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TINH
DONG
Y
TRI
UEU
JiKt
THUOC
IMAM
VI
THUOC
THONG
DUNG
m/VIFiNTINHBIHHTHl
NXB
HONG
DUG
Hgi LUAT GIA VIET NAM
NHA
XUAT
BAN
HONG
OUfC
2D
LY
THAI
Ta -
HQAN
KIEM
-
HA

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OlEN
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LU<tng
Y TUE
TINH
DONG YTR! LIEU
GAV THUOG
NAM
VA
V!
THUOC
CH!U
TRACH
NHIEM
XUAT BAN:
BUI
VIET
BAG
CHjU
TRACH
NHIEM
NOI DUNG:
LY
BA
TOAN

Bien
tap
:
Quynh
Trang
Sufa
ban in
:
Minh
Huy
Ve bia
: A.P
In 1.CC0 ban kho 14.5cm
x
20.5cm tgi Cty TNHH in Nhat Nam.
So DKKHXB: 1092-2013/CXB/31-44/HD.
In xong va nop luu chieu quy IV nam 2013.
I
NOI DAU
C
o the noi nhd si/ Uu da! cua thien nhien nen
d
Viet
Nam
ChungIta
ton tai rat nhieu loai cay tu'di tot va
hufu dung khong nhQng cho moi traci,.g ma ca cho con ngudi.
Trong so do khong the khong ke den cay thuoc nam. Su' ton
tai cua Chung da mang den mot tiem nang rat to Idn trong
viec cham soc va bao ve siJc khoe con ngu'di.

That vay, tren thu'c te da c6 rat nhieu lUdng
y
iJng dung
cong dung va l0i I'ch cua nhiJng cay thuoc nam vao viec
chu'a benh cho con ngu'di va hieu qua dgt du'dc rat dang ke.
Khong nhu'ng the, trong dan gian con ton tsii rat nhieu bai
thuoc hay dUdc bao che
X\S
chi'nh nhQng cay thuoc ton tsii
ngay
d
xung quanh ndi chung ta dang sinh song ma vi mot
ly do nao do, chung ta chu'a nhan biet ra chung.
Quyen sach nay se cho ban thay ro xung quanh chung ta
CO
nhQng loai cay nao ma hang ngay chung ta thu'dng thay,
thu'dng dung lam thQc an nhung khong biet rang do cung
la
mot cay thuoc c6 tac dung chQa benh cho chung ta. Quan
trgng hdn, sach chi ra mot so' vi thuoc nam cu the de chu'a
cac benh thong dung nhu cum, ho, giai doc, tieu ddm, tieu
chay, an
thai,
va hudng dSn each thQc bao che nhQng bai
thuoc hay de tranh sQ tu'dng ky va mang Igi ket qua tot nhat
cho viec chQa benh.
Hy vgng sach se la mot cam nang hQu I'ch cho ban trong
viec tim hieu va Qng dung nhQng cay thuoc de tim quanh ta.
Tac
gia.

[DONGT]
TRI
LIEU
Cay Thuoc Nam
va
V| Thuoc
TIEU
Stf TUE
TINH
Tue
Tinh
Thien
SM*
(1623-1713),
thtfcfng
difcfc goi tat la Tue Tinh
hoac
Hue
Tinh,
ngLfcfi lang Nghia Phu, tong Van Thai, huyen
Cam Giang,
phii
Thifgng Hong (p^ay la
tinh
Hai
Diiong) difcfc phong la ong to nganh
dtfcfc Viet Nam va la
ngif&i
md dau cho nen
y difcfc

CO
truyen Viet Nam. Cac bo
sach
Nam
Difoc
than hieu va Hong Nghia
giac
t\i
y
thuf
ciia ong khong chi c6 y nghia trong
lich
suf y hoc ma ca trong lich
sijf
van hoc
Viet
Nam.
Nhieu
the ky lua, Tue Tinh difcfc ton la vi thanh
thuoc
Nam.
Tai
Hai Difong c m den thcr ong d xa Cam Van, Cam Vu; d
chua
Hai
Trieu lang Yen Trung, nay la
chua
Giam, xa Cam Scfn,
huyen Cam Giang, c6 tifong Tue
Tinh.

TIEU
sCr
Neu nhiJng ket qua nghien cufu van hoc, ngon
ngi?
hoc Viet
Nam sau nay khong
dxia
them bang chufng gi mdi thi
truyin
thuye't
dia phLfOng va nhiJng
cong
trinh
nghien cufu chuyen
mon
khac
cho
phep
khang dinh Tue Tinh la mot nhan vat'doi
Trail.
Ong ten la Nguyen Bd
Tinh,
biet hieu la Trang TiJ V6
Dat,
que d lang Xifa, tong Van Thai, huyen Cam Giang, phu
Thifcfng Hong (nay la thon Nghia
Phii,
xa Cam Vu, huyen Cam
Giang,
tinh

Hai Difang).
Mo coi cha me tU luc 6
tuoi,
Nguyin Ba Tinh
dufgc
cac nha
isif
chua
Hai Trieu va
chua
Giao
Thuy nuoi cho an hoc. Nam 22
tuoi,
ong dau Thai hoc sinh
difdi
trieu
vua Tran Du Tong,
nhufng khong ra lam quan ma d lai
chua
di tu lay phap hieu la
Tue
Tinh.
Nh'jfng
ngay
di tu cung la nhufng
ngay
ong chuyen
hoc thuoc, lam thuoc, chufa benh ciVu ngtfcfi.
TAU^-'^
(Lt^ttu.

i'^pj^ <• 5
Nam 55 tuoi
(1385),
Tue Tinh bi difa di
cong
cho
trieu
dinh
nha Minh.
Sang
Trung Quoc, ong vin lam thuoc, noi tieng,
difcrc
vua Minh
phong
la Dai y Thien sir, mat or do, khong ro
nam
nao. Bia van chi d lang Nghia Phii (do Nguygn Danh Nho
soan
nam 1697)
cung
cac
t\i
lieu
khac
d dia phifcfng deu ghi nhi/
vay.
CONG^INH
Y-DJOC
Nhflng
nam d trong ni/dc, Tue Tinh da

cham
chu
nghe
thuoc:
trong
cay thuoc, sifu
tarn
kinh
nghiem chiJa
benh
trong dan
gian, huan luyen y hoc cho
cac
tang do. Ong da tong hgp y
difgc
dan
tpc
CO
truyen trong bo
sach
gia tri la bo Nam
di/gc
than
hieu chia lam 10 khoa. Dac biet, ong c6 bo Hong Nghia
giac
tif
y
thif
(2
quyen)

bien
soan
bang
quoc
am, trong do c6 ban thao
500 vi
thuoc
nam, vie't
b§ng
thcf Nom Bifang luat, va bai "Phu
thuoc
Nam" 630 vi
cung
bang
chOf
Nom. Tha van Nom dcfi Tran
rat
hiem, neu qua thiTc do la tac phani ciia Tue Tinh thi chung
khong chi gia tri trong y hoc ma con la tac pham quan trong
trong
lich suf van hoc bdi vi day la cac tac pham d thcfi ki dau
cua van hoc
chCf
Nom.
TiJf
bao dcfi nay, gidi y hoc Viet Nam va nhan dan deu
cong
nhan Tue Tinh c6
cong
lao to Idn trong

viec
xay ditag mot quan
diem y hoc doc lap, tir chu, sat vdi thiTc te Viet Nam.
Cau
noi
ciia ong: "Nam dugc tri Nam nhan" the hien quan diem day
bien chijfng ve moi quan he mat thiet giifa con ngiTcri vdi moi
trifcfng
song
xung quanh. Quan diem, ay d§n dat ong len ngoi vi
cao nhat ciia nen y hoc co truyen Viet Nam: Ong Thanh
thuoc
Nam! Trong trUdc tac ciia minh, ong khong rap khuon
theo
cac
trifdc
tac ciia cac di/i tv\i6c. Ong khong difa kim, moc,
thiiy,
hoa, tho len dau ma xep cac cay c6 tru'dc tien! Ong
cung
phe
phan tuf tifdng di
doan
ciia nhffng ng\ibi chi tin vao phu chu ma
khong tin thuoc. Ong da neu ra nhieu phifcfng
phap
khac
nbau
de chijta
benh

nhif: cham, chich, chifcfm, bop, xoa, an,
uong,
hcf,
xong,
v.v.
6 •:• 'T^t^Ji}'\^^<LUiu.rs,4u.
Tue Tinh da khong difng lai d vi tri mot thay
thuoc
chuTa
benh, ong con tif minh truyen ba phifcfng
phap
ve sinh, to
chufc
ccf sd
chaa
benh
trong nha
chua
va trong lang xom. Co tai lieu
cho biet, trong 30 nam
boat
dpng
or
nong
thon, Tue Tinh da xay
difng
24 ngoi
chua,
bien cac
chua

nay thanh y xa
chCta
benh.
Ong tap hpp nhieu y an: 182 chijfng
benh
difpc chffa
bang
3.873
phifcfng thuoc. Ong
cung
luon luon
nhac
nhd moi ngifcfi chu y
nguyen nhan gay benh; tim bien
phap
phong
benh
tich
cifc.
Tue Tinh nhan manh tac dung
viec
ren luyen than the va sinh
hoat dieu dp. Ong neu phifcfng
phap
difSng sinh tom tat trong
14
chOf:
Be tinh, duang khi, ton than
Thanh
tdm, qua due, thu chdn, luyen hinh.

Tue Tinh con tap hpp nhffng bai
thuoc
chffa
benh
cho gia
sue. Co the noi, ong da gop phan dat ccf sd cho nganh
thii
y dan
tpc cua Viet Nam.
Aa^
(LkOu
^d^k <' 7
PHAN
Md DAU
DAI
Cl/dNG MOT SO BENH
THONG THl/ClNG '
-oOo-
1.
BENH
CAM
LANH
Cam
lanh la mot benh nhilm trung duomg ho hap tren. Co han
200 virus khac nhau c6 the gay ra cam lanh
vcJi
nhOfng trieu
chijfng
khac nhau.
Dau hi^u va tri^u

chiiCng
Trieu
chufng thiTorng xuat hien khoang 1-3 ngay sau khi tiep
xuc
v(Si virus va bao gom:
•
Ngat
mui
hoac
chay
niiac mui
• Hong ngiia va dau
• Ho
• Dau ngUdi
hoac
dau dau nhe
• Hat hai
• Chdy nude mdt
• Sot nhe
• Met moi nhe. ,
8 •
t/u,.^c
ez-wju/ge^w'.
f)6nfl Y
gTrt
ai|u
Nguyen nhdn -
Mac dii
CO
horn 200 virus c6 the gay ra cac trieu chijfng cam

lanh,
song rhinovirus la
thii
pham hay gap nhat va rat d§ lay.
Dieu tri
Khong
CO
thuo'c chfla khoi cam lanh. Khang sinh khong c6 tac
dung cho'ng lai virus gay benh. Cac thuo'c khong ke don dimg de
chOfa
cam lanh khong
chiJa
khoi benh cung nhxi khong lam cho
benh nhanh khoi hofn. Difdi day la nhijttig iJu va nhixcfc diem
ciia
mot so' loai thuo'c hay dimg de dieu tri cam lanh.
• Thuo'c gidm dau. Cac
thuo'c
gidm dau khong ke dan nhu
acetaminophen
thudng
dugc
sii dung de dieu tri sot va dau "
dau khi bi cam lanh. Can nha rang
acetaminophen
c6 thi
gay ton thuang gan,
nhat
la khi dung d lieu cao keo ddi.
Khong dung aspirin cho tre em vi

thuo'c
c6 the gay ra hoi
chiing
Reye
— mot
benh
hiem gap nhUng c6 the gay tH
vong.
• Thuo'c xit mui de gidm xung
huyet
mui. NhUng
thuoc
nay
khong nen dung keo ddi vi c6 the gay
viem
niem
mac mui
man tinh.
• Xi ro ho. Cdc loai xi ro ho khong c6 tdc dung dieu tri
nguyen
nhdn gdy ho trong cam lanh. Mot so loai chiia nhUng thdnh
phdn Idm gidm ho, nhiing vai luang qud it nen khong du
tdc dung
hoac
c6 the gdy hai cho tri. Trung tdm phbng
chdng
benh
dich My (CDC) khuyen khong nen diing xi ro ho
cho tre dilai 2 tuoi. Ho do cdm lanh thubng keo ddi it
nhat

la
2 - 3 tudn. Neu ho keo ddi Idu han, can cho tre di khdm
bdc SI.
Cdc
bien phdp tU chdm soc khi hi cdm lanh gom:
• Udng nhieu nUdc.
• Nghi ngai day du.
• Gin cho
phong
d luon dm vd dm.
T.Wt
C/wZrt
^a,J<.
• 9
• Siic
hong
nhieu Idn
trong
ngay bang nUdc
muoi
dm hoqc
udng ni/ac chanh dm pha vai mat ong de lam diu chS hong
bi viem vd gidm ho.
• Nh6 mui hhng
nUdc
mudi sinh ly di lam gidm xung
huyet
mui.
Phong
benh

• Rda tay thudng xuyen.
• Ve sinh nhd ciia sach se thong thodng, nhdt Id khi trong gia
dinh
CO
ngiidi bi cam lanh.
• Vdt bd khdn gidy
ngay
sau khi dung.
• Khong dung chung bat dua, vat dung cd nhdn vai ngitdi
khdc.
•
Trdnh
tiep xuc Idu v6i ngubi bi cam lanh.
2.
BENH
CUM
Benh
ciim
la benh
viem
nhilm
cap
tinh
diTomg ho hap gay nen
bori
virus
cum lay
truyen
nhanh,
thucfng

thanh
dich.
Trieu
chiXng
Benh
cum c6
nhieu
the lam sang, the thUcfng gap la: sau
thcri
gian
nung benh ngan, khoang mot ngay, benh
khdi
phat rat dot
ngot: sot, ret run
nhieu
Ian trong ngay,
than
nhiet
tang len
39-40°
ngay
ngay dau, keo dai 3-5 ngay kem theo la met moi, dau
nhiJc
toan
than,
dau dau nhu
biia
bd, dau cac cor xuorng
khdp,
chan

tay ra
rori,
da kho nong, mat bimg bitog, mat
choi,
chay
nUdc
mat, so mui,
ngat
mui, dau rat hong, c6 khi ho
tiirc
ngUc,
khac
dcfm hoac chay
mau
cam, mieng dang, buon non, tao bon. Sau do
nhiet
do giam
dan,
cac
trieu
chufng toan
than
giam dan trong 5-7 ngay. Mot so"
benh
nhan
cao
tudi
hay bi met nhugc keo dai, su
binh
phuc

cham.
• Benh cum d tri em dudi 5 tudi thudng nhe, sot nhu cdm
lanh.
u tr& so sinh, bieu hien: viem tai, viem chum, viem
thanh qudn cap, cd khi nhi&m doc than kinh
nang
ne.
10 • r/« :v/v«,v e/;^
t)6n9
Y
gTrt
• Ngodi ra con nhieu the khong rd trieu chdng
hoac
the nhe,
gidng cdm lanh: chi c6 hat hai, sd mui, ho; cd the gap the
ndng, rdt ndng do bien chiing ho hdp, tim
mach,
than kinh.
Bien
chufng
• Ho hdp Id bien chitng chii yeu vd ndng nhdt: viem phdi tien
phdt vd
thii.
phdt trong do viem phdi tien phat Id nang nhdt:
nhiet do khong gidm vdo
ngdy
3-5 ma tiep
diin,
kem kho
thd, thd gap, tim tdi, khac ddm cd khi Idn mdu, nhanh

chong ddn den suy hd hdp, suy tudn hodn roi tii vong neu
khong dieu tri.
• Benh cum con ddnh thiic
nhUng
benh tiem tdng nhU viem
tai,
viem xoang, viem nhiem di/dng
tiet
nieu
• Benh cum d phu nd. mang thai hay gay bien chdng phdi
hoac
sdy thai. Neu mac trong 3 thdng dau c6 the gap benh
ly thai, nhdt la ve he thdn kinh trung
Uong,
khong gay qudi
thai.
• Benh cum dc tinh hiem gap
nhUng
tit vong cao, khdi dau
nhu cum thudng, roi xudt hien hoi chdng suy ho hdp do phu
phdi
cdp tinh gay tit vong do thieu oxy mdu khong khdc
phuc duac.
Dieu tri
• Chii yeu la dieu tri trieu chitng ddi vdi the khong bien
chiCng:
dieu tri tai nhd, nghi ngai, ndm giudng, udng nhieu
nUdc,
dung
thiCc

an Idng dm, bd, dil vitamin, gidu vitamin C
• Sit dung thudc ha sot khi benh nhdn bi sot cao. Khong diing
khdng
sinh de du phbng bien chitng boi nhiim
• Tdi Id mot loai gia vi vd cung Id dugc lieu chda cdm cum rdt
tot. Til xUa ong cha ta dd
biet
dung tdi de chda benh cum.
Khdng
nhUng
vdy tdi con Id
dUgc
lieu hd trg dieu tri
huyet
dp,
md mdu cao, tot cho tim, mach, hd trg tieu hoa. Chat
alicin
trong
nhUa
dau tdi ditgc cho Id cd tdc dung diet vi rut
n^,^
e/uiw
'^(j'^/v
<• n
chinh, chat
nay rat di bi phd huy
ngay
cd d
nhiet
do

thubng
VI
vdy nen
ngdm rilau, ngdm
dam
hoac uong vien nang
mem chiCa nhua
ddu nhu
vien
ddu toi Tue
Link (dang vien
nen
bgt toi hi mat hit tdc
dung
doi v6i vi rut cum). Toi tia
,
Viet
nam
cung diCgc
cho Id c6
chiia nheu alicine nhdt
Phong lay nhiem:
• Khi
cham benh
cum, can kip
thbi trien khai
cdc
bien phdp
phong benh ngdn chdn dich
Ian

truyen
• Khi
phdt hien benh nhdn,
nen
cdch
li tai nhd,
cdch
li
phdn
tan
khong
tap
trung
• Khi
tiep
xuc vdi
benh nhdn
thi
ngUdi Idnh, nhdn vien
y te
phdi mang khdu trang
day 4 I6p gac,
trdnh tiep
xuc vai
ngiM benh
d
khodng cdch
gdn
(dudi
Im).

• Khi
benh
Ian
trdn thdnh dich,
can tam
thbi dong cila
cdc
trUang
hoc,
khong
to
chiic
cdc
budi
tap
trung dong ngudi
•
Dung
cdc
bien phdp
du
phong
dac
hieu: khdng virus,
inter-
feron, vacxin
3.
BENH
DQNG
KINH

Dong
kinh
la mot ro'i
loan
pha vd qua
trinh
truyen
tin
hieu
dien trong
nao.
Benh thuomg
gay ra
nhOng
can co
giat
va mat y
thijfc.
Tuy
nhien
trieu
chiJng benh
c6
tile
rat
khac nhau.
Dau hieu va trieu chitng
Cofn
dong
kinh

cue bo
-
Ccfn dong
kinh
cue bo
dcfn gian: khong
gay mat y
thiJc. Chiing
CO
the
thay
doi cam
xiic
hoac
thay
doi
each
nhin,
ngiiri,
cam
giac,
nem
hoac
nghe.
-
Corn dong
kinh
cue bo
phiJc
tap.

NhiJng corn
nay lam
thay
doi
y
thile, khien benh nhan
bi ma't y
thufc trong
mot
thcri
gian.
Can
dong
kinh
cue bo
phiifc
tap
thifcfng
gay ra cai
nhin
cham cham
va
12 • X/Wve/wZtt/^c^v
nhttng
ciif
dong khong
co muc
dich, nhiT
be tay, hem moi, noi lam
nham

hoac
nuo't khan.
C<fn
dgng kinh loan the
- Can
vang
y
thufc
(dong
kinh
con nho), dac
triftig
bai cai
nhin
cham cham, nhiJng
ciif
dong
kho
nhan thay
va mat y
thilc thoang
qua.
-
Ccfn dong
kinh
co.
Thucfng bieu hien nhu nhumg dong
tac
giat
cue

dot
ngpt
a
canh
tay va
chan.
-
Ccfn dong
kinh
mat
triTcfng
luc,
khien benh nhan
dot
ngpt
nga
qui.
-
Dong
kinh
con Idn, la
dang nang nhat,
dac
truiig
bdi mat y
thiifc,
CO
Cling
va co
giat toan than,

doi khi
benh nhan
can
phai
liTori
hoac
tieu tien khong
tiT
ehii.
Nguyen
nhdn
-
Nhieu
the
dong
kinh
co
lien quan
den
khuye't
tat a gen
dieu
khien
each
truyen thong tin
giQa
eac
te'bao
nao,
nhiTng

chi co mot
vai
the
hiem
gap la
phat sinh
tilf
nhChig khuye't
tat gen dac
thu.
Mac
du mot so' the
benh dong
kinh
co
tinh
chat
gia
dinh,
song
di
truyen
ehi
dong
mot
phan
vai tro gay
benh
- co le
thong

qua
viec
khien
ngircfi benh
man cam hon vdi eac ye'u
to'
gay
benh trong
moi
trufofng.
-
Trong nhieu trifomg hpp, dong
kinh
co the bat
nguon
tir mot
tai
nan, benh
hoac
chan thu'orng
-
nhuf
dot qui -
khien
nao bi ton
thuang
hoac
thieu
oxi.
Trong

mot so' it
trUorng
hap,
dong
kinh
co
the CO nguyen nhan
la
kho'i
u
trong
nao. Tuy
nhien, khoang
V2 so'
benh nhan khong
xae
dinh dupc nguyen nhan
gay
benh.
Xet nghi^m vd chdn doan
• Mo td chi
tiet
can
dong kinh.
Do
ngUdi benh
co the
khong
nhd ditgc nhUng
gi xdy ra, nen

thay thudc
se can
nghe
Idi ke
ciia nhUng ngUdi
da
chiing kien ccfn dong kinh.
e/«j«
i^M,^k
13
• Khdm than kinh kiem tra phdn xa, triiang lUc ca, ca lUc,
cam gidc, dang di, tU the, phoi hap dgng tdc vd thdng bang,
cung nhu mot so cdu hoi de kiim tra khd ndng tU duy, nhan
thi2c vd tri nhd.
• Xet nghiem mdu de loai
trii
nhUng nguyen nhdn c6 the gay
con
CO
giat nhU nhiim triing, ngo doc chi, thieu mdu
hoac
tiiu
dUdng.
• Cdc xet nghiem hinh dnh di phdt hien bat thuang trong
ndo: dien ndo do, chup CT, chup
cong
hudng til
(MRI),
chup
cat lap phdt positron

(PET),
chup cat lap vi tinh phdt photon
dan
(SPECT).
Dieu
tri
• Thuoc chong dgng
kinh.
• Phdu thuat cdt bo vung ndo gay ra can dgng
kinh.
•
Kich
thich day phe vi.
• Che do an kieng nghiem
ngat
gidu chat beo, protein vd it
carbonhydrat de gidm sdn sinh
xeton
trong ca thi.
4.
BENH
GUT
Benh gut, hay viem khdfp gut, la
mot dang viem kh6p dac
tritog
hai
nhufng
corn dau dOf doi dot ngot, do va
sung or khd'p. Day la mot ro'i loan phiJc
tap

CO
the xay ra d bat
ciif
ai,
song
nam giori dl bi benh hon phu uuf. Phu
nu:
se bi tang kha nang mac benh sau
khi
man
kinh.
Dau
hi^u va trieu chu'ng
Dau hieu va
trieu
chiifng ciia
gilt
hau nhiT luon la cap
tinh,
xay
ra
dot ngot - thuomg vao ban dem - va khong c6 dau hieu bao
tru'dfc.
>
14 • T/wj;
(2./v<ii4
-'rHc/./v
f)6ng Y gfrt
• Bau khdp dU dgi. Gut thubng dnh hudng den khap I6n cila
ngon chdn cdi nhung c6 thi xdy ra d bdn chdn, co chdn, dau

goi, bdn tay vd c6' tay. Bau thUbng keo ddi 5 den 10
ngdy
ma
sau da hit. Khd chiu gidm dan sau mot hai tudn, di lai
khdp
CO
vi rat binh thudng vd khong dau.
• Khdp bi sUng, ndng vd dd.
Nguyen nhdn
Nguyen nhan gay benh gut la do viem
or
khdrp do sir
tich
luy cac
tinh
the
urat.
Acid uric la mot chat
dugc
hinh
thanh
t\X
qua
trinh
giang hoa
purin.
Chat nay c6 mat tu nhien trong ccf the cung nhu
trong
mot so' loai thuc pham, nhat la
phii

tang dpng vat.
Binh
thiforng
acid uric hoa tan trong mau va
di/cfc
than bai xuat ra
ngoai qua mi6c
tieu.
Neu vi ly do nao do cor the san sinh qua nhieu
hoac
bai xuat qua it chat nay thi acid uric c6 the
tich
luy, tao
thanh
nhOfng
tinhh
the
hinh
kim sac nhon (urat) trong khdp va
cac mo xung quanh khdp, gay dau, viem va sUng.
Xet nghiem vd chdn dodn
• Lay dich tie khap bi benh de tim tinh thi acid uric trong
bach cdu
• Xet nghiem nUdc
tiiu
di do lilang acid uric dugc bai xuat •
• Xet nghiem mdu do nong do acid uric trong mdu
Dieu
tri
• Bd'i vdi can gut cap, cdc

thuoc
chdng viem phi steroid
(NSAID),
nhu ibuprofen vd naproxen co thi lam gidm dau.
• Vdi nhUng triiang hap nung, co thi diing corticosteroid nhU
prednisone. Cung co thi tiem cortisone vdo khdp bi benh di
gidm dau. NhUng phuang phdp nay c6 nhUng tdc dung phu
vd ndi chung khong nen tiem qud 3 Idn/ndm.
• Khi can gut cap dd dugc kiim sodt, co thi dp dung nliUng
bien phdp phong ngiia di Idm cham tdc do sdn sinh acid
uric
ciia ca thi
hoac
tang 13c do bdi xuat.
Tt^c
<2./v^« '^^«./t
•>
IS
• Hy thiem thdo, day dau xUang Id hai vi
thuoc
y hoc cd
truyin
quy cua dan toe c6 tinh mat, tdc dung khu phong, trit
thdp,
hoat
huyet,
gidm dau, lai gdn cot, tri khap sUng nong
do dau, cdc trUdng hap dau lUng moi gdi, dau minh mdy, di
lai
van dgng dau nhiCc do benh gut. Benh

gout
bi gay ra do
qua nhieu axit uric trong mdu (con goi Id da axit
uric):
tren
420 pmol/L (d nam) hay 380 pmol/L (d n0. Vi vay viec
thai
tril
Axit Uric Id rat cdn thiet. Thd phuc
linh,
Ty gidi,
Hodng bd c6 tdc dung tang cUdng chiic ndng bdi
tiet
cua gan
than,
thdm thdp, lai nieu giup ddo thdi acid uric trong mdu
vd chuyin hoa cdc chat khdc Id nguyen nhdn Idm tdng acid
uric
gay nen benh Gut. DUa vdo nhUng dac tinh cua cdc cay
thudc tren da
Idni
ra sdn phdm la Gut Tue
Linh.
Gut Tue
Linh
cdn c6 sU ket hap bdi ban cua Nhdn sdm, Hodng ki,
Thuc
dia, NhU huang, Ddo nhdn c6 tdc dung bd khi, gidi
doc, gidm dau, tdng ciCdng tudn hodn mdu, bdi bd ca the,
chdng met moi, suy nhilgc, cdi thien cdc

hoat
dgng the luc vd
tinh
than ciia benh nhdn.
Phong
b^nh
Khong
CO
each
nao chae
chan
ngan
ngiTa
difcfc
corn
gut cap ban
dau
hoac ve sau,
nhUng
bac si c6 the ke dan mot so' thuoc de lam
giam
nguy cof hoac mufc do
nang
ciia
cac dot benh xay ra sau nay.
Nhu-ng
thuoc nay gom
allopurinol
va probenecid. Khi dirge dung
hang

ngay, thuoc lam
cham
toe dp
hinh
thanh
acid
uric
va day
nhanh
viee
thai
trijf
chat
nay ra
khoi
ca the. Noi
chung,
giu" nong
dp
acid
uric
trong
gidi
han
binh
thuomg la
chia
khoa
de phong
ngifa

benh gut.
5.
BENH
COI
XaONG
- SUY
DINH DUClNG
Mot so' cong
trinh
nghien
cuu cho
tha'y,
tre coi xUcfng khong
xay
ra
rieng
le ma di kem
vdfi
suy
dinh
dueng,
thie'u
vitamin
A,
thieu
mau
16 • tiJ^cy\^,^e.iui«.>^pX
t)6ng
T gfrt 3^"
Nguyen nhdn tre cdi

xUcfng
• Thieu dnh sdng mat
trdi:
Nhieu tre bi cdi xiiong chi vi cha
me giU gin qud ky
hoac
khong c6 dieu kien cho tdm ndng
(do yeu td dia ly khi hdu, mda dong, vimg nui silang md,
nhd d chat chgi, 6 nhiem moi
trUdng ).
•
Tinh
trang thieu hut ndng vitamin D cua ngudi m.e trong
thdi
gian mang thai.
• Che do an cua tre thieu cd vitamin D vd canxi, ty le canxi
I
photpho thdp: Che do an nhieu phytat (c6 nhieu trong tinh
bgt), oxalat (c6 nhieu trong rau) vd chat xa cung Idm gidm
hap thu canxi.
TRE
BI COI XlfONG
Bieu
hi^n c6 nguy ca hi cdi
xiCafng
• Be CO the vdn du cdn ndng vd chiiu cao, tuy nhien phu
huynh cdn chii y cdc trieu
chiCng:
rang cham mgc, toe rung,
hay giat minh, biit nit, gc sUa. Ngu khong yen gidc, hay

khdc dem, dd mo hoi dau. Xuang bi mem, di bien dang
nhU:
dau bep, long ngUc gd, tay chdn
cong,
trdn do, cd 2
budu d dinh dau, thdp cham dong; dac
biet,
tuy tre bu bam
nhUng
CO nhdo Ngodi ra, ca the cdn gidm siic de khdng, tre
hay bi nhiim trung ho hap. Neu khong dieu tri kip, be se
cdi xi/ang that siX nhU: bi tay cdn vd, chdn
cong
vdng kieng,
ngUc
do
hoac
lep
• Khi thdy be cd nhUng biiu hien tren ban cdn xem lg,i coi
mdn an cd du cdc chat cdn thiet vd phu hap vdi Ida tudi, sd
thich
ciia be khong? Mdi ngay, trUdc 10 gid sdng, be cd dugc
cdi bd qudn do de phai ndng 5 phut (vdi tre dudi 18 thdng)
hoac
diioc chai ngodi
trdi
it nhdt 30 phut (vdi tri Idn han)?
Dm be den bac si de dugc tU vdn
hoac
chl dinh diing thudc.

Da sd cdc be khi cd bieu hien tren khong phai chl cdi xUang
ma cdn cd the bi suy dinh
djJdn^Jzemj}]^^
trung
khdc do ca the
^ia^t-sif^p^^fikfi^^^^^
THUAM
Phong
b^nh cbi xitorng
• Trong thdi gian c6 thai va cho con bu, ngudi me nen danh
thdi
gian tdm ndng, di dao ngodi trbi. Nen an uong hap ly,
chu y
thiCc
phdm gidu vitamin D, canxi de phdng trdnh cdi
xiCang
sam cho tre til trong bdo thai vd trong nhUng thdng
ddu
sau de.
• Cho tre bu me
ngay
sau
sinh,
bu hodn todn trong 6 thdng
, , ddu, sau do cho an bd sung.
Chii
y cho an ddu ma, thUc hien
to mdu bdt bqt. Hang
ngdy
phdi cho tre tdm ndng 5-10 phut

de
CO
du vitamin D.
• Bd sung vitamin D 400 dan vi/ngdy cho tre de non, de thdp
can.
Mot trong nhUng bien phdp phdng benh cdi xiiong Id
tang cUdng vitamin D vdo thiic phdm cho bd me vd tre em.
DIEU
TRI TRE COI XlfONG
Bo
xung canxi cho tre
- Canxi luon can diTofc cung cap cho ca the trong suo't cac
giai
doan ciia
cuoc
song,
t\i
trong bao
thai
cho den khi
trifdng
thanh va
ngudi
gia.
Theo
khuyen cao cua Vien
Dinh
dudng
quoc
gia Viet

Nam
va RDA ciia My, m6i ngay tre em can khoang 500 -l.OOOmg
canxi
tiiy
th^o do
tudi.
- SQa va cac che pham ciia sUa nhu sUa chua, banh
flan,
pho-
mai
la ngudn cung cap canxi quan trong, sau do la dau hu, hai
san (ca nho nguyen xUcfng, tom tep nguyen v6 mdi chufa nhieu
canxi), dau cac loai, me, rau xanh Can
chii
y la canxi trong sUa
thi
dl hap thu hon la canxi
tilf
cac ngudn thuc pham khac.
Bo
xung vitamin D cho tre cdi xUang
- Ngoai
viec
cung cap day du cac thUc pham giau
vitamin
D
nhu
sufa,
tnlng,
gan, bor tre em moi do

tudi
deu can phai
dugc
tam
nang nhe 15-20 phut mdi ngay. Anh nang nhe la nang trudc 9 gicf
sang
hoac
4-5 gid chieu. Can boc 16 da
cang
nhieu
cang
tot de anh
18
• rWc/weA,^>§^
nang trUc tiep chieu vao da thi se tao ra nhieu
vitamin
D. Sau
jj^hi
ra nang vai phut cho be am ngUcfi rdi me nen cdi bdrt non, vd,
v^n
ao
hoac
quan be
cang
nhieu
cang
to't. Khong phai nang qua
cda
kinh.
Tre nho chua di

dugc
thi ba me can
bong
be' tre ra ngoai
trdi
de tam nang, ne'u tre da tu di
duorc
thi can
nhac
nhd va tao
(Jieu
kien cho tre ra moi trudng ben ngoai. Ba me dang cho con bu
sGa me cung phai tam nang hang ngay de dam bao cho nhu cau
vitamin
D ciia chinh ngUdi me ddng
thdi
c6 dii
vitamin
D trong
sOa me de cung cap cho tre.
TRE
SUY DINH
DWNG
Nguyen nhdn
- Mot so
cong
trinh
nghien ciJu cho thay, cdi xUomg khong xay
ra
rieng le ma di kem vdi suy

dinh
dudng,
thie'u
vitamin
A,
thie'u
mau.
Tre suy
dinh
dudng thudng hay ro'i loan hap thu cac chat, ke
ca
vitamin
D va muo'i khoang; ddng
thdi
thie'u
hut enzym chuyen
hoa
vitamin
D.
Ngugc
lai,
tinh
trang
thie'u
vitamin
D cung se
lam
giam
sufc
de khang ciia ccf the, tang cam

nhilm
vdi vi khuan,
do do tang nguy ca suy
dinh
dUdng. Nhieu nghien
cilu
da chufng
minh,
tre suy
dinh
dUdng c6 nguy ca cdi xUang cao han so vdi tre
binh
thudng.
- Tre
CO
can nang
liic
de thap (dudi
2.500g)
c6 nguy ca coi xUang
cao han tre c6 can nang luc de binh thudng. Nguyen nhan la ca
the
khong du
triJ
dii muo'i khoang va
vitamin
D trong
thdi
ky bao
thai,

ddng
thdi
he tho'ng men tham gia vao chuyen hoa
vitamin
D
con ye'u.
- Co hoi chijfng kem hap thu:
Tinh
trang
thie'u
vitamin
D de
xay ra d nhOng tre c6 hoi chufng nay. Cac benh
tieu
chay
keo dai,
nhilm
ky sinh
trimg
dudng ruot, viem gan tac mat deu c6 anh
hudng
den hap thu
vitamin
D va tang nguy ca cdi xUang.
Dieu
tri tre suy
dinh
dU&ng
• Tang so bda an trong ngdy: Cho trk an 5-6 bUa mdi ngdy,
Xku^c

n^,^ (Ll^ '^p/./v •:• 19
<S)6nq
r gfrt
9lU?u
tlic
ngoai 3
bUa
chinh, can
them
2-3
bUa
phu bang
sHa,
che,
bdnh
•
Cho
them
chat beo vdo thiic an: Cho
them
1-2 mudng ddu
An
vdo chen chdo cho tre nhd hoac tang cdc thiic dn che bien
nhieu chat beo, thiic dn chien xdo
•
Cho dn dac han: Bot dac c6 ndng lugng
cao
han bpt
Idng
hay

chdo long. Vdi
tr&
dd du rang nen cho dn cam tdn nhuyin.
•
Cho tre dn bu sau giai doan benh.
•
Tdng so luang thiic dn trong mdi bda, vi du: Sau khi dn 11
2 chen cam, cho tri dn 112 chen
ml ;
dn
them
1 hu yaourt,
1
mieng pho mai hay uong
them
1 ly sUa.
•
Sii dung cdc thiic dn dac biet: Co the cho tri dn
them
mot so
loai
thiic dn dac biet c6 ndng lugng cao han thiic dn thong
thiidng,
vi du bot dinh dudng cao ndng liigng PediaPlus vdi
cong
thiic tdng trUdng tdi
Uu,
khd ly tUdng cho tre hap thu
toi
da cdc duang chat dephdt

triin
cd the chat, tri tue vd bat
kip
dd tdng trUdng so vai cdc ban dong trang
liia.
Chufng
liTofi an la nguyen nhan dan tdi tinh trang coi xiTcfng,
suy dinh diTdng d tre em, do khong an
uo'ng
deu dan nen cof the
thirdng thieu cac Acid amin, vitamin, lysin, kem, Vi vay viec bo
sung cac chat
thiet
yeu cho ccf the la dieu ma moi ngifdri deu
mong
muon. San pham siro Tue
Linh
gom c6: Bot nam men bia thiiy
phan
CO
chiifa 70-75% cac acid amin, trong do ham liiong Lysine
rat
cao (4%), vitamin nhom B,
Canxi
na khoang chat, cac chat
chong lao hoa dac
biet
la Se, Glutathion cung cap duSng chat
can
thier cho ccf the, chong coi xucfng, suy dinh di/5ng, tre em

cham Idn, bieng an. Dam diTofc thiiy phan tiT men bia khong
nhilm
hoa chat va dl hap thu hon. hern nOa san pham diioc bao
che'
dirdri
dang siro nen rat dl
uo'ng
bcJi
vi noc c6 vi
ngot.
Khong
nhuCng
vay ma siro Tue
Linh
con c6 tac dung: tang circmg silc de
khang cua cor the tre em,
giup
tre an
ngon
mieng, tre met moi,
ngiTori
gia yeu siJc de khang giam.
20
•:•
Tw /Uu,v
e^.^/g^A,
f)6ng
T STrj at|u
6.
BENH HEN PHE QUAN

Khdi
qudt
Ngifcri bi hen thiforng kho thor, khong so't, khong lay.
•
Hen xdy ra d moi
liia
tudi. Hen thudng ndng vdo mot so
thdng trong ndm vd hay len can hen vdo ban dem.
•
Can hen c6 the den khi dn hoac hit phdi vat gi gay di
ling
vdi
ngUdi do. d tre em, can hen thUdng bdt ddu bdng cam
lanh thong thubng.
XvCly •
•
Khi len can hen: Cho
ngUdi
benh ra chd nai thodng khi, nai
khong khi trong lanh
•
Cho uong nhieu chat long, nhii
nUdc
Idm ddm loang ra se di
thd, hoac hit hai nUdc.
•
Can hen nhe: diong ephedrin hoac teophylin
•
Can hen ndng: tiem adrenalin (ngUdi Idn 1/2 dng; tre em
114

dng. Co the dimg lien nhu the 3 Idn, mdi Idn each nhau
niia
gid theo chi ddn
cila
thdy
thudc).
Ne'u ngiTofi o'm c6 so't, hoac nen com hen keo dai tren 3 ngay: cho
uo'ng
khang sinh tetroxyclin hoac erytrcmjrxin.
Phong h^nh
•
NgUdi bi hen can trdnh dn hoac hit nhUng vat gi thUdng
gay can hen.
•
Can gin sach se r\hd d nai lam viec.
•
Khong de gd vd cdc loai sue vat khdc nhU chim, cho, meo
trong
nhd.
•
Phai ndng giudng, dem, chdn gdi.
•
Ne'u can thi chuyen den nai d trong lanh han.
nii^^
CAou
• 21
f)6ng r g'rt c^u
7.
BENH
NHOI

MAU CCl TIM
Nhdi
mau ca tim hay com dau tim xay ra khi dong mach vanh
cung cap mau cho tim bi tac nghen do cue mau dong. Dong mau
nuoi
duSng co tim bi gian doan c6 the gay ton thiTOng
hoac
pha
huy mot vung co tim.
Tri^u
chiXng
• Cam gidc ttic, nang
hoac
dau thdt vung giUa ngUc Mo ddi
mot vdi phut
• Bau Ian til ngUc len bd vai, cdnh tay, xuyen ra sau lUng hocLC
tham chi len rdng vd ham, c6 the dau keo ddi d vung thuang
vi
• Khothd
• Todt mo hoi
• Chodng ngdt
• Buon non vd non
Nguyen nhdn
• Tac nghen mach vdnh do cue mau dong hinh thdnh khi
mdng bam cholesterol trong dong mach bi vd ra
• Co thdt mach vdnh, nhdt Id do mot so loai ma tuy nhu
cocain.
Xet nghiem vd chd'n dodn
Chan doan diTa
tren

trieu
chiing, benh s\i va tham kham thiTc
the.
Cac xet nghiem
giiip
ich cho chan doan gom:
• Dien tdm do: do ca tim bi ton thuang khong ddn truyen
xung dien nhu binh thUang, nen dien tdm do c6 the giiip
phdt hien vd
theo
ddi tien trien ctla nhoi mau ca tim.
• Xet nghiem mau phdt hien sU c6 mat cda mot so
enzym
diigc
gidi
phong ra khi ca tim bi td'n thiiang.
22 •
e/«2«
>§iWv
• Mot so xet nghiem khdc nhU chup X quang ngUc, sieu dm
tim,
chup mach vdnh.
£)ieu
tri
Cac thuoc
thirdng
dung dieu tri con dau tim gom:
•
Aspirin.
Aspirin

ngdn can sU hinh thdnh
huyet
khdi, nhd do
duy tri dong mdu chdy qua chd dong mach bi hep. Bay dugc
xem Id thuoc du phong
huyet
khdi duac sH dung nhieu nhdt
hien nay.
• Thuoc tieu
huyet
khdi pha vd cue mdu dong dang Idm tac
dong mdu.
• Cac thudc chdng dong mdu ngdn cdn siC hinh thdnh
huyet
khdi
nhu clopidogrel (Plavix) vd cac thudc chen thu thi
tiiu
cdu
lib/Ilia.
_
• Thudc gidm dau.
• Nitroglycerin. Bay Id thudc thudng dung de dieu tri dau
ngUc,
CO tac dung Idm gidn mach tqm thdi, cdi thien lugng
mdu den tim.
• Chat chen beta Idm gidn ca tim, cham nhip tim vd gidm
huyet
dp giiip tim bam mdu de ddng
hern.
• Thudc gidm cholesterol, bao gom statin, niacin, fibrat vd

acid mat.
Phdu
thuat vd cdc thu thudt khdc
- Tao
hinh
mach vanh va dat stent: trong
thii
thuat nay bac si
luon
mot ong thong c6 dau gan mot qua
bong
tiT mot dong mach,
thirong
la d chan, vao ch6 dong mach tac nghen. Sau do qua
bong
diroc bom
cang
de md thong dong mach bi tac. Dong
thcfi
mot
stent mat
lirdri
kim loai se duac dat vao de giOr cho dong mach
khong bi tac
tror
lai.
- Phau thuat noi tat mach vanh: trong do bac sy dung mot
doan
tinh
mach

hoac
dong mach khau no'i vao dong mach vanh
T^c n^u.y
e/uJa
>Se»v/v
<' 23
vugt qua cho tac nghen (no'i tat qua doan tac nghen) de khoi
phuc
dong
chay
cua mau den tim.
Phong
ngiCa *"
- Nho'i mau
cof
tim: rat nguy hiem den
tinh
mang ngifcfi benh
dac biet
or
ngi/ori
gia vi vay
viec
dung thuoc de phong
ngiira
mot
each
thifcfng xuyen la dac biet quan trong. Nhung cac thuoc tay y
trong
dii phong

nhdi
mau cof tim dung lau
thiTorng
mang lai nhieu
tac dung khong mong muo'n: nhu aspirin gay loet da day ta
trang,
thuoc
tieu
huyet khoi gay
chay
mau, cac thuoc con lai chi
cai
thien
trieu
chutng.
- De tang cudng hieu qua va lam giam tac dung khong mong
muon trong phong ngira nhoi mau
ccr
tim
tren
thi
trifdng
hien nay
CO
nhieu che pham nhu: cac
san
pham tir
Giao
co lam lam ha
huyet ap, tang

lifu
thong khi huyet.
- Cac che pham
tif
hoa hoe
nhif
Du9ng mach kien nao: giup lam
ben viJng thanh mach mau, tang ciTomg sufc chiu
diing
cua mao
mach, giam md mau; phong
ngiTa
nhoi mau cor
tim,
dau
that
ngyc,
tai
bien mach mau nao. Cac che' pham c6 chufa Nattokinase
(HOMICIS):
dac tmh sinh hoc
cila
nattokinase rat giohg v6i plas-
min
(enzym duy nhat trong
ccf
the lam
tieu
huyet kho'i).
- Nattokinase nang cao kha nang tir nhien cua

cof
the de lam
tan
cac cue mau bang mot so'
each:
Hoa tan
fibrin
mot
each
triic
tiep.
Nattokinase cung c6 the lam nang cao sir san xuat eiia
ccf
the
vdi
plasmin va cac tac nhan hoa tan cue mau dong, bao gom ca
urokinase (noi bao).
- Nattokinase c6 the ngan chan sU chai cufng eiia mach mau d
lieu
luofng 100 mg/ngay. (5 mot
khia
canh nao do, nattokinase
thufc
sir to't hon thuo'c TPA (plasmin mo), thuo'c hoa tan cac cue
mau
truyen tho'ng, va urokinase.
24 •
Tt^^r^^cLi^i^p^^
8.
BENH PARKINSON

Benh Parkinson thuofng
tie'n
trien
nang dan, bat dSu bang dau
hieu
run kho nhan thay c5r mot ben
ban tay. Tuy run la dau hieu noi
b^t
nhat,
song
benh cung la nguyen
nhan
pho bien gay cuf dong cham
va
Cling
nhae.
Trieu
chvCng
• Run. Thildng bdt dau d mot ben ban tay. Tuy nhien nhieu
benh nhan khong bi run rd ret.
• ca dong cham chap. Benh lam giam kha ndng bdt dau cac
cji
dong tuy, dan dan khien cho
ngay
ca nhitng cu: dong dan
gidn
cUng trd nen kho khdn va mat nhieu thdi gian.
• Cling ca. Thiidng xdy ra d chi va d cS. Ciing co Idm gidm tarn
van
dong vd gay dau.

• Bien dang'vd mat thdng bdng. Trong giai doan muon, benh
nhan
co the bi gu veo vd khong giU diiac thdng bdng.
• Mat cdc dong tdc tU dong nhu chdp mdt, cubi vd vung tay
khi
di. Benh nhan co net mat cilng dd, mdt khong chdp vd
mdt kha ndng dien td bdng dieu bp.
• Thay ddi gigng noi. Gigng noi trd nen yeu at, nhanh hodc
dan
sac, noi liu nhiu, lap lai td hodc ngap ngdng tritdc khi
noi.
• Sa sut tri tue. Trong giai doan muon, mot so benh nhan bi
gidm sut tri nhd vd tdm than.
Nguyen nhan
- Cac
trieu
chijfng ciia benh Parkinson la hau qua cua
thie'u
hut
mot chat dan truyen than
kinh
la dopamin trong nao. Dieu nay
xay ra khi cac
te'bao
nao dac hieu san sinh dopamin bi
chet
hoac
(Liui^i^d.J.
• 25
f)6nfl

r
gfrt
suy giam chufc nang.
ChiTa
ro
nguyen nhan
cua
hien
tLTcfng
nay.
NgUcfi
ta cho
rang cac
dot
bien
di
truyen hoac
doc
chat trong
moi
trufofng dong vai
tro
trong can benh
nay.
Xet nghiem
vd
chart dodn
•
Do
nhieu

nguyen
nhdn
c6 the gay ra cac
trieu chiCng giong
benh
Parkinson,
nen
benh
rat kho
chdn
dqflu,
nhdt
la
trong
glai doan sdni. Hien chila
c6 xet
nghiem
nao
chdn dodn
xdc
dinh
can
benh
nay
• Chdn dodn
benh
thudng
dUa vao
tien
sit vd

khdm than
kinh,
bao gom
ddnh
gid khd
nang
di bo,
phdi
hap
dgng
tdc
cOng
nhu
thUc hien
mot so
nhiem
vu dan
gidn bdng
tay.
Chdn
dodn
sa bo
thUdng duqc
dat ra neu
benh
nhdn
c6:
•
It
nhdt

2 den 3
trieu chiing chinh
la run,
chdm
cil
dong
vd Cling
CO
• Trieu chiing
chi
khdi phdt
d mot ben ca thi
•
Run
thdy
ro
hern
khi
nghi ngai
• Phdn ling
tot vdi
thuoc
levodopa
DIEU
TRI
Dieu
tri ngi
khoa
Levodopa hien
la

thuoc dieu
tri
hieu
qua
nhat. Thuoc difqfc
chuyen
hoa
thanh dopamin trong
nao. Tuy
nhien
khi
benh tien
trien,
hieu
qua
ciia
levodopa
c6 the bi
giam
di. Tac
dung phu
ciia
levodopa
gom lii
iSn, hoang tirdng,
ao
giac
va
ro'i loan van dong
• Chat chii

van
dopamin,
gom
pramipexole (Mirapex),
ropinirole (Requip), apomorphine (Apokyn). NhUng
thuoc
nay
bdt chuac
tdc
dung
cua
dopamin trong
nao. Tuy gdn nhU
khong
CO
hieu
qua
dieu
tri cdc
trieu chiing
cda
benh, song
thuoc
lam
giam phdn
nao
hieu
qua
that thubng
cua

levodopa.
•
Cdc
chat
lie che MAO B.
Nhom
thuoc
nay gom
selegiline
(Eldepryl)
vd
rasagiline (Azilect). Thuoc
lie che
hoat
dong
26 • T/W^/we^^*^^^
cua
enzym
monoamine
oxidase
B (MAO B), nha do
ngdn
ngUa gidng
hoa
dopamin
tao
thdnh
til
levodopa.
Tdc

dung
phu hiem
gap
nhUng
c6 the gom
tuang
tdc
nang
vai cdc
thuoc
khdc
nhu
thuoc
dieu
tri
tram
cam vd
thuoc
ngii.
•
Cdc
chdt
lie che
catechol
0-methyltransferase (COMT),
gom
tolcapone
(Tasmar)
vd
Entacapone (Comtan). NhUng

thuoc
ndy
lie che
enzym
gidng
hoa
levodopa,
nhd do keo ddi tdc
dung
cua
levodopa.
Thuoc
c6 the gay ton
thuang
gan vd suy
gan.
•
Cdc
chdt chdng
tiet
acetylcholin,
nhU
trihexyphenidyl
vd
benztropine
(Cogentin).
Tuy
nhien,
Igi ich
khiem

ton
ciia
thuoc
CO
the
khong tUang xiing
vdi
nhUng
tdc
dung
phu
nhU
III
Idn vd
hoang tUcmg, nhdt
Id d
benh
nhdn tren
70
tudi.
NhUng
tdc
dung
phu
khdc
gom
khd mieng, buon
non, bi
tieu
vd

tdo bon.
• Thuoc chdng virus. Amantadine (Symmetrel)
cd the lam
gidm nhdt thbi
benh
Parkinson
nhe
giai doan
ddu.
Thuoc
cung
CO
the
dugc
ket hap vdi
lieu phdp carbidopa-levodopa
cho
benh
nhdn giai doan muon, nhdt
la khi bi rdi
loan
van
dgng
do
carbidopa-levodopa.
Tdc
dung
phu gom
sUng
ne cd

chdn
vd not
xudt
huyet
tren
da.
Phau
thuat
-
Kich
thich
nao sau la thu
that
pho
bien nhat
de
dieu
tri
benh.
Thu
thuat
nay bao gom cay mot
dien
ciic
vao sau
trong
vimg
nao chi
pho'i
van

dong. Dien
ciTc
dirge
no'i vdi mot
thiet
bi
cay
ngoai
da se
dieu
chinh
liTcfng
kich
thich phat ra.
-
Thii
thuat thirdng dircfc chi dinh
cho
benh nhan
bi
benh giai
doan muon
cd dap
ufng khong
on
dinh
vdi
thuoc (levodopa).
Kich
thich

nao sau
khong
c6
hieu
qua vdi
benh nhan khong
dap
ijfng
vdi
carbidopa-levodopa.
9.
BENH PHOI TAG NGHEN MAN
TINH
Benh phoi tac nghen man
tinh
(COPD)
la
thuat
ngil
chung
chi mot
nhom benh
phoi man
tinh
gay tac
nghen dufofng thc5r
trong
phoi.
COPD
thiicfng

dugc
dung
de
chi
tinh
trang tac nghen do viem phe quan
man,
khi phe thung
va
viem
phe
quan
do
hen.
Tri^u
chiing
COPD
thirofng
khofi dau tham lang. Benh
nhan
c6
the khong bieu hien dau hieu
va
trieu
chufng
gi cho den
khi phoi
bi ton
thiforng dang
ke.

Nhung
mot khi
da
xuat hien thi
trieu
chiJng thifdng nang dan theo
thdi
gian.
Cac
trieu
chiifng
COPD
c6
the gom:
•
Ho dai
ddng
• Tdng tiet ddm
ddi
•
Kho
thd, nhdt
Id khi
hoat
• Thd kho
khe
•
TiCc
ngUc
• Nhiim trung

ho hdp
thiibn
Nguyen nhdn
'
•
Khi phe
thUng.
Bay
Id
ben
huy thdnh
phe
nang
vd cac sgi
chun, khien
cac
tiiu
phe
quan
bi xep
xuong
khi tha ra vd
Idm gidm lugng
khi
lUu
thong trong phoi.
• Viem
phe
quan man tinh
gdy

viem
vd
chit
hep phe
quan
vd
tieu
phe
quan, tdng tiet ddm khien
phe
quan
bi bit tac.
• Khoi thudc
la vd cac
chat kich ling khdc.
O dai da so cac
triidng
hap,
ton
thilang phoi ddn
tai
COPD
la do hut
thuoc
nang,
phd
28
•
"tw./Vu,ve/v.?«/g^,^
la

Idu
ngdy
gdy ra.
NhUng nhieu chat kich
lic
khdc cu-ng c6
the
gdy COP nhu 6
nhiem khong
khi vd
khoi
bui
nghi
nghiep.
Xet nghi^m
vd
chd'n dodn
•
Xet
nghiem cfiiic ndng phoi.
Do phe
dung
c6 the
phdt hien
COPD
trUac
khi
xudt hien trieu chiing benh.
Xet
nghiem

ndy cung thudng diiac ddng
de
theo
ddi
tien trien benh
vd
hieu
qua
dieu
tri.
• Chup
X
quang phoi
de
phdt hien khi
phe
thung
- mot
trong
nhUng
nguyen nhdn chink
gdy
COPD cung nhil loqi trie
cac
benh khdc d phoi hodc
suy tim.
• Phdn tich
khi
mdu dong mgch.
Xet

nghiem
may ndy
ddnh
gid lugng
oxy
dUgc ph6i dUa vdo mdu
vd
lugng
khi
cacbonic
thai
ra. ,
•
Xet
nghiem ddm. Phdn tich
cac te bdo
trong ddm giup
xdc
dinh
nguyen nhdn
vd
logi
tril
mot
so
dang
ung
thu phoi.
• Chup cdt
l&p

vi
tinh (CT). Chup CT c6 the giup phdt hien
khi
phe thUng vd xdc dinh nhUng benh nhdn
c6
the phdu thuat.
Dieu
tri
-
B6
thuo'c
la la
bifdc dau
tien
cof
ban trong ket
hoach
dieu tri
COPD
va la
each
duy nhat
de
giuf
cho
benh khong nang them.
Dieu
tri noi
khoa
• Thuoc gian

phe
quan
c6 tdc
dung gidn
ca d phe
quan,
Idm
gidm
ho vd kho thd.
Tiiy
theo
miCc
do
benh,
c6 thi'
ddng
thudc gidn
phe
quan
tdc
dung ngdn trildc
khi
heat
dgng,
thudc gidn
phe
quan tdc dung
keo
ddi ddng hang
ngdy

hodc
cd
hai.
• Steroid dgng
hit
Idm gidm viem dudng
ho hdp
vd gidm
kho
thd. Song dung thuoc
keo ddi c6 the gdy mot so tdc
dung
phu
nhu
lodng xUang, tdng
huyet
dp,
due
thuy tinh
the vd
tieu dudng.
Xl^c A'u^ (LUM
/t^eVv/v
• 29
• Khdng sink chong bgi nhiem.
Dieu tri ngog.i khoa
• Phdu thuat gidm the tick phSi.
• Ghep phd'i.
10.
BENH TRI - NGUYEN NHAN, DAU HIEU NHAN BIET

VA
HUdNG DIEUTR!
Tri
la benh trong do cac
tinh
mach 6
hau
mon va triJc trang bi siftig va viem.
Tinh
trang nay c6 the do thirdng xuyen
ran
qua miifc trong khi di ngoai
hoac
do
tang ap luc a cac
tinh
mach nay trong khi
mang
thai
va mot so' nguyen nhan khac.
Dau hi^u va tri^u chvCng
Trieu chiing ciia tri thiTomg tuy thuoc vac vi tri
• Tri noi; Binh thucmg khong nhin thdy hoac cam thdy bui
tri.
Nhung
khi ran hoac kich thich do phdn di qua c6 the
gdy ton
thUcmg
be mat bui tri vd gay chay mdu. B6i khi viec
ran

manh c6 thi' khien bui tri noi sa ra ngoai hau mon.
• TrT ngoai; Dang tri ndy thuang gdy dau. Boi khi mdu c6
the li lai trong bui tri ngoai vd tao thdnh cue mdu dong, gdy
dau,
siCng vd viem. Khi bi kich thich, bui tri ngoai c6 the bi
ngiia hoac chay mdu.
Nguyen nhdn
Tri
CO
the xay ra do tang ap liic trong cac
tinh
mach d dau dU(Ji
triic
trang. NhQng nguyen nhan hay gap nhat gay tang ap lire va
gay tri la:
• Tdo bon ddn den phai ran nhieu
• Tieu chay vd phai tdng phdn ra ngoai lien tuc
30 •
T/iwi:
n««v
e<u«
•
Ngoi
nhieu hoac diing Idu, nhat la khi thiCcmg xuyen
ngoi
toilet
Idu do tdo bon
• Beo phi
• Thai nghen vd
sinh

di
Xet nghiem vd chdn dodn
- Tri ngoai c6 the
nhin
thay bang mat thUcmg. Tri noi c6 the
diTcfc phat hien bang tham trUc trang, nhung doi khi tham trUc
trang
khong giiip diTa ra chan doan xac dinh vi tri noi thirorng rat
mem va kho phat hien.
- Co xet nghiem kiem tra phan dudi ciia dai trang gom soi hau
mon, soi triTc trang
hoac
soi dai trang sigma. Kiem tra rpng hon
gom soi dai trang o'ng mem de kiem tra toan bo dai trang. Xet
nghiem nay giup loai
trir
nhCfiig ton thuong gay chay mau khong
chi
of
trirc
trang ma con d toan bo dai trang.
DIEU
TRI
Dieu tri nqi
- Neu bui tri chi gay kho chiu doi chiit, c6 the dung cac loai kem
hay thuoc m5 boi tai cho
hoac
corticoid, ket hop v6i
tarn
nirdc am

hang
ngay
de lam giam trieu chuCng.
Dieu tri ngog,i
• That bui tri. Bdc si se dung day cao su thdt quanh goc bui
tri noi di cdt diit tudn hodn mdu vd Idm bui tri xep di.
• Tiem xa: tiem hoa chat vdo xung quanh mach mdu de lam
bui tri thu nho lai.
• Chieu tia hong ngoai di cdt diit tudn hodn mdu d nhUng bui
tri noi nhd chdy mdu.
• Phdu thuat cdt bui tri trong trUbng hap cdc bien phdp khdc
khong CO kit qua hoac bui tri Ian.
T/wv
r\,u
(LKoa
i^d,.u
•:• 31
• Kep bui tri ngan khong cho mdu chdy den bui tri. Bay la
phuang phdp khd mai vd c6 mot so' nhugc diem nhu gay
nguy
ca tdi phdt vd sa bui tri cao hon ca vai phdu thuat md.
Phong
benh " ' >bji! «<• ut i
• An nhieu chat xa
• Uong nhieu nU6c
• Thubng xuyen tap thi due
•
Trdnh
ngoi nhieu
hoac

ditng Idu
•
Trdnh
ran manh vd nhin thd khi di ngoai.
• Di ngoai
ngay
khi can. Nhin di ngoai Idu se khien cho phdn
khd
vd kho ran.
11.
BENH QUAI
Bj
Quai
bi la mot loai viem tuyen nirdfc bot mang tai do mot loai
virus,
lay Ian qua dudng ho hap. Virus c6 ai
tinh
dac biet vdi
tuyen
niXdc bot,
tinh
hoan va he than
kinh.
Benh thi/dng gap d
tre
nam
tuoi
tir 5-15.
Tri^u
chiing

- Giong nhu ta't ca cac benh do virus khac, khi bi
nhilm
benh,
benh nhan sot cao c6 the len den 40°, dau va sung (khong do) mot
hoac
hai ben goc ham. Sau 7-10 ngay cac
trieu
chiJng thuyen
giam dan va khoi benh. d mot so truomg hop dac biet c6 the kem
luon
viem
tinh
hoan.
- Viem
tinh
hoan chi la mot trong nhUng bien chilng hay say
ra
nhat cua quai bi. Sau 7-10 ngay, benh quai bi da thuyen giam,
dot nhien benh nhan lai sot cao
39-40°,
tinh
hoan mot
hoac
hai
ben sung nong do dau. Sau khoang 10 ngay
trieu
chiJng nay cung
thuyen
giam va khoi.
32 •:•

c.w^e/v««
^gc.w'v
f)6nfl
Y g'rt gt^u
Chan
dodn
Benh nhi nhat la nam
gidi,
sot cao, mot
hoac
hai ben goc ham
sUng,
dau, kho nhai va nuo't, dac biet la c6
sUng
nong do dau
tinh
hoan mot
hoac
hai ben thi
chac
chan la bi quai bi. Ngoai ra cung
gap quai of tre nU, nhung noi chung hiem va cung gay bien
chiJfng
viem buong
triifng.
Xet nghiem: khong c6 xet nghiem dac hieu nao.
Bieu
tri:
trong
thdri

gian
hi h^nh
phdi:
• NAm nghi, dac
biet
khi c6 siCng tinh hoan thi phdi nghi
tuyet
doi.
• Chiiam nong vung goc ham.
• Dung thuoc ha sot, an thdn, giam dau.
• Sue mieng niXde muoi
hoac
cac chat sdt trung khdc.
• An nhe.
• Neu
CO
bien chiing viem tinh hoan c6 the dung corticoid.
• Dac
biet
phdi cdch ly benh nhan, vi rat hay lay.
Bien
chvCng
Thuorng
gap
nhat
la
viem
tinh
hoan,
ngoai ra mot so' trUomg

hofp
hiem
c6 bien
chufng
viem
mang nao,
viem
nao,
viem
tuy
tang.
Trong dan gian, thucfng hay truyen mieng la benh quai bi gay
v6 sinh, nhung thuc te' khong hoan toan dung nhu vay. Vi:
• Khong phdi trUcmg hap nao cung c6 bien chiing viem tinh
hoan.
• Neu
CO
bien chiing viem tinh hoan md duac dieu tri kip thdi
vd
dung cdch thi benh cung khoi khong gay di chiing vd
sinh.
• Du
CO
bien chiing viem tinh hodn gay teo, nhiCng chUa chdc
da
bi teo ca hai ben, vi vay vdn c6 thi c6 con. Trong tri/dng
hap nang bien chiing viem tinh hodn khong dugc dieu tri
Tluc^c y\»j^
i^dt^k
• 33

f)6ng r gfrt at|u
ho&c dieu
tri
khong dung each
gay teo cd hai
tinh hoan,
gay
v6
sinh.
12.
BENH
Ti; KY
Tir
ky la mot
roi loan
d nao di
kem
vdi mot
loat nhOng
van de
ve phat
trien,
chu
ye'u la ve
giao
tiep
va
tifcfng
tac
vdi

xa
hoi. Benh
hay
gap of cac be
trai
gap 4 Ian
cac
be gai.
Dau hi^u va
tri^u chvCng
- Nhin chung,
tre
tiT
ky
thiTcfng
c6
nhijfng
van de
trong
3
linh
vyc quan trong
cua qua
trinh
phat trien
la ky
nang
giao
tiep,
ngon ngfir

va
hanh
vi.
NhiJng
tre bi
benh nang
c6 the mat
hoan
toan kha nang
giao
tiep
hoac
tuang
tac vdi
ngiTori khac.
- Trong
vai
thang
hoac
vai
nam dau sau khi
ra
dcfi,
tre c6 the
hoan toan
binh
thirdng, nhifng
sau do tre dan trd nen kem dap
lifng
vdi

ngiTcfi khac.
Tre
cung kho chia
se
trai
nghiem
\6i
ngiTcfi
khac,
vi
du khi
difgc
nghe
ngifori khac
doc
truyen,
tre
khong chi
ra
difgrc biJc
tranh
trong cau chuyen do. Khi Idn len, mot
so'tre
c6 the
hoa nhap horn
vdi
ngirc/i xung quanh
va c6 the c6
cuoc
song

binh
thuforng
hoac
gan
binh
thudrng.
Tuy
nhien
mot
so' tre khac tiep
tuc
bi
suy giam kha nang ngon ngO
va
giao
tiep,
va c6
nhOfng ro'i loan
hanh
vi
tram trong han.
-
Da
so' tre tiT
ky
cham
hoc
ducfc
cac
kie'n thiifc

va ky
nang mdi.
Tuy nhien
mot so' tre c6 tri tue
binh
thuofng
hoac
kha
thong
minh.
Mot so'
nho
tre con
difgfc
xem la
nhufng "than dong"
va c6
nhufng
ky
nang
dac
biet trong
mot
linii
vUc
nhat
dinh,
nhiT
nghe
thuat

hoac
toan
hoc.
Nguyen nhdn
- Benh tiT
ky
khong
c6 mot
nguyen nhan duy nhat. Benh
c6 ve
lien
quan
den
nliOfng
bat
thi/cfng
or
nhieu vung
nao, va cac nha
34 •
tw.=e/v«w
,
t)6nfl Y gfrt
Ichoa
hoc da xac
dinh
difgrc mot so' khuyet tat
gen c6
lien quan vdri
benh.

Gia
dinh
c6 mot tre bi tif ky c6 1/20 kha
nang
c6
dufa
con
thiif
hai cung
bi
benh.
Tre
CO
trieu
chiJng tif
ky
cung
c6
nguy
ccf cao bi cac
benh sau:
•
Hoi
chiCng
X, gay
cham phat triin tarn than
^.^,
•
Xa
Cling

dang
cu, gay ra
nhUng Midi
u
trong
nao
•
Hoi
chxing Tourette
•
Dong
kinh
Xet
nghiem vd chdn dodn
-
Vi
benh
c6
miifc
dp
nang
va
bieu hien
rat
khac nhau,
nen c6
the
rat kho
chan doan. Khong
c6 xet

nghiem
dac
hieu
nao de
phat hien
ra
benh. Kham
xet bao gom
quan
sat tre va hoi ve sir
phat trien
va
thay
doi
trong
ky
nang
giao
tiep,
ky
nang ngon
ngO
va hanh
vi cua tre qua
thori
gian.
Tre c6 the
difgc
lam
mot

so' trac
nghiem
ve noi
chuyen, ngon ngfif
va cac van de tam ly.
-
Mac
dii dau hieu benh thiTomg bieu hien khi
tre
diXcfc
18
thang
tuoi,
nhiTng chan doan
c6
khi phai dgri
den
khi
tre
difgrc
2
hoac
3
tuoi,
khi bieu hien cham phat trien ngon ngif
da
tror
nen ro
rang.
Chan doan sdrm

la rat
quan trgng
vi can
thiep sdrm
-
trifdrc
3
tuoi
- thifcfng mang
lai kha
nang phuc
hoi
to't nhat.
Dieu
tri
Chifa
CO
each
chiJa khoi benh tif ky,
va
khong
c6
bien phap
nao
phii
hcfp
cho tat ca. Cac
lifa chon dieu tri
c6 the gom:
• Lieu phap hanh

vi va
giao tiep nhhm gidi quyet nhUng
kho
khan
ve
giao tiep, ngon
ngU vd
hanh
vi cua tri.
• Thudc: thuoc khong
cdi
thien dugc
cac dau
hieu
chu ye'u tU
ky,
nhUng
c6 the
giiip kiem sodt
cac
trieu chiing.
•
Cac
lieu phap
hd trg, nhu
nghe
thuat,
dm
nhac,
che do &n

dac
biet,
bo
sung vitamin
vd
mudi khodng
v.v
(Lkiu.i^^k
• 35
Tre thiTcfng dap
ling
to't
vdri
cac chiTorng
trinh
giao
due
dugrc
cau
true
ehat che, c6 sir tham gia cua mot nhom cac
chuyen
gia va bao
gom nhieu hoat dpng
khac
nhau de cai thien ky nang ufng xuf,
giao
tiep va hanh vi.
13. BENH U XOTCTCUNG
U

xor tuT
cung
la mot kho'i u lanh
tinh
CO
nguon go'c tir to chile ccr trofn tuf
cung. Tuoi thi/orng gap tir
35-50
tudi.
Day la loai u chiu anh hiidng ciia noi
tiet
to"
buong
trting
khi Estrogen trong
CQf
the tang cao. U xcf
tiif
cung
thiTorng
to ra dien hinh la trong
thai
ky, thi/cfng
tuf
cung
bi xof eo nhieu nhan kich thich to nho
khae
nhau. U xof tuf
cung
CO

the gay ra rong
kinh,
rong huyet, dau vung
chau
va tieu
lat
nhat.
U
xo
tuT
cung
hiem khi phat
trien
thanh ung
thiT.
Nhiftig
no
gap nhieu hon d nhflng phu nu" sau
tudi
man
kinh.
Dau hieu bao
dong
thifofng gap nhat la khdi u phat
trien
nhanh va can phai
phlu
thuat.
Nguyen nhan
- U xcf tuf

cung
phat
trien
dudri sir kich thich cua hormon estro-
gen
diroc
san xuat tir nhien trong cof the. Sir phat
trien
nay c6 the
bat dau or
tudi
day thi khoang 20
tudi
va thu nho lai sau
tudi
man
kinh
khi ccf the ngirng san xuat mot so' liTorng Idn
estrogen.
- U xcf tuf
cung
CO
the nho va khong gay
trieu
chiing nhimg
chung
cung
c6 the phat
trien
den mi'c c6 the nang den 3-4 kg.

Chung phat
trien
cham. Mot so' phu nOf bi nhieu u xa c6 the la do
di
truyen.
Mot so' yeu to' lien quan den sir phat
trien
cua u xcf tuf cung:
• ThiCa can, beo phi
• ChUa tiing sinh con
36 • 'Zf^^„na.^<Lka^/Sf4'^^
• Co kinh nguyet Idn dau trUdc 10 tudi.
• NgUdi My goc Phi (gap 3-9 Idn so vdi ngildi My da trdng).
Tri?u
chvCng
Hau
he't u xcf tuf cung,
ngay
ca khi ehung rat Idn,
cung
c6 the
khong
CO
trieu
chufng. Thircfng ban se phat hien
benh
khi di kham
phu khoa dinh ky.
NhiJng
trieu

chufng thircfng gap bao gdm:
• Chay mdu am dao bat thiCdng hoac chdy mdu kinh nhieu
han
binh thUcmg, con duqc ggi la rong kinh, rong huyet, doi
khi
con kem theo mdu cue.
• Tang dp lUc d bang quang c6 thi gay tiiu nhieu Idn va c6
cam gidc mudn di tiiu vd doi khi bi tieu.
• Tang dp lUc d trUc trdng, ddn den tdo bon.
• Tang dp lUc d khung chau, cam thdy trhn bung diCdi, dau
bung dudi.
• Thdy bung Idn ra, tdng vong eo. (Co the ban phai ndi rong
quan,
tang ca quan khi mac nhiing khong c6 dau hieu tdng
can
rd ret)
• V6 sinh, diCac dinh nghia Id tinh trang khong the c6 thai
sau 1 n&m cd gdng thu thai vd khong sii dung bat ky bien
phdp trdnh thai ndo.
• Khi bdc si khdm benh c6 the phdt hien ra mot khdi d khung
chau.
Khi
ndo can den sU can thi^p cua y hqc
Ban nen den bac si khi c6 nhufng bieu hien sau:
• Kinh nguyet khong deu hoac luang mdu ra nhieu han, xuat
huyet giUa ky kinh.
• Dau khung chau hoac dau bung.
• Sot hoac vd mo hoi dem
Xu^c
y\t^ <3/^ i^d^k • 37

• Tdng vdng bung. ^
• Lo
Idng
ve thai ky
hoac
khong c6 khd ndng mang thai.
Hay lien lac
vdri
bac si ngay lap
tuTc
hoac
den phong cap
cuTu
neu
CO
nhufng bieu hien sau:
• Mdu kinh thdm qua nhieu han 3 mieng bdng ve sinh nwi
gid.
• Bau bung
hoac
khung chau nang
hoac
keo ddi.
• Chong mat, chodng vdng, thd gap, hodc dau ngUc c6 lien
quan den chdy mdu dm dao.
• • Chdy mdu dm dao c6 lien quan den thai ky
hoac
c6 khd
ndng
mang thai.

Dieu
tri
- Dieu
tri
u xcf tuf cung phu thuoc vao
trieu
chufng, kich thudc va
vi
tri
ciia
khoi u,
tuoi
cua ban (khoang
thcfi
gian tir hien tai cho
den luc man
kinh),
y muo'n c6 con va the trang ciia ban.
- Trong hau het cac
triXcrng
hcfp,
viec
dieu tri la khong can
thiet,
dac biet la neu
nhir
ban khong c6
trieu
chiing,
kho'i u nho

hoac
ban da qua
tuoi
man
kinh.
Neu benh nhan ra mau am dao
nhieu
do u xcf
tiT
cung c6 the can phai ap dung phuang phap nao
cam mau budng tuf cung. Neu khong c6 bang
chiing
ac
tinh
(ung
thif),
thifomg CO the dieu
tri
chay
mau am dao bang thuoc hormon.
- Theo ddi: bac si se theo doi kich thirdc va sir phat
trien
ciia
kho'i
u xof theo
thcfi
gian de
chac
chan do khong phai la ung thu.
Neu ban khong c6 nhiJng

trieu
chiJng nhu
chay
mau am dao, vimg
chau va neu kho'i u khong phat
trien
nhanh, thi ban khong can
dieu
tri.
Tuy nhien, ban cung phai tai kham va kham phu khoa
thifomg
xuyen sau m6i 6 thang de kiem tra sii thay doi ciia kho'i u.
Dung
thuoc:
-
Thuoc
khang viem khong steroid
nhif
ibuprofen (Advil
hoac
mot
loai khac) c6 the lam giam dau vung chau do u xof
tii
cung.
38 • tvwv=
;T««V
e/«2«/S^v/v
^6nfl
r
STrt

gtgu
.
Thuoc
kich thich
tie't
hormon gonatropin (GnRH) c6 tac dung
che tuye'n yen lam
cor
the giam
tie't
estrogen. Su sut giam nong
(Jo estrogen trong
cor
the lam giam kich thudfc ciia kho'i u. Loai
thuoc nay thudng
duoc
dimg tnrdc phlu thuat nham lam kho'i u co
lai
de giam so'
liTcfng
mau mat qua qua
trinh
phau thuat
hoac
cai
thien
cong
thiifc
mau trudc phlu thuat. Kich
thiTdc

ciia kho'i u c6
the giam khoang 50% trong 3 thang
sijf
dung thuoc. Nhirng kho'i u
CO
the phat
trien
trdr
lai neu
ngirtig
dieu
tri.
Han che
siif
dung
each
dieu tri nay lau dai vi chiing c6 nhOfng tac dung phu gay ra do
tinh
trang giam estrogen trong co the (gio'ng
tinh
trang man
kinh
do thuo'c) nhu loang xUcrng, nong bitog va kho am dao.
-
Thuo'c
khang hormon RU - 486 (mifepristone). Loai thuo'c
nay con cho thay c6 tac dung lam giam dau vung chau, giam ap
life
d bang quang, va giam dau vimg
lifng

difdfi.
Suf dung lieu thap
de lam giam kich thudc kho'i u trUdc phlu thuat cat bo.
Thuo'c
con
CO
the giiip
tranh
khong phai phau thuat do no c6 the lam thu
nho kich thudc kho'i u. Nhilng tac dung phu ciia thuo'c do giam
estrogen tuang tu nhu tac dung phu ciia GnRH nhung c6 the it
gap han. RU - 486 c6 the gay say
thai
do do can can trong khi
siif
dung thuo'c neu muo'n c6
thai.
- Thuoc nguon goc thdo
diCac:
Cac dUcfc lieu c6 chiia cac
saponin ca'u true dammaran thucfng c6 kha nang tang
miln
dich
CO
the manh, giai doc va
chong
u tot
nhU
Nhan sam, Tam
that,

Trinh
niit
hoang cung,
Giao
co lam Trong dan gian
Trinh
nuf
hoang cung dirge sii dung de chiJa ung
thuf
vu, ung
thir
tuf cung, ung
thir
tien
liet
tuye'n.
Giao
co lam dirqfc chufng minh la co tac dung
kim
ham
sir
phat
trien
kho'i u manh va
ducfc
suf dung cho benh
nhan
ung thu nao, phdi,
tien
liet

tuye'n, tuf cung,
vii.
Viec
ke't hofp
cac dirge lieu thiTofng dem lai ke't qua kha quan hofn cho
sufe
khoe
so
v6i
khi diing mot loai. Hien
tren
thi trUcfng co nhieu san pham
bao che'
tir
cay
Trinh
nilf
hoang giiip ho trg dieu
tri
u vu,
tiif
cung va
buong
triifng
co hieu qua
nhiT
san pham That diep
linh
(pho'i hop 2
dugc

lieu quy co tac dung tic che manh sU phat
trien
ciia
khoi u).
x/u ^c
e/v^4 /^^ /v •:• 39
Phdu
thuat
-
PhSu
thuat boc nhan xcf : Phuofng
phap
nay c6 the thiTc hien
qua noi soi budng tuf
cung,
noi soi o bung va it gap h.an la md hd
(rach duorng tren bung). Dieu tri trUdrc phSu thuat
bang
thuo'c
GnRH CO the lam giam li/ong mau mat va giam
thdi
gian thuc
hien
cuoc
phlu thuat.
- Cat
tijf
cung
la phlu thuat lay di toan bo tuf
cung

(ciing vdi
kho'i
nhan xor). Day phirong
phap
thifomg thay nhat trong dieu tri
u
xof tuf
cung
va diTgrc xem la
each
dieu tri duft diem. Neu kho'i u la
ung
thir
hoac
kern
theo
u budng trufng, tuf
cung
se dirge cat
hoan
toan
cung
vdi budng trufng va o'ng din trufng.
Phong
ngiia
- Tranh tang can sau 18
tudi
va eo'
gang
gia can nang cua

minh
phu hop vdi chieu cao. Can nang cua ccf the eo the anh
huorng den sir gia tang ndng do cua
estrogen,
do do se lam u xor tuf
cung
phat
trien.
Ban nen tap the due de kiem
soat
can nang va
eon lam giam san xuat hormon kich thich phat
trien
u xa tuf
cung.
-
Thuo'c
la van ehiTa
diTcfc
chufng minh la c6 lien quan den tang
u
xor tuf
cung.
Nhung ngirng hut
thuo'c
la se eai thien
siJe
khoe
ciia
ban neu ban bi u xo tuf

cung.
- Ban nen di kham
sufc
khoe
dinh ky dac biet la kham phu
khoa nham phat hien sdrm benh.
14. BENH
VIEM
MUl
D\G
Benh viem mui di
ling
la
benh
di ufng
cua toan than c6 bieu hien tai ehd, thi/omg
la
nhufng com hat hoi, so mui va tac mui.
Nguyen
nhan
- Di nguyen gay
benh
bao gdm: pha'n
hoa, bui nha, nam mo'c, vai sgi, long gia
sue, gia cam; mot so' thuTc an nhiT dau, dufa,
40 • /w
e/U?«/^e^A
torn
cua, ca; mot so'
thuo'c

nhu aspirin, quinin;
hoac
vi khuan: hen
cau, tu eau, triTc khuan coli
Tri?u
chvCng
. Hat hoi, so mui, tae mui keo dai, thirdng kern
theo
boi nhilm.
Phan loai: c6 hai loai
Viem mui di
tfng
do
phan
hoa:
trieu
chuTng
ro ret,
phat
hi^n dl
dang,
dieu
tri c6
hieu
qua.
Benh
gap of
ngi^cfi
thanh
thi,

xuat
hien
vao
thcfi
ky dau cua mua hoa.
• Trieu
chufng:
hat hai tiing can ddi, trong nhiiu gib, nUdc
mui trong, nhieu, Udt ddm mili xoa, nhitng khong gay hoen
6; ngat mui, c6 cam gidc ngiia kho chiu; nhiic dau, ddi khi
cam gidc cdng d vung xoang mat.
• Cam gidc rat bdng d ket mac, vdm hong, mdt do, nUdc mdt
rdn
rua, benh nhan so dnh sang nhat Id vdo buoi sdng khi
thiCc
day.
• Can xuat hien nhieu Idn trong
ngdy,
tdi diu di. Cdc trieu
chiing
ndng them khi benh nhdn di ra ngodi, dao pho hoac
ve ndng thon vd ngUdi benh thay di chiu khi ddng
ciCa
trong
nhd hodc khi trdi mUa. Viem mui ndy it khi gap d tri em
dudi
10 tudi.
Viem
mui di
vCng

khong
c6 chu ky: rat
thUatng
gap
• So mui thudng xuat hien khi thUc day, giam di trong
ngdy
vd xuat hien trd lai khi gap luong gio, gap lanh, tiep xuc vdi
bui.
Thdi gian dau nUdc mui trong, sau do dac lai thdnh
md, nUdc mui chdy thdnh tilng dot, c6 khi viem
loet
vung
tiin
dinh mui.
• Hat hai xuat hien trUdc s6 mui, hat hai hdng trdng, trUdng
hap ndng hat hai lien tuc nhieu gid trong
ngdy,
gay met
mdi, giam tri nhd.
tku^c
AMH. (LkOu i^pJ^ • 41
• Ngat
mui
thay
doi tuy
tiing thdi gian, thdi tiet
va
theo
miia,
mui

tdc
khong
diu
nhau, phdi
thd
bhng mieng
dan den
viem hong, viem
phe
qudn.
• Ngodi
ra con
xudt hien
cdm
gidc ngiCa trong
mui, dau
thdt
d
goc
mui,
CO
tiet dich li dgng trong
vom
hong
lam
benh nhdn
ludn
phdi khac
nho.
• Thdm khdm niem

mac mui: phd ne,
nhgt nhgt, phii dich
nhdy lodng,
hoac
mu dac
trdng, vdng, xanh
khi c6 bgi
nhiem,
ngodi
ccrn
niem
mac
binh thiidng, khong
c6
thay
doi gi
ddng
ke.
Co the c6
polip
to
nhdn khong chdy
mdu.
Dieu
tri
- Tai cho: giai quyet
ne
niem
mac,
sung huyet, xuat

tiet,
nhilm
trung
or mui, xoang.
Chpc
rufa xoang
de
chan doan
va
dieu
tri.
- Toan
than:
dung khang histamin: phenergan (promethaz-
ine) 25mgx2-6vien/ngay; hismanal (astemizole): ngu'di
Idn
lOmgxlvien/ngay,
tre em
tren
2
tudi
2mg (1ml
sire)
10kg can
nang/ngay
hoac
mot so'
thuo'c
cho'ng
di

ling
khac
nhif
terfenadin,
primalan
- Khang sinh
ket hop v6\d ne'u c6 boi
nhilm.
Dieu
tri
dac
hieu:
giai
mSn cam
Phong benh: kho,
chii
ye'u
la bao ve moi
triTdng
song,
tranh
cac
yeu
to' tac
dong
cua di
nguyen. NgiTori
c6
benh
di

iifng
can
song
6
ncfi
thoang
mat,
khong
khi
trong lanh. Benh
c6
tinh
chat
di
truyen
nen nam
nuf
c6 ccf dia di
ufng khong
nen lay
nhau.
15.
BENH VIEM XOANG CAP VA MAN TINH
Benh viem xoang
cap va man
tinh
la
benh
rat
phd bie'n

d
Viet
Nam,
phan loai viem xoang
cap va man
tinh
thiTc chat
chi la
phan biet
each
xuf
tri:
cap
thiTcfng dieu tri
noi
khoa,
con man thi
phai
dieu tri ngoai.
Viem xoang
cap
theo
thii
tir thuofng
gap la:
viem xoang
ham,
42
•
t:^u^^

n,.^ e/«j«
xoang sang, xoang
tran,
xoang bufdm.
Doi
khi
xay ra
viem nhieu
xoang cimg
mot luc. -••i
Nguyen nhdn
- Nguyen nhan phd bie'n nhat
la do
viem mui,
do
cam, cum,
doi
khi
do
viem hong,
do
rang. Ngoai
ra c6 the do tdm
(nhay
cau,
Ian)
do
chan thiiong,
do ap
liTc thay

doi dot
ngot khi
di may bay
do
di vat d
mui
do
bie'n chiing
gay
viem xoang ciia
cac
benh
cum,
sdi,
ho ga,
viem phdi
do phe cau
khuan.
-
Vi
sinh
vat gay
viem xoang cung
la
nhiJng
vi
sinh
vat gay
viem
nhilm

dircfng
ho hap
tren.
- Ye'u to' thuan
Igri:
moi
trUcfng
6
nhilm,
an
or
kem ve
sinh,
veo
vach ngan,
di
iirng,
u
lanh,
u doc d
mui;
tinh
trang ciia phdi,
phe
quan: viem xoang-gian
phe
quan,
ket hop
viem xoang-gian
phe

quan
vdri
di tat
tim sang phai.
Cdc
the
viem xoang
cap
tinh
- Viem xoang
tran
cap:
it khi dcrn thuan, thuomg pho'i hcfp vdi
viem xoang sang trudc.
Khdi
dau
nhiT
mot sd mui
thong thifomg
keo
dai 5-6
ngay rdi xuat hien nhufng ccfn
dau dac
biet ciia viem
xoang
tran:
ccfn
dau
phia
tren

o
mat,
mot ben va c6 2 chu ky mSi
ngay. Corn
dau
tang
dan
tiT sang
den
giSa tnTa thi
dat
mufc to'i
da,
luc
do
mui
chay
nhieu mii, xoang
voi di va con dau
diu xuo'ng,
den
chieu lai tai dien
con
dau
do.
Doi khi kem
chay
nUdrc mat, mat diTa
di
dira lai cung dau,

da
viing
xoang
tutig
cam
giac,
chi sor
cung dau,
an
day
than
kinh
tren
ho' mat d goc
tren-trong
d mat
cung
dau
nhoi
- Viem xoang
ham cap: bat dau
nhiT
sd mui
thong thircfng
nhung
keo dai
rdi xuat hien
con dau or
vung
dirdi

d
mat,
mot ben,
dau xuyen
ve mot
phia
ham
rang,
dau
tang
khi
gang
sufc,
khi
iihai,
khi nam.
Co
diem
dau ro
dirdri
d
mat,
hoc mui
xung huyet,
thirdrng
tie'n
trien
to't trong
10
ngay.

TAu^c &/u2a
i^pJ^
•:•
43
- TnJcfng
hcfp
viem
xoang
do rang, thiJdng c6 sau rang ham nho
hoac
rang ham, o ap xe quanh rang, mil
chay
vac trong
xoang.
Benh nhan dau nhufc rang dCf doi,
Igri
quanh rang thucrng siftig, vai
ngay
sau mii tho'i do o at vao
xoang.
Nho bo rang sau
benh
khoi
nhanh
chong.
-
Viem
xoang
sang
cap & tre em: Co the gap d

thori
ky 2-4
tuoi.
Trieu
chuCng
bieu hien chii yeu d mat: sau khi so mui, ml mat
tren
va dudi ne do, sitog hup, khong mor dirac mat, nhiet do khong
cao,
vach
mi khong thay c6 t6'n thifong nhan cau.
Viem xirong
tiiy
ham tren, gia dang viem
xoang
ham: xuat
hien d tre con bii thiTcrng t\i 1-3 thang, thi/omg do nhilm tu cau
khuan cua xiXcfng ham tren. Trieu chiicng: nhilm khuan nang: mi
mat dudfi
mong
do, ma sifng, mui
chay
mii,
Icfi
rang
cung
thay
siftig,
CO khi CO 16 ro.
Dieu tri

-
Chong
nhiem
khuan
va dan litu: khang sinh ket
hcfp
vdi
cac
thuo'c
chong
viem, corticoid
difcfc
dung khi c6 uf dpng mu, dung
thuoc
giam xung huyet.
Viem xoang man tinh
Viem
xoang
trd thanh man
tinh
la do 6 viem xiTcfng or thanh
xoang
nhu viem
xoang
do rang. Man
tinh
lien quan den sir bien
doi khong
phuc
hoi ciia niem mac.

ii
Nguyen nhan: tiTcfng tiT viem
xoang
cap.
Trieu
chiing:
• Nhieu ngubi khong cam thdy dau, nhUng nhiic ddu hoac
nhiic
viing mat.
• Ngat mui, mui chay nhdy mu Mo dai tdi phat.
• d trk nhd do nud't phdi chat dick tiet thudng gay viem phe
quan
tdi
diin,
viem da ddy-rugt non, ho tilng can.
• 1 '-'^
f)an8 r gfrt Slt?u
Bieu
tri: tuy
thuoc
niem mac lot c6 ton thiromg khong ma dieu
tri
bao ton hay dieu tri ngoai.
Bieu
tri bao ton: khang sinh, khang histamin,
thuoc
co mach.
choc
rufa
xoang,

vi phau thuat qua mui, cat polip, mo veo
vach
ngan, chiJa rang.
Bieu
tri
ti$t
can (sau khi dieu tri bao ton that bai)
bang
cac
loai
thu
thuat
xoang: nao sang qua mui
hoac
qua diTcrng ngoai,
nao sang ham, mo xoang
tran,
xoang
birdm,
mo
lien
xoang, dung
phiTcfng
phap
vi
phlu
nham tai tao lai sinh ly
binh
thuorng
ciia

xoang.
16.
DAITHAODaCiNG
Dai
thao dirorng hay tieu diTorng,
la
mot nhom
benh
ro'i loan
chuyen
hoa
cacbohydrat
khi
hooc
mon in-
sulin
cua tuy hi thieu hay giam
tac
dong
trong cof the, bieu hien
bang
mijfc dircfng trong mau luon
cao. Benh tieu dircfng la mot trong
nhifng
nguyen nhan chinh ciia
nhieu
benh
hiem
ngheo,
dien hinh la

benh
tim
mach
vanh, tai
bien
mach
mau nao, mil mat, suy than, liet diTofng, hoai tuf
Phdn
loQ,i
- Benh tieu dircfng c6 hai the
benh
chinh: Benh tieu dirdng loai
1
do tuy tang khong
tiet
insulin, va loai 2 do
tiet
giam insulin va
de
khang insulin.
Loai
1 (Typ 1)
- Chi CO khoang 5-10%
tfi'ng
so'
benh
nhan
benh
tieu dircfng
thuoc

loai nay (loai 1), phan Idn xay ra d tre em va ngirofi tre tuoi
(< 20T). Cac
trieu
chiirng thucfng khdi phat dot
ngot
va tien
trien
nhanh neu khong dieu tri. Giai
doan
toan phat c6
tinh
trang
thieu
insulin tuyet doi gay tang dircfng huyet va nhilm
Ceton.
Tfu^c:
(L'/^U ^4^k • 45
NhC?ng
trieu
chiing dien hinh cua Benh tieu ducfng loai 1 la: An
nhieu,
uo'ng
nhieu, tieu nhieu, gay nhieu (4 nhieu), md mat, di
cam va sut can, tre em
cham
phat
trien
va d§ bi nhiem trung.
Loai
2 (Typ 2)

- Benh tieu difcfng loai 2 chie'm khoang
90-95%
trong tong so
benh
nhan
benh
tieu
duomg,
thuofng gap d lufa tuoi tren 40, nhulig
gan day xuat hien
ngay
cang
nhieu
or
lila
tuoi 30, tham chi ca liJa
tuoi
thanh thieu nien.
- Benh nhan thiTdng it c6
trieu
chufng va
thu'omg
chi
dugc
phat
hien bori cac
trieu
chtlng ciia bie'n chiJng,
hoac
chi diTcfc phat hien

tinh
cor khi di xet nghiem mau tmdc khi mo
hoac
khi c6 bien
chufng nhir nhoi mau ccf tim, tai bien
mach
mau nao; khi bi nhilm
trimg
da keo dai;
benh
nhan
ni?
hay bi ngiifa vimg kin do nhilm
nam am ho,
benh
nhan nam bi liet difomg.
Tri^u
chvlng
- Tieu dam ban dem do da nieu c6 the la dau hieu khori phat cua
dai
thao diTorng (loai 1)
or
tre nho. Vdi
benh
nhan dai thao diiorng
loai
2 thirorng khong c6 bat ky
trieu
chufng nao
or

giai
doan
dau va
vi
vay
benh
thirorng chan
doan
muon khoang 7-10 nam (chi c6
each
kiem tra difcfng mau cho
phep
chan
doan
diTgrc or giai
doan
nay).
- Cac
trieu
chuCng tieu nhieu, an nhieu,
uo'ng
nhieu, sut can
nhanh la cac
trieu
chijfng thiTomg thay d ca hai loai. Lu'cfng nifdc
tieu
thirorng tiT 3-4 lit
hoac
horn trong 24 gior, nirdc trong, khi kho
thirorng

de lai vet ban
hoac
mang trang.
- Chan
doan:
Chan
doan
Dai thao diTorng thircfng suf dung phircfng
phap
dinh lirgng dircfng mau huyet tircfng: - Dirdng mau luc doi >
126mg/dl (> 7 mmol/l)
thilr
it nhat 2 Ian lien tiep. - Difcfng mau
sau an
hoac
bat ky > 200mg/dl (> 11,1 mmol/l).
Test
nay diXtfc
thirc
hien nhir sau: - Dieu kien: an 3
ngay
lien dii liTcfng
carbonhydrat (>
200g/ngay),
khong dung
thuoc
lam tang dirorng
mau, diTcfng mau liic doi binh thircfng, khong bi
stress.
46 • /w /g^v

. ThUc hi?n: Nhin doi 12 gior,
uong
75 gam dirdng
glucose
trong
250ml nirdc (khong
nong
- khong lanh). Dinh liromg diTomg
mau sau 2 gior. ^,
Doc ket qua:
• Neu dudng mau 2 gid sau uong dudng glucose
>ll,lmmol
/1:
chdn
doan BTB;
• Neu dudng man 2 gid sau uong dUdng glucose >7,8 mmol/l
nhmg < 11,1 mmol/l: nhQng ngUcfi nay duac xep loai gidm
dung nap dudng glucose. Ngi/di mdc gidm dung nap ditdng
glucose khong nhttng c6
nguy
ca cao tien trien thdnh BTB
sau nay, md con tang
nguy
ca mdc cac benh tim-mach nhu
tang
huyet
dp, nhoi mdu ca tim, tai bien mach mdu nao.
Bien
chvCng *
• Toan

xeton
do dai thdo dubng
• Suy than
• Benh vong mac
• Hoai thu
• Nhiim khudn
DiSu
tri
Lo'i
song va thai do an uong
Che do an tot cho bat ky ngirori tieu diiomg
cung
can thoa man
cac yeu to' cor ban sau:
• Bu chat Bam - Beo - Bot - Budng - Vitamin - Muoi khodng
- Nude vdi khdi luang hap ly.
• Khong Idm tang dudng mdu nhieu sau an.
• Khong lam ha dudng mdu luc xa bUa an.
• Buy tri duac hoat dgng the lUc binh thudng hdng
ngay.
• Buy tri duac cdn nang d miCc can ndng ly tudng hoac gidm
cdn
den miCc hap ly.
Xku^c
/w,v (Lkoa y^&a. • 47
f)6nfl
r
gfrt
at|u
• Khong lam tdng cdc yeu to

nguy
ca nhu roi loan ma mau,
tdng
huyet
dp, suy than
• Phu hop tap quan dn uong cua dia du, dan toe cda bdn than
vd gia dinh.
• Ban gidn vd khong qud ddt tien.
• Khong nen
thay
ddi qud nhanh vd nhieu ca edu cung nhu la
khoi lugng cda ede bUa dn.
Thud'c
dieu tri
Thuoc
dung cho Dai thao du^oTng loai 1:
•
Insulin.
Cdn cit vdo tdc dung, gidi chuyen mon chia ra 3
nhom:
•
Insulin
tdc dung nhanh: gom
Insulin
hydrochlorid, nhu
dieh Insulin-kem
•
Insulin
tdc dung trung binh: Isophan
Insulin,

Lente
Insu-
lin
•
Insulin
tdc dung cham:
Insulin
Protamin kem.
Insulin
kem tdc dung cham
•
Insulin
dugc chi dinh dung cho benh nhdn ddi thdo dicbng
thuoc
Typ 1, no chi dung cho benh nhdn ddi thdo dubng
Typ
2 khi da
thay
ddi che do dn, luyen tap vd dung cdc
thuoc
dieu tri ddi thdo dudng tdng hap md khong hieu qud
Phan ling phu cua Insuhn: Di
iifng
(sau khi tiem Ian dau
hoac
nhieu Ian tiem), ha
Glucose
mau (thiTorng gap khi tiem qua lieu),
phan
ijfng

tai cho tiem (ngufa, dau, ciJng vimg tiem). Do gay roi
loan chuyen hoa md tai vung tiem, tang sinh m9 dl gay u md,
giam se gay xo ciirng (kho tiem, dau).
Thuoc
dung cho Dai thao difcfng loai 2:
Cac din xuat cua Sulfonylure, chia lam 2 nhom:
• Nhom 1: c6 tdc dung yeu, gom - Tolbutamid, Acetohexamid,
Tolazamid, Clopropamid.
48 •
TA^CJ^^C^^^^
• Nhom 2: c6 tdc dung manh han, gom - Glibenclamid,
Glipizid,
Gliclazid.
• Phan ling phu khi dung: ha Glucose mdu, di ling, roi loan
tieu hoa, tan mdu, mat bq,ch cdu hat.
Chila
benh bSng Dong y:
. Ngoai phirong phap dieu tri quen thuoc la tiem insulin
hoac
tiem
thud'c kich thich tuyen tuy san sinh
insulin,
gan day cac
nha khoa hoc trong va ngoai niTdc dang nghien
ciiru
theo
xu hudng
dieu
tri
ttf go'c, giup ccf the cung co' va tu sufa

chOfa
cac te bao bi ton
thirtfng
giiip hoi
phuc
kha nang san sinh insulin npi sinh, sufa
chOfa
nhOrng ton thuomg or mang te' bao giiip tang kha nang dung
nap. Cac
ducfc
lieu cung rat
diTofc
quan tam vi c6 tac dung dn dinh
benh va
cho'ng
bien chiJng to't.
- Gan day cac nha khoa hoc tai Hoi khoa hoc Thuy dien, vien
nghien ciifu Karolinski da tim thay mot hoat chat hoan toan m6i
trong
cay
Gynostemma
pendata c6 xuat xii tir Viet Nam, chat nay
CO
ten phanosid c6 tac dung ha diTorng huyet manh
theo
cof che
kich
thich tuy
tie't
insulin

dong
thdri
lam tang sU nhay cam v(5i
insulin
vdi te bao dich. Cac nghien ciJu cung chiifng minh cac
saponin
khac
trong
Gynostemma
lam ha md mau, dn dinh huyet
ap va tang luc manh, dieu nay rat quan trong cho
viec
phong
chdng bien chuCng ciia benh tieu duofng gay ra
(Gynostemma
pendata
con
dugfc
goi vdi ten
Giao
cd lam).
17. DAU
THAN KINH
TQA
Than
kinh
toa la day than
kinh
dai
nhat

trong ccf the,
chay
tir
vimg that liTng
qua mong xuong mat sau
diii
va chan.
E)au than
kinh
toa la thuat nguf dung de
chi
tinh
trang dau bat ngudn doc
theo
ducfng di ciia day than
kinh
nay - tir
lirng
xudng mong va chan.
/U.V
e/u« /g?«/v •:• 49