Điều trị nhi khoa đông y phần 1

- . i G S . B S . T R A N V A N KY , \ " A
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Giao sir Bac si T R A N V A N K Y

Vien Y Dime hoc dan toe Thanh pho Ho Chi Minh

D ltlJ T R I
NHI KHOA DONG Y
(T A I B A N C O S U A C H U A V A B O SU N G )

NHA XUAT BAN Y HOC
C hi nhanh Thanh pho Ho C hi M inh


LCTI GIOI THIEU

V

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(Lan xuat ban thirnhat)
Nirac ta co mot nen y hex: co truyen dan t6c, vai nhieu kinh nghiem phong
phu ve y va dupe, trong do co nhi khoa.
Sau gan 20 nam lam cong lac thira ke phat huy nhirng krnh nghiem cua nhi
khoa co truyen, limg biroc ket hop vcri nhi khoa hien dai. Bac si Tran Van Ky da
co nhirng hieu biet tuxrng doi sau, co nhihig kinh nghiem thuc te trong khi van
dung nhirng kinh nghiem cua nhi khoa co truyen va da bien soan cuon: Dieu tri
Nhi khoa dong y.
Tap sach nho nay dugc viet diroi dang ket hgp buoc dau giixa y hpc hifn dai
va y hoc co truyen dan tpc.
Ve cach viet, tac gia da dung ngon ngir hi$n dai de trinh bay cac van de.
Ve npi dung tac gia dfe cap trong phan ly luan ca ki6n thuc hifn dai va co
truyen, trong cac phan ten benh, nguyen nhan benh ly, chSn doan, tien luqmg
benh noi theo hien dai, phan difeu tri chu y£u vi6t theo ly luan va kinh nghigm c6

truyen co ket horp ca phan chira benh cua nhan dan.
Day la mot cach viet phu hop vai trinh do hieu biet va kinh nghiem thuc te
con co han cua can bo lam cong tac thira ke phat huy kinh nghiem cua y hpc co
truyen va ket hap chat che giira y hpc hien dai va y hpc co truyen dan toe. No co
iru diem la co nhieu kha nang giup cho cac thay thuoc si} dung kinh nghiem co
truyen de dang hem cach viet hoan toan co truyen. Song do noi dung ket hop
giira y hpc hien dai va y hoc co truyen rat kho, do trinh do tac gia co han nen kho
tranh khoi thieu sot can^dirpc ban doc gop y bo sung.
Dii sao, day cung la mot tai lieu tot co tac dung gop phan thuc day dua y hpc
co truyen vao itganh nhi, tao dieu kien de ket hpp Nhi khoa hien dai va co truyen
tien tai xay dung nganh Nhi khoa Viet Nam.
Vai niem tin tuang nhu vay. chung toi xin tran trong giai thieu cuon “ Nhi
khoa dong y " vai ban doc va dong nghiep.

Ha noi, thang 11 nam 1978
Quyen vien truong Vien dong y
Bac sT H O A N G B A O C H A U

3


u o n

n o i dA u

(L A N X U A T BA N T H U NHAT)

Cuon “D iiu tri N hi khoa dong y " dux?c bien soan theo tinh than ket hop giua
y hqc hi$n dai va y hoc co truyen dan toe nham phyc vu cong tac day m^nh ket
hop y hQC cd truytn dan tqc vai y hoc hien dpi trong nganh Nhi. lam tai lieu hoc

tfip va tham khao cho sinh vien chuyen khoa N hi co truyen dan toe dong thin
giup cac b$n ddng nghiep muon img dung y hoc co truyen dan toe trong cong tac
dieu tri N h i khoa.
N oi dung sach gom 2 phan chinh:
- Phin I la ph3n dai cuong gom co cac myc: Dac diem sinh ly va b^nh ly cua
tre em; ChSn doan theo y hpc co truyen (chu yeu la lit chan). Bipn chimg Nhi
khoa (gicri thieu 3 phep bien chimg: Bien chimg theo bat cinmg, bien chimg theo

t$ng phu va bien chimg benh sot (cap tinh cua tre em), Dieu trj Nhi khoa gom
nhung nguyen tac can thiet khong the thieu dmjrc trong cong tac chan doan va
d iiu tri cac benh tre em bang y hoc co truyen dan tqc.
- Phan 11 la phan benh hoc:

Trong phan nay ch i gun thieu mot so benh mil kha nans y hoc co truyen dieu
tri co k it qua tot hoac ket h(rp vm y hoc hien dai. hieu qua dieu in va phony
b$nh dupe nang cao.
Trong moi benh thi ten benh. Nguyen nhan benh (y, Chan doan. Trieu chimg.
Tien Iirong, Phong benh deu luan theo y hoc hien dai dong thin ket hop gidi

thieu -nhirng kien thuc co ban cua y hoc co truyen dan toe de nghien ciru
Ve phan dieu tri timg benh chu yeu gicri thieu nhung nguyen tac va phu*mg
phap dieu trj theo y hoc co truyen bang bien chimg luan tri, bang nhtmg bai
thuoc kinh nghiem ma cac vj thuoc thuvng la thuoc nam de kiem va de bao che
Ngoai ra timg loai benh co gim thieu them cac phutmg phap ditu tri khac nhu
cham ciru, xoa bop, giac, chich It...
T A C G IA

4

LOT NOI DAU
(Lan tai ban)
Ket hap Y hoc co truyen dan toe vai Y hoc hien dai. xay dung mot nen Y hoc
Viet Nam vung inanh la quan diem ca ban cua nganh Y te nirt'rc ta da dutrc the
che hoa trong Hien phap cua nunc Cong Hoa Xa Hoi C'hu NghTa Viet Nam.
La mot thay thuoc co han 45 nam tuoi nghe va da han 35 nam lam cong viec
nghien ciru, giang day. bien soan tai lieu va chua benh bang Y hoc co truyen, toi
luon co gang quan triet tinh than do. Tir nam 1978, toi da bien soan quyen D IE U
T R I N H I K H O A DONG Y duai dang ket htrp Y hoc co truyen dan toe vai Y hoc
hien dai duac nhieu ban doc va ban dong nghiep hoan nghenh co vu. Trong lan
tai ban nay, ehung toi co sira chua bo sung them cho tai lieu diroc tot han.
Hy vong cuon D IE U T R I N HI KH O A DONG Y duac tai ban lan nay se la
mot tai lieu tham khao bo ich cho cac ban dong nghiep va ban doc. Va mot lan
nira xin chan thanh cam cm nhieu ban dong nghiep va ban doc da co vu gop y
kien, xin chan thanh cam cm Chi nhanh Nha Xuat ban Y hoc TP. Ho Chi Minh
da tich circ giup da cho viec tai ban quyen sach duac thuan lai.

Thanh pho Ho C hi M inh ngay 26 thang 3 nam 1997
G S.B S. T R A N V A N K Y

5



MUC LUC
L a i gidi thieu (Lan xuat han th iin lia t).....................................................^
L a i noi dan (Lan xuat han thunhat)...................................................... {
L a i m adau ............................................................................................ 5
Phan thir n hit: D A I C U O N G v k N H I K H O A ..................................... 9
Su phat trien cua Nhi khoa trong Y hoc co truyen Phurrng Dong............ 9

Dac diem ve sinh ly benh ly tre em..................................................... 12
Dac diem chan doan Nhi khoa dong Y .................................................16
Tuchan trong Nhi khoa.................................................................. 16
Bien chung Nhi khoa I I ............. ^......................................................... 21
1) Bien chimg theo bat cucrng I I ......................................................21
2) Bi?n chimg theo tang phu.......................................................... 22
3) Bien chimg sot cap tinh tre em....................................................26
Dieu tri nhi khoa..................................................................................29
I. Nhimg nguyen tac dieu tri benh tre cm ........................................ 29
II . Nhung phirong phap dieu tri theo Y hoc co truyen..................... 30
- Tam phep tri benh nhi khoa....................................................31
- Cac phircmg phap chira benh ben ngoai bang thuoc................. 33
- Phuong phap chira bpnh khong dung thuoc..............................35
III . Nhung dieu can chu y trong ket hop dieu tri bang thuoc T a y ....40
- Dac diem dung thuoc Tay trong nhi khoa................................40
- Mot so thuoc Tay can ducrc chu y luc sudung......................... 40
Thuoc khang sinh................................................................ 40
Thuoc Sulfamid................................................................... 42
Thuoc Corticoid.................................................................. 43

Phhn th iih ai: D IE U T R I N H I K H O A ................................................. 46
Hoga .................................................................................................. 46
Quai bj ................................................................................................ 50
Vieni gan virut ....................:............................................................... 56


StTi ..............................................................................................

62

Sol xuat huyel ..................................................................................... 68
Thuy dau .............................................................................................72
Viem n ao .............................................................................................76
Bai liet tre e m ...................................................................................... 82
Benh lao. lao phoi ............................................................................... 87
Sot ret ..................................................................................................93
Viem durmg ho hap tren cap tinh ....................................................... 100
lira irueng

..................................................................................... 104

Viem phe quan cap ........................................................................... 107
Ban xuat huyet di img ....................................................................... 111
Dai dam .............................................................................................114
Hen phe quan tre em ......................................................................... 116
Tieu chav tre em ....................... ....................................................... 123
S un dmh duong ................................................................................. 130
Viem cau than c a p ............................................................................. 136
Nhiem khuan dircmg tieu.................................................................... 141
Hoi chimg than h ir............................................................................. 145
Bcng ky sinh (rung durmg ruot .......................................................... 151
Choc 16.............................................................................................. 162
Benh nhot .......................................................................................... 164
Benh ghe ........................................................................................... 166
Ham ke .............................................................................................. 168
Cham tre em ..................................................................................... 169
Tai lieu tham khao chinh ............................................................ ...... 172

8

phAn i

DAI CUONG Vfi NHP KHOA
S U PHAT TRlfiN CUA NHI KHOA TRONG
N fiN Y HOC CO TRUYfiN PHUONG DONG
Ciing vai cac khoa noi. ngoai. phu san, nhi khoa da duac h'inh lhanh va phat
tricn scrm trong nen Y hoc co truyen phuung Dong.
O

Trung Quoc tCr dai Tan-Han. hern 2400 nam ve truoc da co thay thuoc nhi

khoa. Theo sir ghi chep cua cuon siir ky Bien Thuoc liet truyen: "Bien Thuoc la
nguoi thay thuoc noi tieng... Den Ham Duong nghe noi nguoi Tan rat yeu tre, da
lam thay thuoc nhi khoa” . Truoc .cong nguyen mot the ky, thai Han Thanh De,
nha tu y L y Tru Quoc viet cuon ANH NHI PH UO NG gom 19 tap, Luu Huong
viet cuon T H A I G IA O L U A N neu ro tan quan trong cua ve sinh truoc luc sanh.
Trong cung thoi gian nay, nen y hoc co Hy Lap phuimg Tay, trong nhirng tac
pham cua Hyppocrates (truoc cong nguyen 460 nam) va cua Galen (130) nhung
bai ve nhi khoa chi duoc ghi chep le te.
Duoi dai Tiiy Duong (the ky thu 3 den thir 10) tac pham L U T IN K IN H cua
V U PH U O N G la mot cuon sach nhi khoa som nhat the giai. Dac biet Duong thai
y da qui djnh dao lao thay thuoc chuyen khoa nhi 5 nam tot nghiep (luc nay gpi
la thieu tieu nhi), va cung la nuoc da to chiic day chuyen khoa nhi som nhat the
giai. Trong quyen C H U B E N H N G U Y E N H A U L U A N cua SA O N G U Y E N
H U O N G co mo ta ti mi nhung chung hau benh tre em. TON T U M A O (581-682,
dori Duong) viet quyen T H IE N K IM PH U O N G chia benh nhi khoa lam 9 loai va
da chi ra tam quan trpng cua ve sinh. khong khi, mat trai, ren luyen than the va

9

ky 1 1hi a t uuoi duong tre em Nam 752. V L r(JN(.J DAO viet cuon N G O A I DA! Bl
Y E U phan benh ire em lam 86 loai va ilui (hap nhieu bai ihuoc tri benh nhi Khoa
1

ir the ky thir 10 den the k> lliir 14 (thai dai long Kim Nguyen), nganh nhi

khoa da phat trien inanh tai Trung Quoc. Sach IH A N H HI E PH UO NG da chu
\ phan biet skhoa trong do co nhi khoa rieng Thai bay gia co danh v I IfcN A 1 (1023 - 1104)
tac gia cuon T IE U NHI D UO C C H U N G T R U C Q U YH T duyc noi tieng va
ngiroi dai ton lii ong thanh nhi khoa.
Den the ky thu 12 co L U U PH UO N G, V U O N G I.1CH V U O N G D E cung
bien soan cuon A IJ AU T A N T H U gom 40 tap co cac phan bao due anh nhi.
benh tre so sinh, benh di tat bam smh, benh he tieu hoa v.v..., la mot bo sach nlu
khoa Urn The1 ky thu 1.3 co T R A N V A N T R U N G vifet cu6 n TIELU NHI D A U CHAN
PH U O N G I I AN va cuon TlfeU NHI B EN H N G U Y E N PH U O N G L U A N Va
nhieu tac pham khac cua nhieu nha nhi khoa viet nhucuon T IE U NHI V E SINH
TO N G V I L U A N (vo danh) cuf>n H O AT A U TAm T H U cua T A N G THIB
V IN H . Cac sach deu chu trong mo la benh thong thuong tre em. nguyen nhan
benh. chan doan va dieintn Trong luc a phuong t ay mai den the kv thu 15 men
co nhung lac gia viet sach chuyen ve nhi khoa nhu Bhgcllaclus (nguoi Y . 1472)
Metlinger (1473 nguai Dire) Roelems <1483. ngui'n B i) va Thomas Phaer (nguoi
Anh, 1545). Tir ihe ky thur 14 den the ky thu 20, thanh tich cua nhi khoa dong y
ve mat phong benh la sir phai trien cua phuong phap phong benh dau mua, benh
uon van cua tre sT A M GIAVlichi ro nhirng nguyen nhan gay benh tre em bao gom an uong that
thuong. tinh chi thay doi va cac nhan to ben ngoai nhu khi hau, chan thuong.

trung thu can. Den the ky thu 16, T IEN K H A l trong cu6 n B A O A N H N H IE P
Y E U (1556) de xuat phuang phap dot giay ron de phong benh uon van ron Ire w
sinh.
Nam 168k thay dau y nguoi Giang Tay. Truong Vi&m da chiing dau rong rai
trong nhan diin, co phat minh lan ve mien dich hoc va so sahh viVi sy phat minh
ve phuong phap chiing dau cua -nguoi Anh Jenner (1795) ihi y hpc phuong Dong
da di truoc han 1 the ky. Ngoai ra con nhi&u hoc gia nhi khoa khac nhu V A N
T O A n vai tac pham The Y D.tu Chan Tam Phap. gom 2 tap 28 chutmg noi we
benh dau mua kha diy dii, V lfO N G K H A N G D U O N G vidt cu6n A U K H O A
C H U N G T R I C H U A N T H A n G. H A D IN H v iii cudn AU K H O A T H lfiT
C A N H deu la nhung sach co gia tri ve nhi khoa.

10


DGn thd ky thu 17 va 18. co TRAN PHUC CHINH vitu cu6 n AU AU T A P
T H A N H (1750) va NGO K H IE M cung mot so tac gia viet cuon Y TONG KIM
G IA M co ph^n A U K H O A T A M PH A P Y&U QUYfeT hucmg din diy du v£phuong phap chan doan va dieu tri tre cm hang dong y.
O

Viet Nam cac hoc gia dong y cung rat som chu y den nhi khoa. Tu dai

Tran (1310) vi danh y T R IN H T R A N G T U dung bua dung hot xuyen khung cho
tre em deo phong benh. The ky thu 14 co CHU V A N AN viet tap y an chua mot
so benh cap tinh tre em. Thien sudanh y T U E TINH viet tac pham NAM DUOC
T H A N H IE U gom 10 cuon co cuon 9 chuyen ve nhi khoa da mo ta day du cach
xem xet benh va huong dan nhung kinh nghiem dieu trj. Nam 1455. N G U Y E N
T R U C soan bp B A O AN H LU O N G PH UO NG ban ve nhi khoa co phan xoa bop
chua benh tre em.
Den the ky tliu 18 then Hau Le, L E HU U T R A C (bi£t hieu HAI TH U Q N G

L A N O N G ) da nhieu nam day cong nghien ciru nhirng sach kinh dien cua y hpc
co truyen Trung Quoc thira ke kinh nghiem chira benh dan gian Viet Nam, da
soan thanh bo sach H A I T H U Q N G Y TONG TAM L IN H g6 m 55 cu6 n trong do
co cuon A U A U T U T R I day ve cach xem va chua benh tre em va cuon M A
C H A N C H U A N T H A N G tap trung phan tich sau ve y ly benh soi, cach phong
benh va phuong phap dieu tri rat toan dien. Nam 1780. N G U Y E N G IA PH AN
soan bo L IE U DICH PH UO N G PH A P TO AN T A P noi ve cach tn va ph6 ng
benh dich, rat co g ii tri trong cong tac phong va chira benh tre em. Nam 1741,
T R IN H

D O N PH A C

viet curin HO AT NHAN TO A T Y £ U TA N G

BO.

N G U Y fiN THE; L K 'H vi£t cu6n T IE U NHI KH O A (1772) va nhiC>u tac pham
nhi khoa vo danh khac nhu HO AT AU TAM PH A P D A I TH AN H . N G U TOAN
T lfiU N H I KHO A. T IE U NHI DA Dfi V A N G O A I KHOA, T IE U NHI T A P
B E N H , T IE U N H I TONG LU A N . v.v... la nhung sach rat co gia tri tham khao
trong cong tac dieu iri benh tre em.
'Nhin qua su phat trien cua nhi khoa trong nen Y hoc co truyen phuong dong,
chung ta thay dupe cac hoc gia dong y da rat scrm chu y den nhi khoa. xay dung
nganh nhi tu lau thanh mot khoa doc lap, da viet nhieu tac pham ve nhi khoa co
nhieu gia tri ve ly luan va thuc tien. Do la nhung di san y hpc rat qui gia, chung
ta can hpc t§p thira ke nghien ciru va phat huy nhung tinh hoa cua nen Y hpc co
truyen trong nganh nhi cua nuoc ta ngay cang co them nhieu kha nang phuc vu
sue khoe tre em chung ta them kien khang de xay dung dat nuoc ta them giau
manh.

LI


DAC DIEM SINH LY GIAI PHAU
VA BENH LY CHUNG
(chi nhac qua nhirng gi can chu y)
D A C D lfeM G IA I P H A U V A S IN H L Y
Tre em la mot ca the hat dau sinh ra, Ion len va khong ngimg phai men (khac
vai ngirdi lan la mot ca the on dinh. khong hoac it thay d6i). Y hoc co truyen
nhan thuc: Ca the tre em co dac diem la am duong deu non kem (tri am tri
duang), am thuong bat tuc. duong thuong hiru dir hoac ty thurmg bat tuc can
thuong hiru dir (de b| roi loan tieu hoa. sot cao de co giat) hoac thuan duong chi
the (chuyen hoa co ban cao) va co hien tuong bien chimg (luon luon Ion len va
trudng thanh)
Nhung dac diem giai phau sinh li cu the theo y hoc hi?n dai (soluw:):
1/. Ve he ho hap: khoang mui hep. niC'm mac nhieu mach mau, long mui chira
co hoac it... nen tre de bj cam va luc cam de bi kho thd, chay mau cam... Hfiu
hong hep, lai co nhieu mao mach, hach lam ba nen luc nhiem trung, niem mac
phu ne gay kho thd...

21. Ve he lieu hoa: Niem mac mieng mong, nuoc mieng it nen mieng kho de
mac benh nam. Sau 6 lhang, tuyen nuoc bot phat trien tiet djch tang va bit dau
moc rang de chay nuoc rai. Da day tre mm sanh vj tri cao va ngang. co tam V|
yeu ma co that mon vi phat trien manh nen de non tra. Tre dum 3 tuoi gan.co the
sir thay duoi ba sui'm phai khong phai benh ly. Tre em co true trang yeu nen d&
mac chimg sa true trang...

?>/. Ve he tuan hoan: Tim tre em to him nguoi Ion so vai trpng luong ca tbe,
hinh hen iron va rong chieu ngang, luoi mao mach rat phat trien. tieng um nghe
ro ngan va nhanh han Tre cang nho mach cang nhanh (ire so sinh 160-l-UVI

phut, duoi 1 tuoi 120 lan/1 phut, duoi 5 tuoi 1 (X)lan/phut, tre Uen 10 luoi gin nhu
nguoi lan. Huyet ap tre thap han nguoi Ion va vong tuSn hoan ngin hon. Cong
thuc tinh huyet ap tre tren 1 tuoi:
H A M = (80 + 2 x

so

tuoi) mmHg.HA„= 2/3 H A „

H A „ = Huyet ap tam thu. Ha, = Huyet ap tam tnromg.)
4/. Ve he tiet meu: Than tre to han ngudi lan so vai trong luong co the* v i
thap han ve vi tri (tre dudi 2 tuoi). Long be thin va nieu quan rpng. Nieu dan tre

12


nu ngan. gan h^u mon nen 6k nhtcm khuan ucl ni£u. Tre cang nho so lan lieu
cang nhieu va giam dan so voi tuoi do hong dai lo ra. So luong nuoc tieu tang
dan theo voi tuoi, co the tinh theo cong thuc:
So luong nuoc tieu trong 24 gio = 600 + lOOx (so tuoi - 1) ml.
5/. Ve h£ than kinh: Da tre so sinh da co xuc giac, cam giac dau va nong,
lanh. nhay cam voi cam giac lanh nhimg phan xa kem voi cam giac dau nen can
chu y tranh nong vi de gay bong. Tre so sinh da co phan ung voi mui thoi, mat
da co phan ung voi anh sang nhung tai nghe con kem.

6/. H ? xuong: Xuong cua tre em mem, phat trien chua hoan chinh nen can
chu y den tu the nam ngoi cua tre. nam mpt ben hoac nam ngua lau deu co the
gay bep dau. tap ngoi qua som se gay veo lung, nhung gay xuong de lanh. Tre
thuong moc rang tu thang thu 6 ho?c thu 8 , so rang co the tinh theo cong thuc:
So rang = So thang - 4.

7/. He co: Co bap cua tre co nhieu nuoc, it dam mo va muoi khoang nen tre
tieu chay de gay mat nuoc. Trong may thang dau co hien tupng tang truong luc
cosinh ly.

8/. He da: Da tre mem mai co nhieu mao mach. Tuyen mo o da phat trien tot
tre 3-4 thang da co tuyen mo hoi nhung chua hoat dpng nen kha nang dieu hoa
nhiet kem. (7 tie da co chuv nung ho hap manh. ngoai ra da con co nhieu chirc
nang khac nhu chuyen hoa nuoc. cau tao men, san sinh vitamin D. chat mien
dich...

9/. Su tang truong cua tre: C a the cua tre tang nhanh trong nam dau khi ra
dm. eham lai o nam thu hai va lai tang nhanh d tuoi day th'i. chu yeu ve can nang
va chieu cao.
(1) Can nang: Binh quan cua ire moi sanh du lhang la 2.9 - 3,0kg (can
nang duoi 2,5kg coi nhu tre de non hoac suy dinh duong bao thai). Tre 6 thang
can nang gap doi luc sanh va 1 tuoi can nang gap 3 luc sanh, tre len 2 tuoi can
nang co the tang gap 4 lan luc sanh. Can nang cua tre sau 2 tuoi co the tinh theo
cong thuc:
Can nang (K g) = 9 + 1,5 (so tuoi - 1).
(2) Chieu cao: Chieu cao cua tre luc sanh trung binh 48 - 50cm va len 1
tuoi chieu cao tang gap ruoi luc sanh (trong 12 thang tang 23 - 25cm). Co the
tinh chieu cao trcn I tucVi theo cong (hue: Chieu cao (cm ) = 75 + 5 (so tuoi - 1)

13


(3) Vong dau Luc sanh trung binh 30 - 32cm. tre 12 thing khoang 5052cm
(4) Vong ngirc: Luc sanh nho hon vong dau khoang 1cm. 6 thang vong
nyirc hang vong dau va viatt len vong dau irong nhung thang sau.
(5) Ty le can d6 i cua co the: Nhin chung d tre dau turmg doi to. chan

tirtrng doi ngan so vdi toan than.
- ChiOu cao diiu / chic'u cao loan than: Tre so sinh: 1/4. tre 2 tuoi: 1/5.
tre 6 tuoi: 1/6. tre 12 tuoi: 1/7. Nguoi lem: 1/8.
- Chi6u dai tay va chan tre so sinh bang 1/3 chieu cao. cang Ion ty le
tang d5n. luc trinrng thanh chieu din ta> bang 45% chieu cao va chieu dai chan
bang 50% chieu cao.

1

10/. Su phat trien ve van dong, ngon ngu va tri tue cua tre em:
a. Ve van dong: Tre len 2 thang biet ngang dau, 4 thang cuoi ra ueng. 7
thang biet bo. ngoi. 9 -12 thang co the biet dung va di chap chung
b. Ve ngon ngu va tri tue: Tre 2 thang KTet theo nguoi !dn. khoc cudi ro
bat dau phat am, 3 thang nhan ra me. 5 thang biet quen la, 7 thang noi dupe ba,
ba, 10 - I I thang biet noi Ueng kep va lam theo ngudi Ion, 2 tuoi da noi dupe cau
dai 3 - 4 tir. Noi chung su phat trien van dong tri tue va ngon ngu tuy thuoc vao
su hoan thien va phat trien cua nao, sin. khoe va su toan vcn cua cac giac quan
cung vdi su giao due cua gia dinh xa hoi moi trudng song cua tre
D A C D IE M B E N H L Y :
A. Dac diem chong:
; TrA ha m-.c benh ngoai cam (benh nhiem) va benh ve ty vi. Do tre men ra
den, su thich nghi voi moi truong. sue de khang cua co the con yeu kem nen de
mac benh ngoai cam (do luc dam: Phong han thu thap tac hoa gay nen). Tre rat
de mac benh duong ho hap vi phe chu bi mao, dieu hoa am lanh. tang phe con
non yeu, chuc nang bao ve bi mao kem thi la khi de xam nhap ma gay benh. Mat
khac, d tre em ty (hau thien chi ban) thuong la bat tuc (men tieu hoa chua phat
trien) nen de mac benh ve ly vi (roi loan tieu chay do thuong thuc, ty hu). Luc
mac benh ngoai cam de gay sot cao co giat (do chuc nang dieu hoa nhiet kem. he
than kinh chua phat trien) dong y cho la do co the am duong deu yeu kem ttri am
tri duong).

14


2. Benh chuyen bien nhanh: Cung do sue chiing do cua co the veu. ta khi de
xam nhap vao ly, benh nhe cung co the chuyen bien nguy kich neu khong chira
kjp thoi.
3. Benh de hoi phuc: Dc tre em la mot co the dang phat trien va benh cap
tinh nhieu, it phuc tap nen neu chua tri kip thoi thi benh chong hoi phuc. Cho
nen doi voi tre em cong tac phong benh la cuc ky quan trong va khi mac benh
phai chira kip thoi.
B.

Dac diem benh ly theo timg lua tuoi: Doi voi tre em d moi then ky Ion

len do dSc diem sinh ly co khac nen tinh hinh benh ly co khac, nen ngudi thay
thuoc nhi khoa can nam de bao ve sue khoe cho tre duoc tot. Sir phat trien cua
tre em tir luc thu thai cho den tuoi truong thanh co the chia lam 6 thoi ky do dac
•*

•

r

«.

'

■
»

diem sinh ly ma benh tat mac phai co khac.

1. Thai ky bao thai: Tir khi trung thu thai den khi tre ra doi, trung binh
270 - 280 ngay. Sir phat trien cua thai nhi phu thupc hoan toan vao nguoi me.
Benh ly chu yeu la do sir roi loan ve hinh thai thai nhi (dj tat bam sinh) (3 thang
dau cua bao thai) va su phat trien cua thai nhi (suy dinh duong, say thai, chet
luu...)
Nhirng yeu to phia nguoi me lam anh hudng thai nhi:Tuoi tac, so lan de
khoang cach giira cac lan de, tinh trang dinh duong, dieu kien lao dong, tinh
than, benh tat. Vi du: Luc co thai 3 thang dau neu nguoi me mac benh do virut
de gay dj dang cho tre. trong 6 thang sau neu mac benh nhieu. tinh than cang
thang, an uong thieu kem, lao dong nang nhoc deu co the gay de non. suy dinh
duong bao thai, say thai. de non...

2. Thai ky sasin h: Thcri gian 1 thang sau khi sanh tre co nhung dac diem
sinh ly nhu bat dau thd bang phoi, he tuan hoan, he tieu hoa bat dau lam viec, tre
bu me nhung co the rat non yeu, he than kinh b| ire che tre ngu suot ngay, bong
da, sut can, vang da sinh ly...
Benh thuong gap: Nhiem trimg da, nhiem trung ron, de gay nhiem khuan
toan than nang. benh d| dang tien thien, benh do chan thuong san khoa nhu xu§t
huyet nao, liet...

3. Thai ky bu me: La thoi ky trong mot nam cua tre (tu I thang den 12
thang): Tre phat trien nhanh nhung co thi'; con non yeu, de mac benh nhifim
khuan, b?nh roi loan tieu hoa, suy dinh duong. Can het sue chj'i y phong benh
nhiem va benh ve dinh duong.

15

4. Thin kv ring s/hi. Tir I den 7 luoi thuong chia ra luoi vurm ire v i luoi
mau giao (4 - 6 tuoi) Do tiep xuc nhieu tre de mac benh lay ( I - 3 luoi) nhu s*n
ho ga. thuy dau. viem duong ho hap. benh d| ung nhu hen. me da>. benh suy
dinh duong, roi loan tieu hoa. Chu y giao due eho tre dao due va tap quan ve
sinh tot de phong benh.
5. Thai kv ihidu nicn: Tuoi tir 7 den 15 la then ky rang vlnh vien thay dan
rang sua. Tre de mac benh nhiem triing can chu y b£nh thap tim, benh thieu mau.
benh dj dang do tu the (gii lung, veo cQt song...).

6. Thai ky day thi: Tiiy theo giai va moi truong song. Tre gai bat dau tir
13 -14 tuoi den 18 tuoi. Tre nam tir 15 - 16 tuoi den luoi 19-20. Then ky nay co
the tre Ion nhanh, bien doi nhieu ve tam sinh ly. Hoat dong noi tieu sinh due
chiem uu the. Tre it mac benh nhiem. neu mac benh lao de bi nang, de mac benh
roi loan ve tam than, tim mach. bat dau phat hien benh ve sinh dye.

DAC DIEM CHAN DOAN NHI KHOA DONG Y
Pham vi bai nay chu yeu giai thieu ve tir chan va bat cuong trong nhi khoa.
T U C H A N T R O N G N H I K H O A : Trong nhi khoa cung nhu noi khoa. bon
phep vong, van, van. thiet deu can thiet de thu thap tu lieu benh ly da\ du chu
chan doan duoc chinh kuc nhung tu> tinh hinh benh ly va tuoi tac cua tre ma
ngutn thay thuoc can chu y den mat nao nhieu hem. Nhi khoa duorc goi la a khoa
la doi voi nhirng tre durn 3 tuoi. con tre tren 3 tuoi phat trien binh thuong deu co
the tu ke benh cua minh duoc nhung can co thai do diu hien va dong tac nhe
nhang cua ngudi thay thuoc khong lam cho benh nhi so de co su hop tac lot
trong khi hoi va kham benh.
I.

Vong chan: Chu yeu nhin hinh thai (co dong thai), than sac, mieu khieu va

chi van.

1) Hinh thai: thin sic:
-

Co the tre beo tot. phat trien can doi, tinh than lanh loi, sac da hong hao

tuoi nhu|n. toe day den: Tre khoa manh.

16


- C(T

the gay com, hung to dit tco, tinh than u i u . sac da xanh nhat xam vang.

toe thira dimg nguoc: Tre yeu om coi xircrng, chimg cam tich..
- Di dang bam sinh thuong gap: Khuyet moi. khuyet vom khau cai. him tay
sau ngon ...Dan don ngd ngan do than kinh nao phat due cham. chimg Dao. chan
thuong san khoa. di chung cac benh nao (thuong kem liet chi)... (Cac mat khac
nhu nguoi Ion)

2) M ieu khicu (gom tai. mat. mui. mom. tien am. hau am):
( 1) Tai: Tai chay mu vang thoi la trieu chung nhiet doc (viem tai giua) tre sot
cao ma chop tai lanh chu y len sdi.
(2) Mat: Mat do la can nhiet. mat vang la trieu chung thap nhiet (viem gan
tac ong dan mat...) benh nhi sot kem mat do chay nuoc mat so anh sang chu y
benh sdi. mat do co ri vang chu y viem mang tiep hap... Long trang mat co
nhung cham xanh. chu y tre co giun lai ... Mi mat phu la phu thung.
(3) Mui: M ui ngat chay nuoc trong la cam phong han. chay nuoc vang la

phong nhiet. thuong xuyen chay nuoc mui trong la viem mui di ung, chay nude
vang la viem mui man. Dot ngot phat hien tre chay nuoc mui thoi, chu y di tat
trong mui, chay nuoc mui thoi keo dai chu y chung viem mui thoi (Ozena)...
Canh mui nhap phong kem quanh moi tim tai la tre thieu Oxv. tuy muc do nang
nhe khac nhau co the la phe khi nghich (truong hop hen suyen) hoac phe khi hir.
phe khi tuyet (truong hop viem phoi nang).
(4) Mom: (bao gom moi. rang lai. mien mac mom. hong, luoi):
- Moi: Hong tuoi nhuan la hinh thuong. Moi do tuin la chung nhiet. moi kho
la am hu tan dich ton thuong. moi nhai nhat la chimg han. huyC't hu. moi lia tim
bain chu v huyet u. quanh moi tim tai la tre thieti Oxy.. Sul moi la d) dang lien
thien, moi day len chu y phu hay do d| img.
- Rang loi: So rang mix' theo dung tuoi la co the tre khoe manh. neu cham
mix' rang chu v chung coi \uimg. Rang kho, loi sung do la vi nhiet. ke rang liri
chay niau la vi hoa hoc. sac lai tai nhat la chung huyet hu ...
- Niem mac mom: Co dam Id loet co mang trang chu y benh tira. viem mom
do vi nhiet dong y goi la nga khau sang. Truong hirp benh noi sol ma d niem
mac mom co cham do vien trang chu y benh nhi len sdi ...
- Hau hong: Hong do. hanh nhan do dau sung la nhu nga (viem Amidan) Yet
hau dau. sot cao. giong khan hong amidai|TfrmJihg' trang chu y benh h?ich hau

17


- Lirm Xem lirm (thiol chan) La phan quan trong trong vong chan Sac luoi
hinh thuong cua tre mau hong nhat tinn nhuan. neu chat lirm mau hong nhol lai
la huytl hu. mau ti'a tim la khi huyet ir tre. chat lum do lham la on la nhap phan
dinh huyOl. Ilrti do kho khong co reu la am hu kho tan dich. mat luoi co gai do la
nhiC‘1 ihinh. Reu lum iring la han. vang la nhiet. Reu luoi vang da> la thap nhiel
hoac nhu ihuc tich. reu luoi troc nhu hinh dia do la hieu hien tv hir

Reu luoi

day nhdt la dam lhap.
- Tien am. hau am: Tien am chi bo phan sinh d^ic va nieu dao. hau am la hau
mon Tre nam dai khong co khong se la khde manh Dai se ihinmg la khi kem
dai sung to day la am nang tich thuy. dai sung to cung. dung lay an nho lai hoac
mil di la chiing san khi (ihoat vj hen). Tre nu tien am (am dao) do va xuat tiel
nhieu la chung thap nhiet (viem am dao) neu ngira chu y co giun kim hay tniing
roi. ire nu lieu nhieu lan. lo dai do. dai buol chu y thap nhiet duong nieu (viem
duung tiet nieu). Viing quanh tien am hoac hau am da do lay la lhap nhiet (viem
da do la lot). Luc dai lien, ire ran sa true trang (loi dotn) thuong do khi hu ...

Xem thop (doi vai tri' duiri 18 thang):
Tre em cham nhat den I nam ruoi la thop trudc phai kin neu thop con hd la
than khi kem (thuong la trieu chung coi xuong). Tre em sol ma thop phinh cang
la nhiet thinh. nguoc lai neu thop lom la trieu chung am hu. tan dich hao ion.

4)

Chi van: Xem chi van la xem tmh mach nho nong cua ngon iro phia ngon

cai Xem chi van chi dung doi voi ire duoi 3 tuoi. Xem chi van chu yeu la xem 3
mat: Phu train, dai ngan va mau sac.
- Chi van phu (nguoi lhay thuoc linn nhe ngon cai len chi van co the lam
mat) la trieu chung benh nhe. ta khi d phan hieu. Chi van tram (ngudi thay thuoc
luoi manh ngon cai mdi mat chi van) la benh ben irong. ta khi da vao phan ly.
- Chi van dai ngan: Chi van chi hien len den doi I cua ngon trd (luc den
phong quan) la benh nhe. neu hien len dot thu hai ngon iro (tuc den khi quan) la
benh tram trong han. con neu chi van xuyen len den mong lay (tuc xuyen giapi
la bieu hien benh nguy kich can cap cuu kip then.

- Mau sac chi van: Chi van d ire khde co mau hong luoi. neu do tham la
nhiet thinh. mau hong nhai la hu han. mau xanh la ineu chimg phong. mau lia
lham hoac bam tim la hien tuong khi huyet ir ire. Tinh chal benh ly cua chi van
phan anh unh hinh mau luan hoan ngoai vi song co nhieu yeu to anh hudng din
su tha> doi cua chi van nhu (hdi tiel. mau da. hinh dang von co cua tinh mach
nen kel qua xem chi van cung la lu lieu tham khao

18


II. Van chan: Gom nghe va ngiri.

1) Nghe tieng khde va giQng noi: Khoc tieng to. giong noi to la chung
thuc, co the khde, khoc nho, noi nho la chiing hir co the yeu.
- Khoc thet timg con chu y dau hung giun, giun chui ong mat. tre nho can
canh giac long rupt (tre khong chju bu, non sira).
- Khoc hay lac dau co sot la co dau dau. Khoc ma khong co nuoc mat la tan
djch hao ton, chiing am hu. Sot cao hon me noi sang la nhiet nhap tam bao.
- Tre mac benh giong noi khan, chan tay mat la ngoai cam phong han,
truong hop benh nang lau ngay ma giong noi nhu tieng vjt keu trong hong la phe
khi sap tuyet.

2) Nghe tieng thd va ho: Thd kho ma suyen la phe khi uat, thd kem tieng
kho khe d hong la dam tr£. chiing hao. thd yeu la phe khi hu, thd tho la phe khi
thuc.
- Ho timg tieng kem so mui nuoc trong la ngoai cam phong han. Ho tieng to
co luc la phe thuc, ho tieng nho yeu la phe hu, ho khan la phe tao. ho timg con
do mat tia tai la ho ga.

3) Ngui mui vi: Mom tre co mui hoi la vi nhiet. co miii chua la thuc tich.

an khong tieu. Phan thoi kham la dai trang tich nhiet. phan long nhieu chat
khong tieu. khong miii lanh hoi la ty hu han. Nude tieu vang khai la bang quang
thap nhiet. nude tieu trong khong mui la huhan.
III. Van chan: Doi vdi tre thuong hoi benh qua ngudi trong gia dinh tre. tre
Urn co the hoi true tiep.
Noi dung hoi ve tinh hinh benh ly. tinh hinh an ngu tieu tieu. nong. lanh mo
hoi cung nhu ngudi Ion. Ngoai ra tuy tinh hinh benh ly ma chu y hoi them ve
tinh hinh phat trien co the cua tre. che do nuoi day tre. dieu kien sinh hoat. tinh
hinh thai nghen va sanh de cua me (doi vdi bcMih co dj dang bam sinh I tinh hinh
tiem chung. tiep xuc vdi benh tat (doi vdi benh lay).
IV . Thiet chan: Gom xem mach va so nan cac phan co the cua tre.

19



BIEN CHUNG NHI KHOA
Bien chimg cua y hpc co truyen la phuong phap quy nap cac trieu chung thu
nhap Iren lam sang thanh nhung the benh hoac nhirng hoi chimg benh ly Trong
nhi khoa thui'mg quy nap benh theo bat cutmg, theo tang phu, theo ve khi' dinh
huyet (neu la benh truyen nhiem, sot do ngoai cam).
I. B IE N C H U N G T H E O B A T C U O N G :
La cach quy nap cac trieu chiing thanh 8 loai: Am duong, Han nhiet, Bieu ly,
Hu thuc. No noi len vj tri. tinh chat cua benh va trang thai khde. yeu cua co the
benh nhi, tren co so do chon phuong phap dieu trj thich hop. Sau day gidi thieu
dac diem benh ly cua timg loai:
1. Bieu, ly:
Noi len giai doan benh va tinh hinh benh nang nh$.
- Chiing d bieu: Thuong la thoi ky dau cua b$nh ngoai cam, b§nh nhe,
thuong co nhung bieu hien nhu sot, so lanh, ra mo hoi (ho$c khong), dau dSu, so

mui. lac nui, reu luoi trang mdng, mach phu.
- Chimg d ly: Thuong la benh da xam nhap vao tang phu, la giai doan loan
phat cua benh nhiem trung. I rieu chiing chu yeu la sot cao tre quay khde. but
rut. khat nude. Nang thi me man. hon me, co giat, dai tien tao. tieu tien vang. reu
luoi vang day, mach sac ...
2. Han, nhiet:
La hai loai tinh chat benh ly doi lap nhau (cung la hai loai phan ling khac han
nhau cua co the khi co benh).
Xac dinh tinh chat benh ly nay de dung thuoc mat hay thuoc nong luc dieu
tri.
- Chimg han: Co bieu hien la so lanh, khong sot hoac sot khong cao. chan
tay mat lanh, khong khat nude hoac thich nude nong. Nude tieu irong nhieu.
phan long. Chat luoi nhpt. reu trang, mach cham. Chung han thuong gap trong
truong hop cam lanh mac benh lau ngay co the suy nhupc...
- Chimg nhiet: Gap nhieu d tre em co bieu hien chu yeu la: Sot, mat do, khat
nude, tieu ti?n vang, dai tien tao, chat ludi do. reu luoi vang, mach sac. Thuong
gap luc b£nh nhi cam phai nhiet ta. thoi ky toan phat phat benh cua benh lay.


3. H it, thuc:
Chung hu la chi err the hu nhirtTc. phan ung vm nguyen nhan benh yeu. chung
thuc la chi ta khi thuc (sue tan cong cua nguyen nhan henh manh). ca the benh
nhi khoe va phan ung cua ca the doi van nguyen nhan benh manh Phan biet cac
chimg hu thuc dua vao cac mat sau:

a) Thai gian mac benh Benh men phat thuong la chimg ihuc. benh lau
ngay thuong la chimg hu

b) C a the benh nhi khoe. yeu Co the benh nhi khoe. phat due diy du mic
benh thuong bieu hien chung thuc Nguoc lai co the hu yeu, bam thu tien thien

bat tuc luc mac benh thuong bieu hien chimg h u ...

c) K ei hop c.ic incu chimg lam sang: V i du: Mach co luc. tieng khoc to,
chan tay cu dong khoe la chimg thuc; mach vo luc. tieng khoc, noi nho ho|c
khoc khong ra tieng >.han tay cu dong yeu la chimg hu..
Phan biet hu thuc de luc chua benh dung thuoc b6i bo’ chinh khi la chinh
hoac dung thuoc cong ta la chinh.
4. Am, duong:
Tat ca cac chiing benh dfeu bao gom trong 2 hpi chung Ion la am va duong:
cho nen trong bat cuong. am va duong la 2 cuong long quat. Chung 6 btfeu,
chiing thuc \a chung nhiet thuoc duong Chimg a ly, chung hu va chung ban
thuoc am.
Tren lam sang cac bieu hien benh ly co khi kha phuc tap. cac chimg irai
nguoc nhau co khi cung ton tai tren mot benh nhi trong cung mot thoi gian. cho
nen van dung hat cuong trong bien chung cung phai rat linh hoat. Nhu trong
chiing a bieu van co bieu hu. bieu thiic. bieu han. bieu nhiet. Co khi bieu han ly
nhiet. co khi trong hu co thuc. trong thuc co hu. V i vay, can qui nap tot cac tn£u
chiing de chan doan duoc chinh xac va dieu tri co ket qua.
II. B IE N C H U N G T H E O T A N G P H U :
Hpc thuyet tang phu phan chia su hoat dong sinh ly cua co the thanh nhirng
don vi chirc nang theo 5 tang (tam, can, ly, phS, than) va 6 phu (dom. vi. tifcu
trang. dai trang bang quang va lam tieu). M di khi chuc nSng sinh ly cua mot tang
hay phu bi roi loan tren lam sang thuong co nhi£u trieu chung rieng Net. va
ngudi thay thuoc dua vao do de chin doan. Quy n?p theo tang phu thuong dung
doi voi cac benh noi tang (benh n $ thuong). Sau d ly chi gidi thi£u tom til mpt
so hoi chung benh Iv cua cac t*uig va phuong phap difeu t r i.

22

1. Hoi chung benh ly cua tam:
Chuc nang sinh ly chu yeu cua lam la: l am chu huyet mach. chu than khi.
khai khieu d luoi, do do benh ly cua tam co lien quan den su roi loan cua he
thong tuan hoan va than kinh (bao gom than kinh trung uong va than kinh thuc
vat). Nhung hoi chung cua tam gom:

a)

Tam khi hu: Tim dap hoi hop, kho tho (luc hoat dong tang them), ra

mo hoi (tu han), luoi nhat, mach te vo luc, kem theo sac mat nhat. met moi hay
thd dai. Phep chira la bo tam an than, bai thuoc thuong dung la Bo tarn dan.

h) Tam duimg suy: Nhirng trieu chimg tren nang han: Neu Tam duong hu
thoat benh nhi sac mat tai nhat, loan than va mo hoi, chan tay lanh, thd yeu.
quanh moi tim tai, mach vi kho bat (nhu trieu chung suy tim cap, truy tim mach).
Phep chua la hoi duong cuu nghich cap ciru dung bai Nhan sam tir nghich thang
cho uong ket hap tiem thuoc tra tim mach, chong choang nang huyet ap.

c ) Tam hoa vuong: Tre quay khoc but rut. loet mom luoi, tieu tien vang it,
dau luoi do, reu vang, mach sac (trudng hop viem luoi viem loet mom). Phep
chira la thanh tam hoa. dung bai Thanh tam hoan (khoa nhi) hoac Hoang lien giai
doc thang. Neu co loet boi Nga khau tan (khoa nhi) tai cho.

d) Dam hoa nhieu tam: Co trieu chung tinh khi that thudng, cudi noi vo
nghTa, khoc la hoac chui. danh ngudi. mat tri. luoi do, reu day nhat vang. mach
hoat sac. Phep chua la thanh tam. hoa dam dung bai On dam thang gia vi.

e) Nhiet nhap tam bao: Tre em mac benh nhiem trimg, sot cao. me man
noi sang hon me co giat, lucri cung, chat luoi do, reu ludi vang, mach hoat sac

hoac te sac. Phep chua la thanh nhiet giai doc khai khieu dung vai cac loai iliuoc
Yen cung ngiru hoang hoan, Tu tuyet don hoac Mai sung trau (simg te giuc nei
co), uong vai nude sac Thach xuong bo tuoi. Ket hap cham Nhan trung. Hap
coc, chich Thap tuyen...

2. Hoi chung benh ly cua can:
Chuc nang sinh ly chu yeu cua can la: Can tang huyet, chu so tiet (co vai tro
chi huy, dieu tiet chuc nang cac tang phu trong ca the), khai khieu ra d mat. Do
do benh ly cua can co lien quan den su roi loan cua he thong than kinh, he tieu
hoa va mQt so chuc nang cua h? tim mach. Nhung hoi chimg b£nh ly ciia Can
thuong gap d tre em la:

a)

Can hoa vuqng: Sac mat do, mat do, co khi chay mau mui. u lai hoa

mat, dau dau, co khi run giat, mom dang, d?i tien tao, tieu tien vang. ria ludi do.

23


reu vang, mach huyen sac (trirung hup \iem lhan co huyet ap cao) Phep chua la
hinh can giung hoa dung hai Long dam la can lhang gia giam

b) Can am bai luc: bieu hien dau dau chong mat hoa mai, mat mo. long
han chan lay nong hoac cam thay te dai (nhu trong henh thieu sinh to A. benh
teo thi than kinh) mach te sac, 1utri thon chat do. Phep chua la tu duong can am.
thirung diing hai Ky cut dia hoang lhang gia vj.

c) Can phong noi dong: Trong cac henh nhiem trung. ire sot cao co giai

(do nhiet circ sinh phong) hoac di chung cua henh nao (do am hu phong dong)
Tuy tinh hinh cu the dung phep thanh nhiet hinh can tire phong, hai Thanh on hai
doc am sac uong ket hop cham Khuc tri. Hop coc, Thai sung hoac phep lu am
tuc phong. hai Tire phong hoan ket hop cham Tam am giao. Am lang luyen

d) Can d('rm thap nhiet: An kem. bung day, sircm dau, da mai vang. nuoc
lieu vang, reu lum vang nhat, mach sac co lire (truong hop viem gan cap linh)
Phep chira la thanh loi thap nhiel d can dam thuong dung hai Nhan Iran chi lu
thang.
3. Hoi chung benh ly cua ty:
Churc nang sinh ly chu yeu cua ty la: Ty thong huyet, chu van hoa (bao gom
chuyen hoa ihuc an, hap thu chat dinh duong va liru thong dich the uong coihe).
ty chii ca nhuc. Nhir vay. chuc nang cua ty co cjuan he den mau. he tieu hoa va
he ca van dong. Nhirng hoi chimg benh ly chu yeu cua ty la:

a) Ty dinrng hu: Tre ca the suy nhuae, gay met moi. sac mat vang. an
kem. tieu king hoac phan Ion nhon khong tieu (tre suy dinh during, tieu chay keo
dai...). Phep chua la kien ty hoa vi dung Com bo ty (khoa nhi).
- Neu ty hu tich tre: Ngoai trieu chimg tren kem bung day. phan thoi kham
Phep chira lii kien ty tieu tich. thirong dung bai Tieu cam ly ty tan
- Neu ty hu thap tre: (ty hu thuy thung) Ngoai nhirng trieu chime tren kem
piii toan than, dai it. reu lum day nhat (truxmg hap phu suy dinh durmg. phu than
hir nhiem ma...). Phep chua la kien ty lai thap, thuong dung bai Huong sa luc
quan hap Tir linh tan hoac Ngu bi am

b) Ty khong thong huyet: Sac mat tai nhat, xuat huyet durn da. chai luoi
nhat, ia co mau (trudng hcrp xuat huyet do giam tieu cau). Phep chua la bo ty
nhiep huyet. thirong dung la bai Quy ty lhang gia giam.

24

c)

Ty khi ha ham (trung khi ha ham): Tieu chay hoac ly. kco dai bien

chung loi dom, Ire em mac benh ihoat vi ben hoac sa da day.. Phep chira la ich
khi thang duong, thuong dung hai Bo trung ich khi thang gia giam.
4. Hoi chung benh ly cua phe:
Chuc nang sinh ly chu yeu cua phe la: Phe chu khi. phe chu bi mao. phe
trieu bach mach, khai khieu d mui. Nhu vay, chik nang cua phe cung la chuc
nang cua he ho hap va co tac dung dieu tiet the dich va tuan hoan trong ca the.
Nhung hoi chung benh ly chinh cua phe co:

a) Phe khi'hir: Tieng ho yeu, hai thd ngan gap, ddm loang ngudi met moi.
an it, sac mat trang bech, hay do mo hoi (tu han). Gap d truong hap viem phe
quan man, ... Phep chua la bd phe ich khi, thuong dung bai Sam linh bach truat
tan gia giam.

b) Phe am h ir Ho khan khong co ddm hoac it ddm, co luc ddm co mau,
co luc sot nhe ve dem, ra mo hoi trom, long ban chan tay nong, ma do, mach te
sac, chat ludi do, than ludi thon. Thudng gap trong b£nh lao phoi. Phep chua la
tu am nhuan phe, thudng dung bai Thanh tao cuu phe thang gia giam.

c ) Phe nhiet: Ho, kho thd, ddm vang dac kem theo sot cao hoac nhe, co
khi ho co mau, nguc tuc dau, chat luoi do, reu vang, mach sac co luc Phep chira
la thanh phe, chi khai. binh suyen, thudng dung hai Ma hanh thach cam thang
hoac Ta bach tan, Sa sam mach dong thang gia giam. Ngoai ra, con co nhirng hoi
chung han dam uat phe. dam nhiet be phe deu la nhirng hoi chimg benh ly cua
phe.

5. Hoi chung benh ly cua than:
Chuc nang sinh ly chu yeu cua than la: Than tang tinh, than chu cot, chu
thuy, khai khieu d tai. Nhu vay, chuc nang cua than la chuc nang cua he tiet
nieu, sinh due va co lien quan den noi tiet, xuong. Nhirng hoi chung benh ly cua
than d tre em thudng gan lien vdi cac tang khac nhu phe, ty, can, tam. Nhung hoi
chung thudng gap co:

a)

Phe thpn luong hu (phe than am hu): Ho lau ngay ddm it, ca the suy

mon co luc ho ra mau, lung goi moi, sot nhe buoi chieu, dem ra mo hoi trom.
ma do m$t bung nong, ludi do reu it, mach te sac hoac t6 nhuoc. Thudng gap d
benh hen lau ngay, lao phoi va benh gian phe quan d thcri ky cudi. Phep chua la
tu bo phe th^n, thudng dung bai Mach vi dia hoang thang gia giam.