3 cham cuu tri lieu

ThS.BS Nguyen Manh Tri

ThS. BS. NGUYEN M~NH TRI

1. Mo ta duoc

kY thudt Chdm

va Cuu.

2. Trinh bay phuong phap chdm B6.
3. Trinh bay phuong phap chdm Ta.
4. Trinh bay phuong phap chdm CUu ai~u tri cac benh If Han - Nhiet
5. Nhdn thuc duce gia tri cua phuog phap chdm cuu trong viec phong
- tri benh va b6i duimg ndng cao sire khoe.

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ThS.BS Nguyln Manh Tri
Sau khi eo mot chan doan theo Y hoc cd truyen,
d€ lap ra mot phuong

chung ta eo eo sd

huyet diSu trio Bai nay giup cho cluing ta eo

th€ chu dong chori huyet mot each linh hoat phu hQP vdi tirng hoan
canh ma khong phai thuoc long nhieu cong tlnrc nghiern phuong.

A. Ml)C

etcn CHAM CUU

1. NHAC 14-1 PmidNG pIlAp CHAN DoAN.
V oi hinh anh Cay Nhan Sinh Bang Y, eo thS diSn dat pp chan doan
theo y hoc cd truyen la giai dap nhtrng eau ho i sau :

1. Tinh trang 12 r~ : nguyen khi ( nguyen am, nguyen dU011g)
2. Tinh trang 12 canh cay nrc tang phii, kinh nao benh.
3. Tinh trang 5 la cay : nguyen nhan tu hanh nao trong ngii hanli
(5 eo nang phd bien) dac biet nguyen nhan tu han hay nhiet
Benh di~n ra la noi thuong man tinh tren eo dia suy ye'u ( hu)
hay ngoai cam dip tinh tren eo dia con khoe manh (thuc).
4. Ch~n doan nguyen nhiin

11.ssuc

oicn

CRAM COO TRI Ll$U.

Tren eo Sd chan dean, chung ta eo muc dich tri lieu sau :

1. B6i dtiong nguyen khi : nguyen am, nguyen dU011g
2. Di~u chinh ngfi hanh ( dac biet la Thiiy - Hoa) cua kinb b?nh :
Hu thi bd, Thuc thi
3. Dieu tri them C\lC bQ cac chung va benh

ta.

B. KY THU~ T CHAM CUU
1. Gi8i thieu v~ chum va cuu
Chum la dung kim charn vao huyet nharn rnuc dich phong va tri
benh.
Kim eo th€ duce lam bang nhieu

kim loai khac nhau nhu bac,

vang, sat ma khong d. Kim eo nhieu loai : to, nho, dai, ngan khac nhau.
Ngoai charn kim, nay con nhieu phuong phap charn khac nhu kich
thich dien tai huyet, tac dong len huyet bang laser, bang bim huyet, go
huyet, tac dong lien tuc bang chon chl, dan vien tu hay thuy charn ...

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ThS.BS Nguyen Manh Tri
Cuu la dung nhiet va hoi cua diroc thao thong kinh hoat lac duce
d6t chay d~ tac dong Ie n huyet.
C6 nhicu each ciiu : ctiu true tiep, ctru each girng, ciru each toi,
ciru gian tiep bang dieu ngai ; dat v~t n6ng Ien huyet

; sa'y a'm huyet

bang can cuu va den hong ngoai hay may s~y toe, ...
Sau day la mot phuong phap charn ciru vdi nhirng ky thuat don
gian va hieu qua.

2.

Ky thuat

cham cuu

- Thai dQ cua ngiroi thay thudc: hoa nha, nghiern

nic, an can, giai
thich, hudng dftn tan tinh, 6n dinh tarn ly va tao niern tin noi nguoi benh.
- Benh nhan na m hoac ngdi theo tu the' that tu nhie n thoai mai
nhat.
- Xac dinh dung huyet c~n cham ( phuong phap do thon, m6c giai
ph~u, ... )
- Vo trung dung cu charn ciru va sat khufin d huyet c~n cham phai
thuc hien nghiern chlnh d~ tranh viern nhiern tai hai.
- Thuong dung loa i kim nho , nen charn cho cay kim dung vung la
du
- f)i~u quan trong la phai diic khi nrc la cam giac kim cham mut
chat tai ch6, benh nhan cam tha'y te r~n, ca ng, nang d ch6 charn, da noi
cham irng hong, ...
- C6 th~ charn kim thang dung vdi mat da, hoac charn xien tuy
theo vung da va eo day - mong khac nhau.
- Charn nhanh, gon theo thu phap sau :
•
•

Cam can kim doe theo ng6n tay cai va tro.
Co va barn manh 2 d~u ng6n tay vao kim nhu the.
tnrong cung.

•

B~ t manh hai ng6n tay v~ phia tnrdc d~ ph6ng

kim

nhu ban mui ten.
- Dung dieu ngai to bang dieu thuoc la ma ha tren huyet, mudn
a'm huyet thi dti xa, mudn n6ng huyet thi d~ g~n. C6 th~ ctru each girng,
chu

y

tranh d~ phong da. C6 th~ dung may sa'y t6c, den hong ngoai va

can ciru d~ cuu.

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ThS.BS N guyln Manh Tri

C§n chu

y phong

tranh cac tai biSn eo th~ xay ra khi cham ciru:
- V1Jl1g cham (shock) : eo th~ do benh nhan qua met, doi bung, hay
qua SQ' hai, l~n d~u cham nhiSu kim va kich thich qua manh, ... Xir tri: binh
tinh rut hSt kim, cho benh nhan nam nghi, day barn huyet Nhan Trung,
Bach Hoi, Dung TuySn, Thap Tuyen, ...

- Chay mau, b~m tim: c~n trong khi cham cac huyet g~n mach mau,
chirom nong noi b~m tim, ...
- Cong kim - gay kim: kh6ng dung kim bi cong, gi set, tranh thu
thuat th6 bao qua manh. Khi gay kim, neu than kim con 10 tren mat da thi
binh tinh g~p ra, nSu than kim kh6ng con tren mat da thi danh dau, c6 dinh
noi kim gay, goi tieu ph~u.
- NhiSm trung: kh6ng cham noi vung da viem nhiem, 16 loet, can
dam bao thu thuat v6 khu~n khi cham.
- Phong: c~n chu y, c~n trong va ti mi khi CUu cho benh nhan, tranh
d~ rot tan len da.

3. Ky thua t ba

ta

3.1. Chiim biJ
- Hirdng charn kim thuan chieu voi du'ong kinh.
- Ve nhe kim thuan chieu d6ng h6 d6i vdi cac kinh ly tarn (tire dfty
ngon tay cai v€ phia tnrdc, keo ngon tay tro lui lai ).
Ve nhe kim nguoc chieu kim d6ng h6 d6i vdi cac kinh hudng tarn
(tiic dfty ngon tay tro v€ phia tnrdc, kco ngon tay cai lui lai ).

- Thoi gian hill kim la u.
- Rut kim nhanh, bit

- Muon b6 am khi
huyet d~ keo them
Mucn b6 duong
huyet d~ keo them

16 charn.

thi charn nhe cue duong vao kim dang charn am
dien tich am v€ do.
khi thl charn cue am vao kim dang charn dirong
dien tich duong v€ do.

Kinh ly tarn
Ve thudn chieu

Kinh hirdng tarn
Ve nguac chieu

M6i ngai ciiu eo tinh fim nong, ho vao duong huyet eo nghia la b6
duong.

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ThS.BS Nguyen Manh Tri

3.2. Chain

la

- Hirdng charn kim nguoc chieu vdi duong kinh.
- Ve kim nguoc chieu d6ng h6 d6i vdi cac kinh ly tarn.
Ve kim thuan chieu kim d6ng h6 d6i vdi cac kinh hudng tarn.
- Thai gian hru kim ngan.
- Rut kim tu tu, kh6ng bit 16 cha m

- Dung cue am cua may dien charn dS tii am; dung cue duong dS
ta dirong.

Kinh huong tarn
Ve thudn chieu

Kinh ly tarn
Ve nguac chieu

M6i ngai ciru c6 tinh ffm n6ng, khi ta ha cac am huyet chinh la
lam cho n6 bot am (ta am).

4. Nghe thuut chum cuu:
Ky thuat charn ciru that ra rfft don gian: nhung cung mot ky thuat
lai c6 nhirng k€t qua khac nhau d6i vdi nguoi charn va benh nhan khac
nhau. Sir khac nhau do d trong nghe thuat charn crru.
Nguoi thay charn cuu do h9C thirc ro rang va kinh nghiern day dan
se toa ra mot niern tu tin va gay niern tin Ion manh d6i vdi benh nhan.
Khi benh nhan tin tudng thl m6i mtii kim la mot qua tang vui mirng dS
don nhan, con khi benh nhan chira tin nrdng thi rn6i mui kim la mot v~t
nhon dam vao da thit ho c~n d~ khang lai.
Mat khac, neu ngiroi nhac SI vdi cay dan "la mot" mdi c6 khuc
nhac hay, thi ngiroi th~y charn ciru va benh nhan cling vay. Trong khi
cham ciru hay theo dei. hop tac lang nghe dien bien cua nhirng trieu
chirng mot each ky hrdng cho den khi ngiroi benh cam thffy d~ chiu do
mdi la mot thii phap cao tay.

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ThS.BS N guyln Manh Tri

C. CHAM CUU TRJ BtNH THUQC HAN
1. CaA.M CUu VLEU TRl Hl1 HAN (Duong thuy suy)

1. Cham b6, ciru

tm cac

Pht
Tarn
Tarn bao
£)~i tnrong
Ti~u tnrong
Tarn tieu
Ty
Th~n
Can
Vi
Bang quang
£)Cfm

dirong thuy huyet cua kinh benh
---+
Xich tracli
---+
hai
---+
Khuc tracli
---+

Nhj gian
---+
tu» cdc
---+
Djch m/in
---+
Am ldng tuyen
---+
Amcoc
---+
Khac tuyen
---+
NQi dinh.
---+
Thong cdc
---+
Hi?p khe

tus«

2. Charn b6 cac du mo huyet, nguyen huyet cua kinh benh

11. CHAM CUu VLEU TRl THl/C HAN (am thuy vtfQng)

1. Ta charn, ciru n6ng, xoa n6ng cac am thuy huyet
---+
Xich trach.
Ph€
---+
Thie'u hai

Tarn
---+
Khuc trach.
Tarn bao
---+
Nhi gian
Dai tnrong
---+
Ti~u tnrong
tu« cdc
---+
Tarn tieu
Djch m/in
---+
Am ldng tuy~n
Ty
---+
Amcoc
Th~n
---+
Can
Khuc tuyen
---+
NQi dinn
Vi
---+
Bang quang
Thong cdc
---+
£)Cfm

Hiep khe
2. Charn b6 cac du mQ huyet, nguyen huyet cua kinh benh
3. Ciru tm, xoa tm cac huyet nhay cam khac va Cs cac vung dau,
eo cirng do lanh
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ThS.BS Nguyen Manh Tri

D. CHAM CUU TRJ B~NH THUQC NHI~T
1. CHAM CUu TRJ HL1 NH1$T (Am Hoa suy)
1. Charn b6 cac

am ho a huyet

cua kinh benh

PhS

~

Ngute'

Tarn
Tarn bao
Dai tnrong
Ti~u tnrong
Tarn tieu

~

~

Thieu phii
Lao cung

~ Duang khe
~ Duang cdc

Th?n
Can

Chi eau
Dai do
~ Nhien cdc
~ Hanli gian

Vi

~

Gidi khe

Bang quang
Bdrn

~

Con [on

~

Duang phu

Ty

~
~

2. Charn b6 cac du me) huyet, nguyen huyet cua kinh benh
11. CHAM CUu THl/C NH1$T (Duong Hoa vUQng)
1. Charn
cac duong hoa huyet cua kinh benh
PhS
~ Ngu te
Tarn
~ Thieu phu
Tarn bao
~ Lao cung
BC;li tnrong
~ Duang khe
Ti~u tnrong
~ Duang cdc
Tarn tieu
~ Chi eau
Ty
~ Dai do
~ Nhien cdc
Th?n
~ Hanli gian
Can

~ Giai khe
Vi
~ Con [on
Bang quang
~ Duang phu
Bdrn

ta

2. Cha rn b6 cac du me) huyet, nguyen huyet ciia kinh benh
3. Chuorn mat cac huyet vung dau n6ng

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ThS.BS Nguy~n Manh Tri

KETLU!N
1. Benh chung xuflt hien thieri hmh van trang voi nhieu ten goi
khac nhau. Nhung cluing v~n eo nhirng cai chung. Tnrdc bit cu benh
nhan nao, benh gt thi cluing ta c~n :
1. Ch~n doan g6c rS Nguyen am - Nguyen duong
2. Chan doan Tang phu Kinh benh
3. Ch~n doa n Han hay Nhiet
4. Chan doan Hu' hay Thuc
Tu do chung ta eo mot chan doan huong d~n cluing ta l~p phucng
hudng dieu tri
2. Bai nay nhan manh den Han - Nhiet, Thiiy - Ho a VI phan IOn
cac tnrong hop (khoang 80%) d~u do 2 nguyen nhan tren. Nhtrng
nguyen nhan khac se d~ c~p d bai sau.

3. Bang phuong phap ch~n doan kha don gian, chung ta dff tun
duce m~ u s6 chung cua rit nhieu chirng benh khac nhau va d~ xuat ra
cac phuong phap charn ciru va phuong duce gop phan tri duce nhieu
chung benh tren.
4. Qui luat "hoijc co hoijc khollg": Nhi~u th~y charn ciru charn
rtt nhieu kim len rit nhieu huyet; nguci thi charn nhorn huyet nay,
nguoi thi charn nhorn huyet khac; ngtroi thi dung kim dai charn sau,
nguoi dung kim ng~n cham can, nguoi dung dien charn, ngirci dung mai
hoa cham ... ngiroi nao cung da t kSt qua rieng cua minh. Va mot di~u rit
may man la h~u nhu kh6ng eo tai bien do tac dong len huyet (d6i khi eo
tai bien do scj hai lam vung charn, do nhiern trung neu kh6ng v6 trung
hay do th6 bao trong ky thuat). Co thS neu len qui luat tac dung cua
huyet hodc no dap ling, cam ling cho muc tieu di~u hoa dieu chinh eo
quan tang phii, hoac kh6ng eo tac dung nao ca VI no kh/ing cam ling.
5. Nguni thay charn ciru cting gi6'ng nhir nhirng ngirci di sari ban
chim:
Hoac ho dung dan eo nhieu vien nho ban tdi con chim dang d~u
treri canh. S6 dan nho ca ng nhieu thi cang eo nhieu hy vong tning con
chim. Do la cham nhieu kim theo cac c6ng thirc, hoac dau dau charn
diy vdi nhieu hy vong se g~p huyet cam ling.
Hoac ho dung tirng vien dan bari tirng con chi m dang d~u tren
canh. Di~u thti vi la sir tinh toan ky va eo ky thuat chinh xac. Do la
cham ciru it kim ma d~ dang tning huyet cam irng.
Hoac ho dung tirng vie n dan ban tirng con chim dang bay!

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