu tr thiu sa theo cc th
bnh ca YHCT.


1. theo y hc hin i
1.1. nh ngha thiu sa
Thiu sa l tnh trng sn ph sau khi sinh c t sa hoc khng c
cht no.
1.2 Chn on thiu sa
Du hiu t ngi m: bu v mm nho, chm xung sa, nn ra t sa
hn so vi bnh thng.
Du hiu t tr:
+ Tr khng hi lng sau ba b (tr khc, i b tip sau mi khi ngng
cho b, bng khng cng sau b).
+ Cc ba b qu ngn (di 5 pht) hoc qu di (trn 15 pht).
+ Tr tng cn chm (di 500g/thng).
+ Tr i tiu t (di 6 ln/ngy).
1.3. Nhng bin php khc phc khi ngi m t sa
Cn cho tr b thng xuyn, 2-3 gi cho b mt ln, mi ln 5-10 pht.
Cho tr b ng t th.
Khng nn cho tr n sam qu sm.
B m nn ung nhiu nc, n thc n nhiu m.
Nu cc bin php trn khng c kt qu th c th cn nhc dng
galactogil, primperan, metoclopramid.
194
2. theo y hc c truyn
Thiu sa y hc c truyn gi l chng khuyt nh. Sa m l cht dch
c c sinh ra t huyt. Mch nhm m bo m huyt ca ton thn, mch
xung thuc kinh dng minh l b ca huyt; cho nn cc kh thnh, b huyt
trn y th sa xung y .
C ch sinh sa, bi tit sa tu thuc hai mch xung - nhm v c quan
h mt thit vi tng ph. Ph n sau khi , nu mch xung - nhm thnh
vng; cc tng tm, can, t, ph, thn sung tc th sa y cho con b.
2.1. Th kh huyt h
Triu chng: khng c sa hoc c rt t sa, v khng cng tc, da kh,
mt mi, chng mt, tai, tim p nhanh, th ngn, n t, i tin phn
nt, tiu nhiu, mch h t.
Nguyn nhn: sn ph vn yu ui hoc khi mt nhiu mu lm kh
huyt thiu, kh huyt thiu th khng sinh c sa.
Php iu tr: b huyt, ch kh, sinh sa.
Phng:
Bi 1: Thng nh n
ng sm 20g Mc thng 12g
Hong k 20g Ct cnh 12g
ung quy 20g Mng gi 2 ci
Mch mn ng 20g
un k mng gi n, nc thuc ung.
Bi 2: Xuyn sn gip 20g
Thin hoa phn 20g
Mng gi 1 ci
un k ung nc v n tht chn gi.
Bi 3: Mng gi ln c 1 b
Thng tho 4g
un k ung nc v n tht chn gi.
Ch : mng gi thng ch dng on c mng en (dng bn chi c
sch mng).
Bi 4: c chp 1 con t, tn nh, mi ln ung 4g.

195
2.2. Th can kh ut
Triu chng: v cng nhng sa khng ra, ngc chng au, ngi pht
st, pht rt, n gim, li nht, mch huyn.
Nguyn nhn: can kh ut tr lm kinh mch ngng tr, kh huyt tun
hon b tr ngi, khng sinh huyt v sinh sa.
Php iu tr: s can, gii ut, thng li sa.
Phng:
Bi 1: Tiu giao thang gia gim
ng quy 12g Si h 12g
Bch thc 12g Trn b 8g
Bc h 8g Bch linh 12g
Mc thng 12g Bch trut 12g
Thng tho 6g Sinh khng 3 lt
Sc ung ngy mt thang, ung 5 - 10 thang.
Bi 2: H nh dng tuyn thang
ng quy 12g Bch thc 12g
Sinh a 20g Xuyn khung 8g
Mc thng 12g Xuyn sn gip 12g
Vng bt lu hnh 20g Thin hoa phn 12g
Thanh b 8g Ngu tt 16g
Si h 12g Cam tho 8g
Sc ung ngy 1 thang, ung 5 - 10 thang.
Bi 3: Thanh b 8g Chi t 12g
Si h 8g Cam tho 4g
Hng ph 8g
Sc ung ngy mt thang, ung 5 - 10 thang.
Bi 4: L hoa ph du gi nh p ngoi
Bi 5: Thng tho 4g
Vy t t 12g
Sc ung ngy mt thang , ung 5 - 10 thang.
Chm cu: nh cn, n trung, thiu trch, kin tnh. Nu h chm b tc
tam l, nu thc chm t thi xung.
196
Tc ng ct sng (phng php ca Lng y Nguyn Tham Tn) hoc xoa
bp vng gip tch t t sng c 2 n tht lng 5, mi ngy 1 ln 30 pht, liu
trnh 10 -20 ngy lin tc.
T lng gi
1. Hy in ch cho cu ng, ch S cho cu sai:
Du hiu ca thiu sa l:
Bu v ca ngi m nho /S
Mt ba b ca tr ko di 10 pht /S
Tr tng cn bnh thng /S
2. Trnh by triu chng thiu sa th kh huyt h nhc theo YHCT.
3. Trnh by triu chng thiu sa th can kh ut tr theo YHCT.
4. in vo ch trng cm t thch hp
Php iu tr thiu sa th kh huyt h nhc l b huyt.
Php iu tr thiu sa th can kh ut tr l s can.
197
Bi 35
Sa sinh dc
(m nh)
Mc tiu
1. Trnh by c triu chng c nng v thc th.
2. Nu c phng php iu tr sa sinh dc bng y hc c truyn.


1. i cng
1.1. Theo y hc hin i
1.1.1. Cc phng tin gi t cung ti ch
Bnh thng b phn sinh dc ca ngi ph n c gi vng chc nh 2
h thng: h thng nng (gm cn c y chu, tng sinh mn, 2 c nng hu
mn) v h thng treo (gm dy chng trn, dy chng rng, dy chng t cung
cng, dy chng tht lng - bung trng v t cung - bung trng).
Khi suy yu mt trong hai h thng ny l nguyn nhn gy nn sa sinh dc.
1.1.2. iu kin thun li
nhiu ln.
Rch tng sinh mn khng hi phc.
Lao ng nng.
Teo t sinh dc ngi gi.
1.1.3. Triu chng
C nng: tu theo ngi sa nhiu hay sa t, thi gian sa v tn thng phi
hp m bnh thy c cc triu chng lm sng khc nhau. Thng thng
bnh nhn cm thy kh chu, nng bng di, i tiu tin kh khn,
kinh nguyt vn u, c thai hay b sy hoc non.
Thc th: chia 3
+ 1: c t cung thp, cch m h 3- 4 cm cha sa ra ngoi.
+ 2: c t cung thp th ra ngoi m o c khi sa xung nhng t co
ln c.
198
+ 3: c t cung v thn t cung sa hn ra ngoi km theo sa thnh m
o, bng quang.
1.1.4. X tr
Ni khoa: ngh ngi, v sinh.
Ngoi khoa: p dng vi sa 3 vi phng php Crossen (ct t cung
theo ng m o).
1.2. Theo y hc c truyn
c m t trong chng m nh, thot m, thot tr.
Nguyn nhn: do kh h h hm.
2. phng php iu tr Cc th bnh theo y hc c truyn
2.1. Th kh h h hm
Triu chng: c cm gic tc nng bng di, m o c khi sa ra ngoi,
nu cn nh th khi sa t co ln, nu bnh nng th khi sa khng t co
c, c khi ngi bnh phi dng tay y ln, c t cung khng b vim
lot. Km theo bnh nhn thy ngi mt mi, n km, au lng, tai,
i tin bnh thng hoc to, tiu tin nhiu ln, nc tiu trong, cht l-
i nht bu, ru li trng mng, mch trm nhc.
Php iu tr: ch kh, thng
Phng: bi B trung ch kh l chnh
ng sm 12g ng quy 12g
Bch trut 12g Thng ma 12g
Hong k 12g Si h 12g
Trn b 8g Cam tho 4g
Thm: sinh khng 3lt; i to 3 qu.
Sc ung ngy 1 thang, ung m, xa ba n, ung 20-30 thang.
Nu c thn h gia thm: tc on 12g, th ty t 12g, cu tch 12g, k t
12g, trng 12g.
2.2. Th kh h h hm km thp nhit
Triu chng: gm cc triu chng ca th kh h h hm, km thm c t
cung vim lot, ph n, chy nhiu dch bn, tiu t, nc tiu vng, li
, ru li vng, mch hot sc.
Php iu tr: ch kh, thng , tr thp nhit h tiu.
Phng: dng bi B trung ch kh gia thm thng trut 10g, hong b
10g, th phc linh 12g, kh sm12g.
199
Hoc dng bi Long m t can thang
Long m tho 12g Si h 12g
Trch t 10g Mc thng 10g
Sa tin t 10g Sinh a 12g
ng quy 12g Chi t 8g
Hong cm 8g Cam tho 4g
Sc ung ngy 1 thang, xa ba n, ung 20-30 thang.
Nu ngi bnh c tng huyt p phi ch b cc v thng dng.
Chm cu: chm b cc huyt bch hi, quan nguyn, kh hi, tam m giao
Ngoi dng thuc v chm cu nh trn ngi ta cn kt hp vi ra m
o v t vin m nh hon.
Thuc ra m o gm: kh sm 16g, th phc 12g, bch ch 8g, phn phi 4g.
Mi thang sc ly 1 bt nc, m 36-37
o
C, lc qua vi mn, cho vo bc,
ra m o cch ngy. Sau khi ra xong t vin m nh hon vo cng
sau m o.
Thnh phn vin m nh hon gm:
Bch cp Ng bi t
Bch ch Phn phi
Liu bng nhau, tn bt, dng glycerin ho thnh vin, v ngoi bng
hng hong.
Phng bnh
Sinh c k hoch.
Rch tng sinh mn phi khu hi phc.
Sau , sy, no phi king gi.
Trnh lao ng gng sc.
Trnh ngi xm lu.
t lng gi
1. Hy in ch cho cu ng v ch S cho cu sai
Sa sinh dc YHCT gi l m nh /S
Nguyn nhn gy bnh l do kh h h hm /S
Sa sinh dc khng nn iu tr bng ngoi khoa /S
2. Trnh by phng php iu tr sa sinh dc bng y hc c truyn.
200
Kinh lc phn b khp c th, bt ngun t cc tng ph thng ra ngoi b
phu, mch, c, cn ct lm cho kh huyt lu thng v nui dng cc tng
ph, b phu, mch, c cn, xng hot ng. Cho nn bt lun nguyn nhn gy
bnh no, d trong (tc l tng ph), d ngoi (l b phu), mch, c xng
u nh hng ti kinh lc, u lm cho kh huyt tc tr m pht sinh ra
bnh. V d: bnh l lot da, c (biu) c t c th theo kinh lc vo c quan
ni tng (l) gy bnh l lot tng ph; ngc li trong tng ph b bnh c
th c t t tng ph theo ng kinh lc ra ngoi da, c, xng, khp m gy
bnh.

Bt u t 1960, Khoa Chn thng Bnh vin Hu ngh Vit - c v
Bnh vin Xanh - Pn (Saint-Paul) phi hp vi Vin Nghin cu ng y (nay l
Bnh vin YHCT Trung ng) p dng phng php YHCT iu tr
nhng chn thng gy kn. Trong nhng nm u p dng cho mt s gy
xng n gin ngi ln ri tr em. T thng 5 nm 1960 n cui 1963
iu tr 1841 trng hp chn thng kn, trong c 658 ca gy xng, 1183 ca
chm thng bong gn v trt khp.

Mc ch ca phng php rung l lm cho cc din xng gy khp li
vi nhau. Hay dng cho gy xng kiu din gy rng ca. Th php ny c
tin hnh cc chi di, chiu ko thng lc va phi, sau lc i vi gc
5-10
o
(hnh 7.4).

Hin nay, ti Bnh vin Hu ngh Vit - c chng ti s dng dy dn
(dy vencro) c n hi v cho php thao tc d dng, nng cao hn kh nng
v cht lng c nh.

Ru (bi thuc gia truyn nhiu i ca lng y Bi Xun Vn Th
Xun - Thanh Ho)

Kinh sau k, lng t (h hn, huyt hi bt tc): mch trm tr.

2. Anh (ch) hy trnh by c im v vn chn trong bnh ph khoa?

6. Khoanh trn vo ch cho cu ng, ch S cho cu sai.