Các vị thuốc Nam thông dụng: Phần 1

Cây thuốc Nam vị thuốc thông dụng: Phần 1 trình bày các nội dung chính sau: Đại cương một số bệnh thông thường, bệnh cảm lạnh, bệnh động kinh, bệnh hen phế quản, bệnh nhồi máu cơ tim, một số vị thuốc Nam chữa bệnh thông dụng,... Mời các bạn cùng tham khảo để nắm nội dung chi tiết.

jf^^ L^ongy TUB TINH

Co the noi nhd s i / 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 d d m , 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

T I E U Stf T U E T I N H

Tue Tinh Thien SM* (1623-1713), thtfcfng

difcfc goi t a t la Tue T i n h hoac Hue T i n h , ngLfcfi lang Nghia Phu, tong Van Thai, huyen Cam Giang, phii Thifgng Hong (p^ay la t i n h Hai Diiong) difcfc phong la ong to nganh dtfcfc Viet N a m va la ngif&i md dau cho nen

y difcfc CO truyen Viet Nam Cac bo sach

Nam Difoc t h a n 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 T i n h difcfc ton la v i t h a n h thuoc Nam Tai H a i 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 T i n h

T I E U sCr

Neu nhiJng ket qua nghien cufu van hoc, ngon ngi? hoc Viet

Nam sau nay khong dxia them bang chufng gi mdi t h i t r u y i n

thuye't dia phLfOng va nhiJng cong t r i n h nghien cufu chuyen mon khac cho phep khang dinh Tue T i n h 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, t i n h H a i Difang)

Mo coi cha me tU luc 6 tuoi, N g u y i n Ba T i n h dufgc cac nha

isif chua H a i Trieu va chua Giao Thuy nuoi cho an hoc N a m 22 tuoi, ong dau T h a i hoc sinh difdi trieu vua T r a n Du Tong,

nhufng khong ra lam quan ma d l a i chua di tu lay phap hieu la

Tue T i n h 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 T i n h b i difa di cong cho trieu dinh

nha M i n h Sang Trung Q u o c , ong v i n lam thuoc, noi tieng,

difcrc vua M i n h phong la Dai y Thien sir, mat or do, khong ro

n a m 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 n h i /

vay

C O N G ^ I N H Y-DJOC

Nhflng nam d trong ni/dc, Tue T i n h da cham chu nghe thuoc:

trong cay thuoc, sifu tarn k i n h nghiem chiJa benh trong dan

gian, huan luyen y hoc cho c a c tang do Ong da tong hgp y difgc

d a n tpc CO truyen trong bo sach gia t r i la bo N a m 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 v i cung bang chOf Nom Tha van Nom dcfi T r a n

rat hiem, neu qua thiTc do la tac phani ciia Tue T i n h t h i chung

khong chi gia t r i trong y hoc ma con la tac pham quan trong

trong lich suf van hoc bdi v i day la cac tac pham d thcfi k i dau

cua van hoc chCf Nom

TiJf bao dcfi nay, gidi y hoc Viet Nam va nhan dan deu cong

nhan Tue T i n h c6 cong lao to Idn trong viec xay ditag mot quan

diem y hoc doc lap, tir chu, sat vdi thiTc te Viet Nam C a u 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. Q u a n diem, ay d§n dat ong len ngoi v i

cao nhat ciia nen y hoc co truyen Viet N a m : Ong Thanh thuoc

Nam! Trong trUdc tac ciia m i n h , ong khong rap khuon theo cac

trifdc tac ciia cac di/i tv\i6c Ong khong difa k i m , 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 t i n vao phu chu ma

khong t i n 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 T i n h da khong difng lai d v i t r i mot thay thuoc chuTa

benh, ong con tif m i n h truyen ba phifcfng phap ve sinh, to chufc ccf sd chaa benh trong nha chua va trong lang xom Co t a i lieu

cho biet, trong 30 nam boat dpng or nong thon, Tue T i n h d a x a y

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; t i m bien phap phong benh tich cifc Tue T i n h nhan manh tac dung viec ren luyen t h a n the va sinh

hoat dieu dp Ong neu phifcfng phap difSng sinh tom tat trong

Aa^ (LkOu ^d^k <' 7

PHAN M d D A U

D A I Cl/dNG MOT SO BENH

THONG THl/ClNG '

-oOo-1 BENH CAM LANH

C a m lanh la mot benh n h i l m trung duomg ho hap tren Co h a n

200 virus k h a c nhau c6 the gay r a cam l a n h vcJi nhOfng trieu

chijfng khac nhau

Dau hi^u va tri^u chiiCng

Trieu chufng thiTorng xuat hien khoang 1 - 3 ngay sau k h i tiep

xuc v(Si virus va bao gom:

• Ngat mui hoac chay niiac mui

• Hong ngiia va dau

benh n h a n h 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 S I 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

B e n h ciim la benh viem n h i l m 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 k h i 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

• 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 / u i w ' ^ ( 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 B E N H D Q N G K I N H

D o n g k i n h la m o t ro'i loan pha vd qua t r i n h t r u y e n t i n h i e u

dien t r o n g nao B e n h thuomg gay r a nhOng can co g i a t va m a t y

thijfc T u y n h i e n t r i e u chiJng b e n h c6 tile r a t k h a c n h a u

Dau hieu va trieu chitng

Cofn d o n g k i n h c u e bo

- Ccfn dong k i n h cue bo dcfn g i a n : k h o n g gay m a t y thiJc C h i i n g

CO t h e t h a y doi c a m xiic hoac t h a y doi each n h i n , ngiiri, c a m giac,

n e m hoac nghe

- Corn dong k i n h cue bo phiJc t a p NhiJng corn n a y l a m t h a y doi

y thile, k h i e n b e n h n h a n b i ma't y thufc t r o n g m o t thcri g i a n Can

dong k i n h cue bo phiifc t a p thifcfng gay r a cai n h i n c h a m c h a m va

12 • X / W v e / w Z t t / ^ c ^ v

n h t t n g ciif dong k h o n g co muc dich, nhiT be t a y , h e m m o i , n o i l a m

n h a m hoac nuo't k h a n

C<fn dgng kinh loan the

- C a n v a n g y thufc (dong k i n h con nho), dac t r i f t i g b a i cai n h i n cham c h a m , nhiJng ciif dong k h o n h a n t h a y va m a t y thilc t h o a n g qua

- Ccfn dong k i n h co Thucfng bieu h i e n n h u nhumg dong tac g i a t

cue dot ngpt a canh t a y va chan

- Ccfn dong k i n h m a t triTcfng luc, k h i e n b e n h n h a n dot ngpt nga q u i

- D o n g k i n h con I d n , l a dang n a n g n h a t , dac t r u i i g b d i m a t y thiifc, C O C l i n g va co giat toan t h a n , doi k h i b e n h n h a n can p h a i liTori hoac tieu t i e n k h o n g tiT ehii

Nguyen nhdn

- N h i e u t h e dong k i n h co l i e n quan den khuye't t a t a gen dieu

k h i e n each t r u y e n t h o n g t i n giQa eac te'bao nao, nhiTng c h i co m o t

v a i t h e h i e m gap l a p h a t s i n h tilf nhChig khuye't t a t gen dac t h u Mac du m o t so' t h e b e n h dong k i n h co t i n h chat gia d i n h , song d i

t r u y e n e h i dong m o t p h a n v a i t r o gay b e n h - co le t h o n g qua viec

k h i e n ngircfi b e n h m a n cam h o n v d i eac ye'u to' gay b e n h t r o n g m o i trufofng

- T r o n g n h i e u trifomg hpp, dong k i n h co t h e b a t nguon t i r m o t

t a i n a n , b e n h hoac chan thu'orng - nhuf dot q u i - k h i e n nao b i t o n

t h u a n g hoac t h i e u o x i T r o n g m o t so' i t trUorng h a p , dong k i n h co

the CO nguyen n h a n l a kho'i u t r o n g nao T u y n h i e n , k h o a n g V2 so'

b e n h n h a n k h o n g xae d i n h dupc nguyen n h a n gay b e n h

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 d l bi benh hon phu uuf Phu

nu: se bi tang kha nang mac benh sau

k h i man kinh

Dau hi^u va trieu chu'ng

Dau hieu va trieu chiifng ciia gilt hau nhiT luon la cap t i n h , xay

ra dot ngot - thuomg vao ban dem - va khong c6 dau hieu bao

• 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 t u 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 v i ly do nao do cor the san sinh qua nhieu

hoac bai xuat qua i t chat nay t h i acid uric c6 the tich luy, tao thanh nhOfng tinhh the hinh k i m 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

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 1 3c 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 l a m

giam nguy cof hoac mufc do nang ciia cac dot benh xay ra sau nay

Nhu-ng thuoc nay gom allopurinol va probenecid K h i 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 h a n 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 m a di k e m 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 k h i 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

t h i d l 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 • r W c / w e A , ^ > § ^

nang trUc tiep chieu vao da t h i 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 t h i ba me can bong be' tre ra ngoai trdi de tam nang, ne'u tre da tu di duorc t h i 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 n h i l m vdi v i 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

Dieu tri tre suy dinh dU&ng

• Tang so bda an trong ngdy: Cho trk an 5-6 bUa mdi ngdy,

X k u ^ c n^,^ (Ll^ ' ^ p / / v •:• 19

<S)6nq r gfrt 9lỦu

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 đu

An vdo chen chdo cho tre nhd hoac tang cdc thiic dn che bien

nhieu chat beo, thiic dn chien xdọ

• Cho dn dac han: Bot dac c6 ndng lugng cao han bpt Idng hay

chdo long Vdi tr& đ 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 maị hay uong them 1 ly sUạ

• 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 đ tdng trUdng so vai cdc ban dong trang liiạ

Chufng liTofi an la nguyen nhan dan tdi tinh trang coi xiTcfng,

suy dinh diTdng d tre em, do khong an uóng 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

ché dirdri dang siro nen rat dl uóng 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 •:• T w / U u , v ệ^/g^A,

f)6ng T STrj at|u

6 B E N H H E N PHE Q U A N

Khdi qudt

Ngifcri bi hen thiforng kho thor, khong sót, khong laỵ

• Hen xdy ra d moi liia tudị 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 dọ d tre em, can hen thUdng bdt đu bdng cam lanh thong thubng

• 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 đn cila thdy thudc)

Néu ngiTofi óm c6 sót, hoac nen com hen keo dai tren 3 ngay: cho uóng 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 gdị

• Néu 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 t i m hay com dau t i m xay ra k h i dong mach vanh

cung cap mau cho t i m bi tac nghen do cue mau dong Dong mau

nuoi duSng co t i m bi gian doan c6 the gay ton thiTOng hoac pha

huy mot vung co t i m

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

• 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« > § i W v

• Mot so xet nghiem khdc nhU chup X quang ngUc, sieu dm tim, chup mach vdnh

£)ieu tri

Cac thuoc thirdng dung dieu t r i con dau t i m 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 k i m 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 <' 2 3

vugt qua cho tac nghen (no'i tat qua doan tac nghen) de khoi phuc

dong chay cua mau den t i m

Phong ngiCa *"

- Nho'i mau cof t i m : rat nguy hiem den tinh mang ngifcfi benh

dac biet or ngi/ori gia v i vay viec dung thuoc de phong ngiira mot

each thifcfng xuyen la dac biet quan trong Nhung cac thuoc tay y

t r o n g dii p h o n g n h d i mau cof t i m 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 c a i

thien trieu chutng

- De tang cudng hieu qua va lam giam tac dung khong mong

muon trong phong ngira nhoi mau ccr t i m tren t h i trifdng hien nay

CO nhieu che pham nhu: cac s a n pham tir Giao co lam lam ha

huyet ap, tang lifu thong k h i 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 n g i T a nhoi mau cor tim, dau that ngyc,

tai bien mach mau nao Cac che' pham c6 c h u f a Nattokinase

(HOMICIS): dac t m h sinh hoc c i l a 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 s U chai c u f n g eiia mach mau d

lieu l u o f n g 100 mg/ngay. (5 mot khia canh nao do, nattokinase

thufc s i r to't h o n 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

• 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 k h i 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 n h a n 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 t r i hieu qua nhat Thuoc difqfc

chuyen hoa thanh dopamin trong nao T u y nhien k h i benh tien

trien, hieu qua ciia levodopa c6 the bi giam di T a c dung phu ciia

levodopa gom lii iSn, hoang tirdng, ao giac v a ro'i loan v a n 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

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

- K i c h thich nao sau la thu that pho bien nhat de dieu t r i benh T h u thuat nay bao gom cay mot dien ciic vao sau trong vimg nao chi pho'i v a n dong Dien ciTc dirge no'i vdi mot thiet bi cay ngoai da se dieu chinh liTcfng kich thich phat r a

- Thii thuat thirdng dircfc chi dinh cho benh n h a n bi benh giai doan muon cd dap ufng khong on dinh vdi thuoc (levodopa) K i c h thich nao sau khong c6 hieu qua vdi benh n h a n 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, k h i 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 g i cho den k h i phoi b i ton thiforng dang ke Nhung

mot k h i da xuat hien t h i trieu chiJng thifdng nang dan theo thdi

gian Cac trieu chiifng COPD c6 the gom:

• 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 • " t w / V u , v e / 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 t r i 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

X l ^ c A'u^ (LUM / t ^ e V v / v • 2 9

• Khdng sink chong bgi nhiem

Dieu tri ngog.i khoa

• Phdu thuat gidm the tick phSi

r a n qua miifc t r o n g k h i d i ngoai hoac do

t a n g ap luc a cac t i n h mach nay t r o n g k h i

m a n g t h a i va m o t so' nguyen n h a n khac

Dau hi^u va tri^u chvCng

T r i e u c h i i n g ciia t r i thiTomg tuy thuoc vac v i t r i

• T r i n o i ; 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

• T r T n g o a i ; 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

T r i CO t h e xay r a do t a n g ap liic t r o n g cac t i n h m a c h d dau dU(Ji

t r i i c t r a n g N h Q n g nguyen n h a n hay gap n h a t gay t a n g ap lire va

gay t r i l a :

• Tdo bon ddn den phai ran nhieu

• Tieu chay vd phai tdng phdn ra ngoai lien tuc

3 0 • 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

- T r i ngoai c6 the n h i n t h a y b a n g m a t thUcmg T r i n o i c6 the diTcfc p h a t h i e n b a n g t h a m trUc t r a n g , n h u n g doi k h i t h a m trUc

t r a n g k h o n g giiip diTa r a chan doan xac d i n h v i t r i n o i thirorng r a t

m e m va k h o p h a t h i e n

- Co x e t n g h i e m k i e m t r a p h a n dudi ciia d a i t r a n g g o m soi h a u

m o n , soi triTc t r a n g hoac soi d a i t r a n g sigma K i e m t r a r p n g h o n gom soi d a i t r a n g o'ng m e m de k i e m t r a t o a n bo d a i t r a n g X e t

n g h i e m n a y giup loai trir nhCfiig t o n t h u o n g gay chay m a u k h o n g

c h i of trirc t r a n g m a con d t o a n bo d a i t r a n g

DIEU TRI Dieu tri nqi

- N e u b u i t r i c h i gay k h o c h i u doi c h i i t , c6 t h e d u n g cac l o a i k e m

hay thuoc m 5 b o i t a i cho hoac corticoid, k e t h o p v6i t a r n nirdc a m

h a n g ngay de l a m g i a m t r i e u 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/ w v 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 " ' > b j i ! «<• u t 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 b i la m o t l o a i v i e m t u y e n nirdfc bot m a n g t a i do m o t l o a i

v i r u s , l a y I a n qua dudng ho hap V i r u s c6 a i t i n h dac b i e t v d i

tuyen niXdc bot, t i n h h o a n va he t h a n k i n h B e n h t h i / d n g gap d

t r e n a m t u o i tir 5-15

Tri^u chiing

- G i o n g nhu ta't ca cac b e n h do v i r u s khac, k h i b i n h i l m b e n h ,

b e n h n h a n sot cao c6 the l e n den 40°, dau va sung ( k h o n g do) m o t

hoac h a i b e n goc h a m Sau 7-10 ngay cac t r i e u chiJng t h u y e n

g i a m dan va k h o i benh d m o t so truomg hop dac b i e t c6 t h e k e m

l u o n v i e m t i n h h o a n

- V i e m t i n h h o a n c h i l a m o t t r o n g nhUng b i e n c h i l n g h a y say

r a n h a t cua quai b i Sau 7-10 ngay, b e n h quai b i da t h u y e n g i a m ,

dot n h i e n b e n h n h a n l a i sot cao 39-40°, t i n h h o a n m o t hoac h a i

ben sung n o n g do dau Sau k h o a n g 10 ngay t r i e u chiJng n a y cung

t h u y e n g i a m va k h o i

32 •:• c w ^ e / v « « ^gc.w'v

f)6nfl Y g'rt gt^u

Chan dodn

B e n h n h i n h a t l a n a m g i d i , sot cao, m o t hoac h a i ben goc h a m

s U n g , dau, k h o n h a i va nuo't, dac b i e t l a c6 s U n g n o n g do dau t i n h hoan m o t hoac h a i b e n t h i chac chan l a b i quai b i N g o a i r a cung

gap quai of t r e nU, n h u n g n o i chung h i e m va cung gay b i e n

chiJfng v i e m buong triifng

X e t n g h i e m : k h o n g c6 x e t n g h i e m dac h i e u 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 g a p n h a t l a v i e m t i n h h o a n , n g o a i r a m o t so' t r U o m g hofp h i e m c6 b i e n c h u f n g v i e m m a n g n a o , v i e m n a o , v i e m t u y

• 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

ve p h a t t r i e n , chu ye'u l a ve giao

tiep v a tifcfng tac v d i x a h o i B e n h

hay gap of cac be t r a i gap 4 I a n

cac be g a i

Dau hi^u va tri^u chvCng

- N h i n chung, t r e tiT k y thiTcfng c6 nhijfng v a n de t r o n g 3 l i n h

vyc quan t r o n g cua qua t r i n h p h a t t r i e n l a k y n a n g giao tiep,

n g o n ngfir v a h a n h v i NhiJng t r e b i b e n h n a n g c6 t h e m a t hoan

t o a n k h a n a n g giao tiep hoac tuang tac v d i ngiTori k h a c

- T r o n g v a i t h a n g hoac v a i n a m dau sau k h i r a dcfi, t r e c6 t h e

h o a n t o a n b i n h thirdng, n h i f n g sau do t r e d a n trd n e n k e m dap

lifng v d i ngiTcfi khac T r e cung k h o chia se t r a i n g h i e m \6i ngiTcfi

khac, v i du k h i difgc nghe ngifori khac doc t r u y e n , t r e k h o n g c h i r a

difgrc biJc t r a n h t r o n g cau chuyen do K h i I d n l e n , m o t so'tre c6 t h e

hoa n h a p horn v d i ngirc/i x u n g quanh v a c6 t h e c6 cuoc song b i n h

thuforng hoac g a n b i n h thudrng T u y n h i e n m o t so' t r e khac t i e p tuc

b i suy g i a m k h a n a n g ngon ngO v a giao t i e p , v a c6 nhOfng ro'i l o a n

h a n h v i t r a m t r o n g h a n

- D a so' t r e tiT k y c h a m hoc ducfc cac kie'n thiifc v a k y n a n g m d i

T u y n h i e n m o t so' t r e c6 t r i tue b i n h thuofng hoac k h a t h o n g

m i n h M o t so' nho t r e con difgfc x e m l a nhufng " t h a n dong" va c6

nhufng k y n a n g dac b i e t t r o n g m o t l i n i i vUc n h a t d i n h , nhiT nghe

t h u a t hoac t o a n hoc

Nguyen nhdn

- B e n h tiT k y k h o n g c6 m o t nguyen n h a n duy n h a t B e n h c6 ve

l i e n quan d e n nliOfng b a t thi/cfng or n h i e u v u n g nao, v a cac n h a

34 • t w = e / v « w

, t)6nfl Y gfrt

Ichoa hoc da xac d i n h difgrc m o t so' k h u y e t t a t gen c6 l i e n quan vdri benh G i a d i n h c6 m o t t r e b i t i f k y c6 1/20 k h a n a n g c6 dufa con thiif h a i cung b i b e n h

Tre CO t r i e u chiJng tif k y cung c6 nguy ccf cao b i cac b e n h 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

- V i b e n h c6 miifc dp n a n g va bieu h i e n r a t khac n h a u , n e n c6 the r a t k h o c h a n doan K h o n g c6 x e t n g h i e m dac h i e u nao de

p h a t h i e n r a b e n h K h a m x e t bao g o m quan s a t t r e v a h o i ve sir

p h a t t r i e n v a t h a y d o i t r o n g k y n a n g giao t i e p , k y n a n g n g o n ngO

va h a n h v i cua t r e qua thori gian T r e c6 t h e difgc l a m m o t so' trac

n g h i e m ve n o i chuyen, ngon ngfif va cac v a n de t a m l y

- M a c dii dau h i e u b e n h thiTomg bieu h i e n k h i t r e diXcfc 18 t h a n g tuoi, nhiTng chan doan c6 k h i p h a i dgri d e n k h i t r e difgrc 2 hoac 3 tuoi, k h i bieu h i e n c h a m p h a t t r i e n ngon ngif da tror n e n ro r a n g

C h a n doan sdrm l a r a t quan t r g n g v i can t h i e p sdrm - trifdrc 3 t u o i

- thifcfng m a n g l a i k h a n a n g phuc h o i to't n h a t

Dieu tri

Chifa CO each chiJa k h o i benh tif ky, va k h o n g c6 bien phap nao

phii hcfp cho t a t ca Cac lifa chon dieu t r i c6 t h e g o m :

• 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 t r i n h 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 v i

13 B E N H U X O T C T C U N G

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 k h i Estrogen trong

CQf the tang cao U xcf tiif cung thiTorng

to ra dien h i n h 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 k h i 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

p h l u 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 t h i khoang 20 tudi va thu nho lai sau tudi man

k i n h k h i 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 k h i ehung rat Idn, cung c6 the

khong CO trieu chufng Thircfng ban se phat hien benh k h i 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 k h i 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 b a c 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 t r i u xcf tuf cung phu thuoc vao trieu chufng, kich thudc va

vi t r i 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 t r i l a khong can

thiet, dac biet l a neu nhir ban khong c6 trieu c h i i n g , 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 c h i i n g ac tinh (ung

thif), thifomg CO the dieu t r i 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, t h i ban khong can

dieu t r i 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

m o t loai khac) c6 the lam giam dau vung chau do u xof tii cung

3 8 • 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 p h l u thuat nham lam kho'i u co lai de giam so' liTcfng mau mat qua qua t r i n h phau thuat hoac cai thien cong thiifc mau trudc p h l u 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 t r i Han che siif dung each dieu t r i nay lau dai v i chiing c6 nhOfng tac dung phu gay ra do

tinh trang giam estrogen trong co the (gio'ng t i n h 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 p h l u 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 t u nhu tac dung phu ciia GnRH nhung c6 the i t gap han RU - 486 c6 the gay say thai do do can can trong k h i 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 m i l n dich

CO the manh, giai doc va chong u tot n h U Nhan sam, Tam that,

Trinh niit hoang cung, Giao co lam Trong dan gian T r i n h nuf hoang cung dirge s i i dung de chiJa ung thuf vu, ung thir tuf cung, ung thir tien liet tuye'n Giao co lam dirqfc chufng m i n h la co tac dung

kim ham sir phat trien kho'i u manh va ducfc suf dung cho benh nhan ung t h u 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 k h i diing mot loai Hien t r e n t h i trUcfng co nhieu san pham bao che' tir cay Trinh nilf hoang giiip ho trg dieu t r i u vu, tiif cung va buong triifng co hieu qua nhiT san pham That diep l i n h (pho'i hop 2 dugc lieu quy co tac dung tic che manh s U phat trien ciia khoi u)

x/u ^c e/v^4 /^^ /v •:• 3 9

Phdu thuat

- PhSu t h u a t boc n h a n xcf : Phuofng phap n a y c6 the thiTc h i e n

qua n o i soi budng tuf cung, n o i soi o b u n g va i t gap h.an la m d h d

(rach duorng t r e n bung) D i e u t r i trUdrc phSu t h u a t b a n g thuo'c

G n R H CO the l a m g i a m li/ong m a u m a t va g i a m t h d i gian thuc

h i e n cuoc p h l u t h u a t

- C a t tijf cung la p h l u t h u a t lay di toan bo tuf cung (ciing v d i

kho'i n h a n xor) D a y phirong phap thifomg t h a y n h a t t r o n g dieu t r i

u xof tuf cung va diTgrc x e m la each dieu t r i duft diem N e u kho'i u l a

u n g thir hoac kern theo u budng trufng, tuf cung se dirge cat h o a n

t o a n cung v d i budng trufng va o'ng d i n trufng

Phong ngiia

- T r a n h t a n g can sau 18 tudi va eo' gang gia can n a n g cua

m i n h p h u hop vdi chieu cao Can n a n g cua ccf the eo the a n h

huorng den sir gia t a n g n d n g do cua estrogen, do do se l a m u xor tuf

cung p h a t t r i e n B a n n e n tap the due de k i e m soat can n a n g va

eon l a m g i a m san x u a t h o r m o n k i c h t h i c h p h a t t r i e n u xa tuf cung

- Thuo'c l a v a n ehiTa diTcfc chufng m i n h l a c6 l i e n quan den t a n g

u xor tuf cung N h u n g ngirng h u t thuo'c l a se eai t h i e n siJe khoe ciia

b a n neu b a n b i u xo tuf cung

- B a n n e n d i k h a m sufc khoe d i n h k y dac biet l a k h a m phu

k h o a n h a m p h a t h i e n sdrm b e n h

14 BENH VIEM MUl D\G

B e n h v i e m m u i d i l i n g l a b e n h d i ufng

cua t o a n t h a n c6 bieu h i e n t a i ehd, thi/omg

la nhufng com h a t h o i , so m u i va tac m u i

Nguyen nhan

- D i n g u y e n gay b e n h bao g d m : pha'n

hoa, b u i n h a , n a m mo'c, v a i sgi, l o n g gia

sue, gia cam; m o t so' thuTc a n nhiT dau, dufa,

• T r i e u 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

- T a i c h o : giai quyet ne niem mac, sung huyet, xuat t i e t , n h i l m

t r u n g or m u i , xoang Chpc rufa xoang de chan doan va dieu t r i

- T o a n t h a n : dung k h a n g h i s t a m i n : phenergan

Phong b e n h : k h o , chii ye'u l a bao ve m o i triTdng song, t r a n h cac

yeu to' tac dong cua d i nguyen NgiTori c6 b e n h d i iifng can song 6

ncfi t h o a n g m a t , k h o n g k h i t r o n g l a n h B e n h c6 t i n h c h a t d i

t r u y e n n e n n a m nuf c6 ccf dia d i ufng k h o n g n e n l a y nhau

15 BENH VIEM XOANG CAP VA MAN TINH

B e n h v i e m xoang cap v a m a n t i n h la b e n h r a t phd bie'n d V i e t

N a m , p h a n l o a i v i e m xoang cap va m a n t i n h thiTc chat c h i l a

p h a n b i e t each xuf t r i : cap thiTcfng dieu t r i n o i k h o a , con m a n t h i

p h a i dieu t r i ngoai

V i e m xoang cap theo t h i i tir thuofng gap l a : v i e m xoang h a m ,

4 2 • t:^u^^ n,.^ e/«j«

xoang sang, xoang t r a n , xoang bufdm D o i k h i x a y r a v i e m n h i e u

xoang cimg m o t luc - • • i

Nguyen nhdn

- N g u y e n n h a n p h d bie'n n h a t l a do v i e m m u i , do cam, cum, d o i

k h i do v i e m hong, do r a n g Ngoai r a c6 t h e do t d m (nhay cau, Ian) do chan t h i i o n g , do ap liTc t h a y doi dot ngot k h i d i m a y bay

do d i v a t d mui do bie'n chiing gay v i e m xoang ciia cac b e n h c u m ,

sdi, ho ga, v i e m phdi do phe cau k h u a n

- V i s i n h v a t gay v i e m xoang cung la nhiJng v i s i n h v a t gay viem n h i l m dircfng h o h a p t r e n

- Ye'u to' t h u a n Igri: m o i trUcfng 6 n h i l m , a n or k e m ve s i n h , veo

vach n g a n , d i iirng, u l a n h , u doc d m u i ; t i n h t r a n g ciia p h d i , phe

quan: v i e m xoang-gian phe quan, k e t h o p v i e m xoang-gian phe quan vdri d i t a t t i m sang p h a i

Cdc the viem xoang cap tinh

- Viem xoang tran cap: i t k h i dcrn t h u a n , thuomg pho'i hcfp v d i

viem xoang sang trudc K h d i dau nhiT m o t sd m u i t h o n g thifomg keo d a i 5-6 ngay r d i xuat h i e n nhufng ccfn dau dac b i e t ciia v i e m xoang t r a n : ccfn dau p h i a t r e n o m a t , m o t b e n va c6 2 chu k y mSi ngay Corn dau t a n g d a n tiT sang den giSa tnTa t h i d a t mufc to'i da, luc do m u i chay n h i e u m i i , xoang v o i d i va con dau d i u xuo'ng, d e n chieu l a i t a i d i e n con dau do D o i k h i k e m chay nUdrc m a t , m a t diTa

di dira l a i cung dau, da v i i n g xoang tutig c a m giac, c h i sor cung dau,

an day t h a n k i n h t r e n ho' m a t d goc t r e n - t r o n g d m a t cung dau

n h o i

- Viem xoang ham cap: b a t dau nhiT sd m u i t h o n g thircfng

n h u n g keo d a i r d i x u a t h i e n con dau or v u n g dirdi d m a t , m o t b e n , dau xuyen ve m o t p h i a h a m r a n g , dau t a n g k h i g a n g sufc, k h i

i i h a i , k h i n a m Co d i e m dau ro dirdri d m a t , hoc m u i x u n g h u y e t , thirdrng tie'n t r i e n to't t r o n g 10 ngay

TAu^c &/u2a i^pJ^ •:• 4 3

- 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 k h i so mui, m l 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 n h i l m tu cau

khuan cua xiXcfng ham tren Trieu chiicng: n h i l m khuan nang: m i

mat dudfi mong do, ma sifng, mui chay mii, Icfi rang cung thay

siftig, CO k h i CO 16 ro

Dieu tri

- Chong nhiem khuan va dan litu: khang sinh ket hcfp vdi

cac thuo'c chong viem, corticoid difcfc dung k h i c6 uf dpng mu, dung

thuoc giam xung huyet

Viem xoang man tinh

Viem xoang t r d thanh man tinh la do 6 viem xiTcfng or thanh

xoang nhu viem xoang do rang Man t i n h 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

t r i bao ton hay dieu t r i 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 k h i dieu t r i 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 v i p h l u nham tai tao lai sinh ly binh thuorng ciia

xoang

16 D A I T H A O D a C i N G Dai thao dirorng hay tieu diTorng,

la mot nhom benh ro'i loan chuyen hoa cacbohydrat k h i hooc mon i n -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 n h a n chinh ciia nhieu benh hiem ngheo, dien hinh la benh t i m 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

L o a i 1 ( T y p 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 t r i Giai doan toan phat c6 t i n h trang thieu insulin tuyet doi gay tang dircfng huyet va n h i l m 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

L o a i 2 (Typ 2)

- Benh tieu difcfng l o a i 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 i t c6 trieu chufng va thu'omg chi dugc phat

hien bori cac trieu chtlng ciia bie'n chiJng, hoac chi diTcfc phat hien

t i n h cor k h i di xet nghiem mau tmdc k h i mo hoac k h i c6 bien

chufng nhir nhoi mau ccf t i m , tai bien mach mau nao; k h i bi n h i l m

trimg da keo dai; benh nhan ni? hay bi ngiifa vimg k i n do n h i l m

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 l i t hoac horn trong 24 gior, nirdc trong, k h i 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 i t nhat 2 Ian lien tiep - Difcfng mau

sau an hoac bat ky > 200mg/dl (> 11,1 mmol/l) Test nay diXtfc

thirc h i e n nhir sau: - Dieu k i e n : an 3 ngay l i e n 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: N h i n 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

Lo'i song v a thai do a n 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

• Insulin Cdn cit vdo tdc dung, gidi chuyen mon chia ra 3

• 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 k h i tiem Ian dau hoac

nhieu Ian tiem), ha Glucose mau (thiTorng gap k h i 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 d l gay u md,

giam se gay xo ciirng (kho tiem, dau)

T h u o c 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,

Chila benh bSng Dong y:

Ngoai phirong phap dieu t r i 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 t r i ttf go'c, giup ccf the cung co' va t u 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 v i 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 m i n h 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 k i n h toa la thuat nguf dung de chi tinh trang dau bat ngudn doc theo ducfng di ciia day than k i n h nay - tir lirng xudng mong va chan

/ U V e/u« /g?«/v •:• 49

Dau hieu vd trieu chiing

Dau bat nguon tir vung that lUng chay doc xuo'ng mong va mat

sau chan l a dau hieu dien hinh cua dau than k i n h toa Cac trieu

chijfng k e m theo c6 the gom:

• Te hoac yeu ca doc theo di/dng di cua day than kinh d chan

hoac ban chan Mot so trudng hap benh nhan c6 the bi dau d

mot vung cua chan vd te d mot vung khdc

• Cam gidc kien bo hoac cam gidc nhu bi kim chdm, hay gap

nhdt d ngon chan hoac mot phdn ban chan

• Mat kiim sodt dai tiiu tien Bay Id dau hieu cila hoi chiCng

duoi ngUa, mot tinh trang hiem gap nhung nang can dieu

tri cap ciiu

Nguyen nhdn

Dau than k i n h toa thUcfng xay r a k h i re than k i n h d vung cot

song that luttig bi chen ep Cac nguyen n h a n hay gap gdm:

• Thodt vi dla dem

• Hep ong tuy vdng cot song thdt lUng

• Trat dot song

• Hoi chjing ca thdp

• Khoi u d cot song

• Chan thuang

• Khoi u hoac chan thiimg day than kinh toa

Xet nghiem vd chan dodn

• Cac xet nghiem ca bdn kiim tra siic manh vd phdn xa

• Chup X quang xUang song c6 the phdt hien duac khoi u, hep

dla dem hoac trat dot song

• Chup cong hudng tiC: Id xet nghiem nhay nhdt di ddnh gid

dau day than kinh toa Xet nghiem c6 thi phdt hien diigc

ton thuang dla dem vd day chdng cung nhii khoi u

50 • T / W t - ' ^ e / ^ v

^6nfl Y gfrt

• Chup cdt Idp vi tinh c6 thi phdt Men dugc thodt vi dla dem

vd khoi U ffj}^ •.::•:•':'/ Dieu tri

Cac bien phap tu cham soc gom nghi ngcfi, chuorm lanh, chUcfm nong, keo gian v a thuo'c giam dau

• Vat ly tri lieu

• Tap luyen thudng xuyen

• Khi dieu tri bdo ton khong lam giam dau, c6 thi thic nhiing bien phdp quyet liet han:

• Tiem steroid ngodi mdng ciing

* Phdu thuat cdt bo phdn dla dem thodt vi gay chen ep day

• Luyen tap thubng xuyen

• Gia dung tu the khi ngoi, diCng hoac ndng vat nang

18 SOI THAN

S6i than l a mot khoi r a n bao gom mot tap hgp cac h a t tinh the nho Co the c6 mot hay n h i l u soi xuat hien cung luc trong than hay trong nieu quan

Nguyen nhdn, ti mac, vd cdc yeu

to CO tinh nguy cor

- Soi than c6 the h i n h thanh k h i nUdc

(Ll^^ K^dt^k • 51

tieu ciia ban trd nen qua c6 dac vdi cac chat nhat dinh nao do

NhCfng chat nay c6 the tao ra cac tinh the nho va trd thanh soi

than Soi than c6 the khong tao ra cac trieu chufng cho tdi k h i

chiing di chuyen xuong nieu quan, gay dau Can dau thifomg la

nang va thiforng bat dau d vung sifcrn, sau do di chuyen xuong

hang

- Soi than la mot benh l i pho bien Khoang 5% phu nu" va

khoang 10% nam gidi se mac i t nhat trong mot giai doan trudc

tudi 70 Mot ngifdri da tijfng c6 soi than thong thuforng se lai c6

trong tUcfng lai Soi than phd bien d nhOfng tre sinh non

- Cac ye'u to' c6 tinh nguy ccf bao gom nhiem axit ong than va

n h i i m canxi than thuf cap

- Mot so' loai cua soi than c6 xu hurdng hoat dong trong cac gia

dinh Mot so' loai c6 the lien quan tdi benh diTcfng ruot, cac khie'm

khie'm khuye't cua ong than

Cdc loai ciia soi than bao gom:

- Soi canxi la phd bien nhat Mufc dp phd bie'n gap 2 den 3 Ian

or nam gidi, thudng xuat hien d do tudi t\i 20-30 Tai phat la c6 the

xay ra Canxi c6 the ket hop vdi ca chat khac nhuf oxalat (chat

phd bien nhat), phosphat hay carbonnat de tao thanh soi Oxalat

xuat hien trong mot so' thiirc an Cac benh cua ruot non lam tang

xu hirdng tao soi oxalat canxi

- Soi axit uric phd bien hcfn d nam gidi Chung cd lien quan vdi

benh gout hay hoa t r i lieu Soi axit uric chic'm khoang 10% tat ca

cac loai soi

- Soi xystin cd the hinh thanh d nhOng ngiTdi mac xystin nieu

La mot rd'i loan di truyen anh hirdng den ca nam va nOr

- Soi struvite chu ye'u ducfc t i m tha'y d phu nff la ket qua cua

n h i i m trung dirdng tiet nieu Chung cd the Idn leu nhanh chdng

va lam tac than, nieu quan, hay bang quang

- Cac chat cd the ket tinh, ket tiia va hinh thanh soi

52 •:• r w ^ / w e ^ v g ^

^)6nfl Y gfrt Sttfu

Cdc tri?u chiing

• Bau sUdn hay dau lUng

• Mot hay ca hai ben sUdn

• Bau tang dan

• Bau bung (gidng co thdt)

• Co thi toa ra hay di chuyen xuong vung di/di sUbn, khung chau, hang, ca quan sinh due ngoai

• Buon non, non

• Bi tieu thxlbng xuyenjhhdn cdp, gia tdng (cdm gidc muon di tiiu keo ddi)

Ban d viing bung

Bi tieu dau

Ngdt quang khi di tiiu

Bau tinh hodn

- Loc nirdc tieu c6 the thu diTcfc soi tir dirdng tiet nieu k h i chiing

<Juac thai ra

- Xet nghiem soi cd the cho tha'y mot so loai soi

- Xet nghiem nirdc tieu cd the cho thay cac t i n h the va cac hong cau trong nirdc tieu

(LUa^ )^6tJ^ 53

- Axit uric tang len

- Soi hay tac nieu quan c6 the diforc nhin thay k h i :

- Sieu am than

- Chup X quang than nieu quan qua diforng t i n h mach (IPV)

- Chup X quang than nieu quan hoi lifu

- CT scan bung

- Chup M R I bung.than

- Cac xet nghiem c6 the cho thay miifc canxi trong mau hay

nirdc tieu cao

Dieu tri

- Muc tieu cua dieu t r i la lam nhe di cac trieu chufng va ngan

chan cac trieu chufng khac (soi than thiXcfng t u no mat di) Dieu t r i

se thay doi tuy thuoc vao loai soi va mufc do cua cac trieu chufng

hay bien chufng Nhap vien c6 the di/grc yeu cau neu cac trieu chufng

la nang

- K h i soi bat ra, niTdrc tieu phai diXcfc loc va soi dugc liAi giOf de

xet nghiem xac dinh loai soi

- Uong du nUcJc de san sinh mot lufang nxidc tieu cao I t nhat

6-8 coc/ngay Chat long qua difofng truyen tinh mach cung c6 the

ducfc yeu cau

- Cac thuo'c giam dau c6 the can thiet de dieu t r i cac cofn dau

bung do than (cac com dau lien quan Wi sir bat ra ciia soi) Cac can

dau nang c6 the doi hoi den thuo'c giam dau gay me

- Tiiy thuoc vao dang cua soi, cac thuo'c c6 the dugc ke de giam

sir hinh thanh soi va/hay trg giup pha vd va thai ra ngoai ciia cac

chat gay ra soi Cac thuoc c6 the bao gom thuo'c Icfi tieu, cac dung

dich phosphat, allopurinol (dimg cho soi axit uric), cac thuo'c khang

sinh (danh cho soi struvite), va cac thuo'c kiem hoa niTofc tieu nhiT

muo'i bicarbonat, hay muo'i citrat

54 •:• Ti^cyu.^(Lk^^^dfj^

Neu nhu soi khong tir bat ra, phSu thuat lay ra c6 the diTcfc ygu cau Thu thuat tan soi c6 the la mot giai phap thay the phau thuat Song sieu am hay song xung kich dirge suf dung de tan nho

f.^c vien soi do vay chiing c6 the dirge than day ra nirdc tieu (tan goi bang song xung kich tir ben ngoai) hay soi c6 the dugc lay ra bang mot o'ng noi soi dirge dira vao than thong qua vet rach nho or sir&n (ggi la mo than lay soi qua da)

- Ban CO the can thay doi che do an cua ban de ngan chan mot

so' loai soi khong cho chiing tai phat

Tien litgrng

- Soi than gay dau d6n nhimg thiTcfng dirge thai ra ngoai ma

khong gay ra cac hir hai lau dai cho than Chung c6 xu hirdng tai

phat trd l a i , dac biet k h i cac nguyen nhan ngam khong dirge t i m

ra va dieu t r i *

Cdc bien chtXng

• S6i tai phat Nhiem trung dubng tiet nieu Tdc nieu qudn, benh It tdc mot ben nieu quan cap Suy than, hinh thanh seo

Suy giam hay mat chiic ndng than cua than bi dnh hudng bod soi

Ngan chan

- Neu CO tien suf bi soi than, chat long dirge khuye'n khich uo'ng

de san sinh dii so' lirgng nirdre tieu loang (thircfng tir 6-8 co'c/ngay)

Tiiy thuoc vao loai soi, cac thuo'c hay cac phiTofng phap khac eo the dugc yeu cau de ngan chan tai phat

TiM^e e/Utt »»/v • 55

19 SOT RET

So't r e t la mot benh n h i l m ky sinh

trung lay truyen tiT ngif&i nay sang ngi/cfi

khac do mu6i dot Benh gay ra nhOrng ccfn

sot kem theo ret run tai d i l n va c6 the

gay tilr vong

Ddu hi^u vd tri^u chiing

Benh dac triftig bdi nhflng can t a i dien vdi cac daii hieu va trieu

• Cam gidc kho d

Cac trieu chufng khac gom dau dau, buon non, non, tieu chay

Nguyen nhdn

Nguyen nhan gay benh sot ret la ky sinh trung dan bao

Plas-modium Co khoang 170 loai Plasmodium, nhiAig chi c6 4 loai gay

so't ret cf ngirori la:

• P falciparum Chu yen gap d chdu Phi, gay trieu chiing

nang nhdt vd chiem phdn Idn cac trildng hap t^ vong do sot

ret

• P vivax Chu yen gap d vimg nhiet ddi cua chdu A, gdy trieu

chiing nhe hon nhiCng c6 the ton tai trong gan vd gdy tai

phdt benh trong nhieu nam

• P malariae Bugc phdt hien thdy d chdu Phi, c6 the gdy

trieu chiing sot ret dien hinh nhung trong mot so it trUdng

hap CO the nam yen trong mdu ma khong gdy trieu chiing

Benh nhdn c6 the Idm Idy ky sinh trung sang ngUdi khdc

qua vet dot cua muoi hoac qua truyen mdu

56 • t w ^ / w e ^ / * ^ ^ ;

^6nfl r gfrt g ^ u

• p ovale Chil yeu gap d vimg Tdy Phi Tuy hiem gap nhUng

Cling CO the gdy benh tdi phdt

Xet nghi^m vd chdn dodn

Xet nghiem k i n h phet: Lay mau lam tieu ban nhuom va soi di/cJi k i n h hien v i de t i m ky sinh trung 2 mau mau lay each nhau

6 giof CO the xac nhan sir c6 mat ciia k y sinh trung sot ret la loai

Icy sinh trung nao Cung mot liic ngiTofi benh c6 the bi n h i l m nhieu loai Plasmodium khac nhau

Dieu tri ' '

- Benh so't ret, nha't la so't ret do n h i l m P falciparum, can difgfc kham va dieu t r i kip thdi Cac thuo'c cho'ng so't ret hien nay gom:

- Mot nhom thuo'c khac thuorng difcfc ke dcfn d chau A hien nay

la cac dan xua't cua artemisinin, v i du nhif artesunate

- Halofantrine doi k h i cung dirac dung de dieu t r i so't ret Khong dung halofantrine cho ngudi dang dung mefloquine de phong sot ret hoac ngiTcfi bi benh t i m

- Primaquine c6 the diigc dimg de cho'ng lai dang ky s i n h trung

an trong gan va phong ngiTa tai phat Khong dimg thuo'c cho phu

niJ CO thai hoac nguori bi thie'u men G6PD (glucose-6-phosphate

dehydrogenase)

T/u^c / W , v 'gc^.A • 57

Phong b?nh

• Hien chiXa c6 vaccin phdng sot ret Cdch phbng berth chd yeu

Id ngdn khong cho muSi dot, bao gom ntm man tdm thudc

diet muoi vd phun thudc diet mudi trong nhd

• Dieu tri du phbng bdng cdc thudc chdng sot ret

• Boi thudc xua con triing nhit DEET len vung da hd vd phun

thudc diet mudi tai nai d

• Mac qudn do bdo ho '

• Nam mdn khi ngu •

20 L O A N G X a O N G

L o a n g xi/crng la mot ro'i loan chuyen hoa

cua bo xifofng l a m ton thiTcfng sdc manh ciia

xifcfng difa den tang nguy cof gay xifcfng cho

con ngifcfi Sufc m a n h cua xUomg bao gom sir

toan ven ca ve kho'i lirgng ciia xiTOng

Lodng xitomg la gi?

L o a n g xUcfng la mot rol loan chuyen hoa cua bo xUcfng l a m ton

thiTofng siifc m a n h ciia xuang dua den tang nguy cof gay xUOng cho

con ngucfi SiJfc manh ciia xiTtfng bao gom sir toan ven ca ve khoi

lirgng ciia xufcfng

Cdc yeu to nguy cof cua b^nh lodng xiiang '"

• Benh lodng xUang se trd nen ndng ne hen, sdm hem, nhieu

bien chdng han neu ngitdi benh c6 them mot hoac nhieu yeu

to nguy ca dildi day:

• Kem phdt trien thi chat til khi con nhd, ddc biet Id coi

xUang, suy dinh dudng, che do dn thieu Protid, thieu Calci

hoac ty le Calci / Phospho trong che do dn khong hap ly,

thieu vitamin D hade ca the khong hap thu diCgc vitamin D

vi vdy khoi liCgng khodng chat dinh cua xiCang d tu6i trUdng

Thieu ndng cdc tuyen sinh due nam vd nU (suy buong trdng sdm, mdn kinh sdm, cdt buong trdng, thiiu ndng tinh hodn ) Bdt dgng qud Idu ngdy do benh tat (chdn thiCang cot song, phdi bdt dgng), do nghe nghiep (nhUng ngiCdi du hdnh vu tru khi tdu vd tru di ra ngodi khong gian) vi khi bdt dgng Idu ngdy cdc te bdo huy xUang tdng hoat tinh

Bi cdc benh ngi tiet : cUdng tuyen gidp, eUdng tuyen can gidp, cUdng tuyen v6 cUdng than, tieu dudng

Bi benh suy than mdn hoac phdi chay than nhdn tao Idu ngdy gdy rdi loan chuyen hoa vd mat calci qua dudng tiet nieu

Mdc cdc benh xUang khdp mdn tinh khdc ddc biet Id Viem khdp dang thdp vd Thodi hod khdp

Phdi sit dung ddi han mot so thudc: chdng dgng kinh (Dihydan), thudc ehUa benh tieu dudng (Insulin), thudc chdng dong (Heparin) vd ddc biet la cdc thudc khdng viem nhom Cortiosteroid (cortiosteroid mot mat de chetrUc tiep qud trinh tao xUang, mat khdc lam gidm hap thu calci d rugt, tdng bdi xudt calci d than vd lam tdng qud trinh huy xUang)

Tu^c(^/Urt /^^o/v • 59

Tri^u Chang

• Bau mdi ma ho d cot song, dau doc cac xi/ang ddi (ddc biet

xUang cdng chdn), dau mdi ca bap, dn Iqnh, hay bi chuot rut

(vqp bi) cac ca

• Bau thuc sU cot song, dau Ian theo khoang lien siidn, dau

khi ngoi Idu, khi thay ddi tU the Co the dau man tinh hoac

cap tinh sau chdn thiCang (gay xUang cd tay, gay lun dot

song, gay cd xUang dui )

• Bay bung cham tieu, nqng ngUc kho thd

• Gil liCng, gidm chieu cao

• Tuy nhien, lodng xUang la benh diin bien dm thdm, ngudi

ta thiCdng vl benh gidng nhu mot ten dn cdp thdm Idng,

hdng ngdy cti Idy dan calci trong ngdn hang du trU xUang

cila ca thi con ngUdi Khi c6 ddu hieu lam sang, thitdng la

liic dd CO bien chiing, ca the da bi mat tdi 30% khoi lugng

xUang

Bien chvCng ciia lodng xUcfng

• Bau keo ddi do chen ep than kinh

• Gil veo cot song, bien dang long ngUc

• Gay xUang cd tay, gay lun dot song, gay c6 xicang dui

• Gidm khd ndng van dgng, dnh hudng nghiem trgng tdi chat

liCgng song cua ngicdi c6 tudi

Lam thenao de phdt hi?n s&m b?nh

1 P h a t hien cac yeu to" nguy cor gay loang xifcfng thuf phat (da

neu tren)

2 D i k h a m benh sdrni, ngay k h i c6 cac dau hieu dau moi mof ho

Of cot song, or he thong xiiong khdp, doc cac xi/ong dai (dac biet

xuong cang chan), dau moi co bap, vgp be

60 • T/^-^Aa.^C,/^^^^

f)6na Y gfrt Cac bac si chuyen khoa se cho k i e m tra:

• Chup X-quang xUang hodc cot song

• Bo khdi luang xUang (Bone Mass Bensity - BMB)

• Lam cac xet nghiem kiim tra

• Kham vd phdt hien cac yeu to nguy ca

K h a m benh v a theo doi dinh k y (tuy mijfc do benh) Luon CO y thuTc phong benh (suo't cuoc dcfi)

Che do sinh hoqt, tap luyen tdng cUdng hoqt dgng ngodi trdi, tap van dgng thudng xuyen vd phu hap vdi siCc khoi, duy tri loi song ndng dgng, trdnh cdc thoi quen xdu: udng nhieu bia, rilau, cafe, thudc Id

• Che do dn udng luon luon bdo dam mot che do dn udng day

da Protein vd khodng chat, ddc biet la Calci Vi vdy sUa vd

cdc che phdm til sUa (Ba, Phoma, Yaourt ) Id thiic dn ly tudng cho mot khung xitang hhoe mqnh

he do nay can ducfc duy tri suo't cuoc dori mOi ngifofi

K i e m soat to't cac benh ly anh hirdng v a cac yeu to nguy cO cua benh

So* dung cdc thuoc dieu tri lodng xiiofng

1 K e t hop thuoc cho'ng hiiy xuong va thuoc tang tao xiTOng:

- Bisphosphonate + Calci va Vitamin D

- Calcitonin + Calci va Vitamin D

- Hormon thay the + Calci va Vitamin D

2 K e t hop cac thuoc cho'ng hiiy xirong va thuoc tang tao xiTOng:

- Isphosphonate + Hormon thay the' + Calci & V i t a m i n D

- Calcitonin + Hormon thay the' + Calci & V i t a m i n D

- Biphosphonate + Calcitonin + Hormon thay the + Calci & Vitamin D

f)6nfl Y gfrt at|"

Cac bac si chuyen khoa se cho cac chi dinh dieu t r i , tuy thuoc

vao tutig ca the, mure do loang xUcfng, tinh trang sufc khoe, thoi

quen sinh hoat, kha nang k i n h te' cua mSi ngiTcfi benh

Phong h^nh

- Loang xUOng hien la van de mang tinh toan cau, benh loang

xirong va cac bien chilng nang nhii g§y co xuorng dui, g l y xiicfng cd

tay, gSy xep dot song la mot ganh nang do'i vdi y te cong dong

v i chi phi dieu t r i cho benh loang xi/ofng rat 16n, viTgrt qua kha

nang ciia phan Idn benh nhan (phan Idn cac thuoc cho'ng hiiy

xi/ong deu dat tien)

- Tuy nhien, phong benh se k i n h te hofn chOfa benh rat nhieu,

day la giai phap to't nhat cho moi quo'c gia, dac biet cac nifdc

ngheo nhiT niTdc ta

- Hay phong ngtfa benh loang xuong bang viec "dau tif cho

xufong ciia ban" va "dau t\i cho xUOng ciia con ban" cang s6m cang

to't Do'i vdi nhufng ngiTofi thuoc nhom c6 nguy ccf cao ke tren, ngoai

mot che do an hcfp ly, c6 the sijf dung thifc pham chuTc nang nhiT

cao xUcfng ngifa, mot difcfc lieu da duforc ong cha ta suf dung hang

ngan nam nay phong ngilfa va dieu t r i cac benh ve xUcfng khofp

Cao xiTorng ngiTa da diTofc khoa hoc hien tai chufng minh c6 ham

lifcfng cao calci hOfu co, acid amin va cac nguyen to' v i lufcfng khac,

CO tac dung bd sung di/dng chat cho cof the dac biet la he xUOng

khdp Hien nay tren t h i triTdng da co san pham Cao xiToing ngiTa

Tue L i n h , san xuat tiT ngudn xUcfng ngiTa bach

21 Xa VUfADQNG MACH

Xor vffa dong mach la tinh trang xuat hien

mang bam ben trong dong mach Mang bam

nay diTcfc tao ra bdri m5, cholesterol, canxi va

nhOfng chat khac co trong mau Theo thofi gian,

mang bam se cutng dan len va lam hep dong

mach la giam liTong mau giau oxy den nuoi

62 •:• / A i / , v >§£,./v

^6nfl Y gfrt at|u

di^^ng cac ccf quan va nhufng bo phan khac cua ccf the d i n den nhieu hau qua nang ne bao gdm nhdi mau ccf t i m , dot quy hoac tham chi co the tur vong

Tri$u chiing

• Xo vUa dong mach thudng khong gay ra nhUng dau hieu hay trieu chiing ndo cho den khi no lam cho dong mach bi hep nang hoac bit tdc hoan toan Nhieu ngUai tham chi khong biet rhng ho co benh cho den khi phdi vao phong cap ciiu do nhoi man ca tim hoac dot quy

• Mot so ngudi co nhUng bieu hien va trieu chitng ciia benh tuy thuoc vao dong mach nao bi hep hoac bit tdc

• Dong mach vdnh:

- Dong mach vanh cung cap mau giau oxy cho t i m nen k h i bi mang xcf vQa gay hep hoac bit tac (tinh trang nay difgfc goi la benh mach vanh) t h i trieu chufng thirdng gap se la dau ngiic hoac

CO cam giac kho chiu or ngUc k h i ccf t i m khong dxigc cung cap dii

mau Benh nhan cung co the cam tha'y b i de nen hoac co that of

long nguc Nhilng cam giac nay cOng co the xuat hien d vai, tay,

cd, ham hoac lUng

- Corn dau CO the nang hon k h i van dong va khoi k h i nghi ngcfi NhiJng stress ve cam xiic cung co the lam khori phat com dau

- Cac dong mach canh cung cap mau giau oxy cho nao nen k h i

bi mang xa vufa gay hep hoac bit tAc t h i benh nhan co the se bi

dot quy Benh nhan co the dot ngot co cam giac te, yeu va hoa mat, chong mat

Nguyen nhan

- Nguyen nhan chinh xac gay xor vufa dong mach van chiTa dirorc biet den Tuy nhien, co mot so' nghien cufu cho tha'y rang xo vfla tJgng mach la mot tien trinh tien trien cham, phiifc tap va co the bat dau tir luc benh nhan con nho No se tien trien nhanh horn

k h i tudi ngay cang Idn horn

T / W c y\tutv (LUOa i^dt^k • 63

- Xof viJa dong mach c6 the bat dau k h i c6 m o t so' tac n h a n gay

ton t h i f o n g Idp t r o n g ciia dong mach N h O n g tac n h a n do bao

g o m :

• Hut thuoc Id " '

• Liiang chat beo vd cholesterol cao trong mdu

• Tdng huyet dp

• Luang dudng trong mdu cao do de khdng insulin hoac ddi

thdo dudng

Nhiing ngitcfi c6 nguy cct

- B e n h m a c h v a n h ( m a n g xor vOfa xuat h i e n or mach vanh) la

nguyen n h a n gay tijf v o n g h a n g dau t a i M y

- B a n CO the k i e m soat durgc hau h e t cac yeu to' nguy co giup

n g a n ngiifa hoac l a m c h a m l a i t i e n t r i n h ciia benh M o t so' yeu to'

nguy cor k h o n g the k i e m soat difoc

- Nhufng yeu to' nguy co c h i n h :

• Nong do cholesterol trong mdu bat thudng

• Tdng huyet dp

• Hut thuoc Id

• Be khdng insulin

• Bdi thdo dudng Thiia can hoac beo phi

• Thieu van dong

• Tuoi Tudl cdng cao thi nguy ca bi xa vUa dong mach cung

cdng tdng

• O nam gidi, nguy ca gia tdng sau 45 tudi

• U nU gidi, nguy ca gia tdng sau 55 tudi

• Tien sii gia dinh bi benh tim mach sdm

- N g o a i r a cung cd m o t so ye'u to' nguy ccr khac c6 the l a m gia

t a n g nguy ca b i xo viifa dong m a c h bao gom:

6 4 • Tl^;^cy\u,.(L/^i^^^

NgiAig t h d liic ngii L a k h i b a n ngCmg t h d hoac t h d r a t n o n g

j j i i dang ngu N e u k h o n g difcfc d i l u t r i c6 the l a m t a n g nguy ccf b i tang huyet ap, d a i thao difcfng va t h a m c h i l a n h o i m a u co t i m hoac dot quy

Stress

Rugfu b i a

Chan dodn

Bac S I se chan doan xo viJa d6ng m a c h difa vao cac yeu t o :

• Tien sH benh tat vd gia dinh

do m a n g xo vijfa

Bac SI cung co the k i e m t r a x e m m a c h of m o t v i t r i nao do t r e n

ccf the b a n (chang h a n nhiT chan) c6 yeu hoac m a t k h o n g M a c h yeu hoac m a t la bieu h i e n ciia t i n h t r a n g dong m a c h b i b i t tac

Cdc xet nghi?m vd thu thudt

Cac bac sl co the thirc h i e n m o t hoac nhieu x e t n g h i e m de c h a n doan benh N g o a i r a nhOCng xet n g h i e m nay con giup bac si b i e t diroc sir tie'n t r i e n cua b e n h va chuan b i ke hoach dieu t r i to't n h a t

• Xet nghiem mdu

Dien tdm do (ECG - Electrocardiogram)

• Nghiem phdp gang siic

• Chup mach mdu

Dieu tri

Dieu t r i xor viJa dong mach bao gom thay doi loi song, uong

thuo'c, thu thuat hoac p h l u thuat

T h a y doi loi song

• Thay doi loi song thiCcmg c6 thi giup ngan ngila hoac dieu

tri xa vUa dong mach Boi vdi mot so ngubi, nhUng thay dot

nay c6 the du di dieu tri diigc benh

• An nhUng thiic dn c6 it chat beo bao hoa vd nong do

choles-terol thdp

• Khong dn mudi trong bUa dn neu bi tdng huyet dp

• An nhieu thiic dn c6 chiia chat xa (iihu ran qua vd trdi cay)

• An cd it nhdt 2 Idn/tudn

• Bo thudc Id

• Gidm can neu thiCa can ^

• Tap the due diCdi sU tu vdn cda bdc si

• Neu benh nhdn cd nong do dudng trong mdu coo, can phdi

theo doi dubng huyet vd HbAlc thu&ng xuyen

Dieu tri

Muc tieu cua qua t r i n h dieu t r i la phuc hoi l a i dong chay cua

mau den nori b i anh hirdng het mufc c6 the Muc tieu nay c6 the dat

diToTc bang each giam nhttng yeu to' nguy co qua mot so" hxidc sau:

• Udng thudc de dieu hoa huyet dp neu bi tdng huyet dp

• Udng thudc di dieu hoa dUdng huyet, ddc biet d nhUng benh

nhdn bi ddi thdo dubng

• Udng thudc de gidm lipid mdu neu nong do chat ndy trong

mdu cao NhUng loai thudc ndy giup Idm gidm LDL va

triglycerid vd tdng HDL Statin la loai thudc ha lipid mdu

Tdp the thao, gidm can, vd thay ddi che do dn cung giup lam ngdn ngiia tien trinh xa vSa

Aspirin cung nen dUgc dung deu dan d nhUng ngubi dd c6 mdng xa vUa d bat ky dong mach ndo vd nhitng ngudi c6 nguy CO cao Aspirin ngdn khong c6 cdc tieu cdu c6 trong

mdu ket dinh Igi vdi nhau hinh thdnh huyet khdi vd Idm bit tdc nhUng dong mcich dd bi hep til trildc do mdng xa vUa

trong gia dinh b i benh nay, hay noi vdi hac si Ngoai ra cung bao

cho bac si biet ne'u nhiT ban c6 hut thuo'c la

Xo vufa dong mach la qua t r i n h d i l n bien lang le va lau dai, sir boi dap dan dan cac chat cholesterol, triglycerid lam cho Idp xcf rat ben va kho loai bo Hien nay cac chat saponin c6 cau true triterpen trong thao diTcfc diTcrc cho la c6 kha nang "hoa tan va tay rufa" dan dan cac Idp l^ng dong do, trong k h i cac chat flavonoid

thi lai CO tac dung lam deo dai thanh mach mau, cho'ng thoai hoa

va bie'n dang te bao thanh mach

T / W t ^dt^A •:• 67

Ten hhac: Bac ha nam, rau Hiing cay, Doc mung

Ten khoa HQC: Mentha Arvensis L i n n ,

thuoc ho Hoa moi (Lamiaceae)

Thanh phdn hoa hgc: Hoat chat chu ye'u

la t i n h dau Bac ha nhu menthol, la loai t i n h

dau quy, c6 gia t r i de xuat khau

Cong dung: ChUa cam sot, ho viem hong

tieu Ngoai ra dung de xoa bop noi dau nhiJc

khdp xiTOng, nhiJc dau, so mui, dau nhufc rang

Cdch dung: La tuori moi ngay 4 - 8g sac

uong, hoac nau niTdc xong Neu dung t i n h

dau, m6i Ian uong vai gipt, ngay uong 2 - 3 Ian Neu la con Bac ha

t h i uong m6i Ian 5 - 10 giot Dung xoa ben ngoai thucfng la cac

loai cao nhif cao sao vang con ho deu c6 t i n h dau Bac ha Ngoai

ra con dung lam keo Bac ha de ngam ho, viem hong va pha vao

thuoc danh rang cho thcfm Tinh dau Bac ha cham vao cho rang

dau

68 • TAu^^nn^CAou/^f^A

Cdch che bien: Cay moc hoang nhieu noi trong nUdc, ngi/cfi ta jgy canh dem ve trong cho dat am mat, nhieu mun Co the thu

j i ^ i 4 Ian trong nam vao thang 6 - 7, 8 - 9, 10 - 11 va 2 - 3 Hai

ve phori tai xong dem cat tinh dau Tinh dau Bac ha la loai thuoc

quy, CO gia t r i xuat khau, can khuyen khich trong va cat t i n h dau

2 - TIA TO

Ten hhac: Tuf to

Ten khoa hqc: Perilla Ocymoides L thuoc ho hoa moi

(Labiatea)

Thanh phdn hoa hgc: Toan c a y c6 chuTa t i n h d a u mui therm

Cong dung: ChOra cam cum, sot ho,

lam ra m d hoi, giai cam, t r i non muTa,

dau bung, c6 tac dung an thai dung cho nhufng trirofng hcfp dong thai, giai doc khi an phai ca, cua doc

Cdch dung: La hoac qua kho, m6i

ngay 5 - lOg sac uong, neu dung canh la

kho t h i lieu gap doi, c6 the dung la txidi

gia nho vat lay nUdc uong m6i Ian 30g (Cam ky: kieng an ca chep)

20-Cdch che bien: Tia to la loai cay

diXofc trong khap ncfi vira de lam gia v i trong cac mon rau song vira de lam thuoc

Trong bang hat vao dau xuan, sau hai

thang CO the hai la gia, m6i nam hai 2-3 Ian, cuo'i cung chat lay

canh va hat gia Cac thil do phori kho, diTdfi nang nhe, de rieng tifng loai va bao quan chohg am moc

3- KINH Gldl

Ten khdc: Canh gidi, Khirong gidi, K i n l i gidi tue, Gia to

T/u^c (LkdM / ^ c « / v 69

Ten khoa hgc: Elsholtzia cristata Willd, thuoc ho hoa moi

(Lamiaceae)

Thanh phdn hoa hgc: Thanh phan chu yeu la tinh dau nhu

menton va 1 i t limonen c6 v i cay, mui thcfm, khong doc

Cong dy,ng: ChOra cam cum, nhufc dau, viem hong, non mufa

chay mau cam, di tieu ra mau, dai tien c6 mau trong cac chiJng ly,

bang huyet sau de

Cdch dung: Dung la tiroi 1 nam gia nho vdi 1 mieng GiTng,

vat lay nirdc uong, lay ba con lai xoa bop minh may chan tay de

chila cam sot, hoac canh la kho, do 20g sao vang sac uong Phu nuf

bang huyet t h i dung hoa phoi kho sao den 15g sac uong Canh la

sao den s^c uong thifdng dung cam mau trong cac benh khac

Cdch trong, thu hdi vd che bien: Trong bang hat vao dau

xuan, nho ca cay phoi kho vao miia thu neu lay hoa rieng goi la

K i n h gidi tue Nen phoi nang nhe, bao quan cho'ng am moc

4 - H a C l N G N H U

Ten khdc: Huong nhu tia, HiTorng nhu trang, ritog, tia, t,

Idn la, Hiing gioi tia

Ten khoa hgc: Ocimum sanctum Linn (HiTorng nhu tia) thuoc

ho hoa moi (Lamiaceae)

Huong nhu trang: Loai cay nho cao horn loai tia, la moc do'i

treo chuf thap, mep khia rang ciTa, dau nhon dai, c6 long Hoa mau

trang, moc thanh chum of ke la hoac ngpn canh Hat nho hinh

cau, khong c6 chat nhay bao quanh k h i ngam trong n\idc

Thdnh phdn hoa hgc: Ca 2 loai hiTOng nhu noi tren deu c6

tinh dau ogenola, nhitog loai trang cho tinh dau cao hcfn Loai

tinh dau nay diTpc dung lam thuoc te trong nha khoa va dieu che

chat thom vani (vanilin)

Cong dung: Chufa cam cum, so't nhufc dau, dau bung non, tieu

chay, dau rang Cam ky: nhflfng ngiTofi am hif, k h i hiT (suy nhiTcfc)

khong dung difofc

70 •:• e / « j « / ^ e ^ v

Cdch dung: M6i ngay dung 3-8g (than va canh la phoi kho)

g^c uong Co the uong tLfori va dung l a ti/ofi nau nirdc xong Dung

tinh dau cham vao chS rang sau cho dd nhuTc

Cdch che bien: Gieo hat vao thang 11-12, trong vao mua

xuan Thu hai liic cay dang ra hoa, phoi kho diTdi nang nhe hay

trong ram Cay tiroi cat lay tinh dau dung trong midc va xuat

khau <

5 - GL/NG

Ten khdc: Khi/ong, Sinh khirong

(Gitog song), Can khiTOng (Gitog kho)

Ten khoa hgc: Zingiber officinale

Roseoe, thuoc hp Gitog (Zingiberaceae)

Thdnh phdn hoa hgc: Thanh phan

chij yeu la t i n h dau c6 camphen va phelandren, mot so' chat cay khac

Cong dung: Kich thich tieu hoa

dung trong nhiJng trUomg hop kem an, kho tieu, non mufa, dau bung tieu chay, chufa cam cum, so't ho, viem hong, dung trong cac triTcfng hop cam lanh va xoa bop dau

Thifomg dung trong cac bai thuo'c khac c6 tac dung dieu hoa am

han (kem chiu lanh) ma l a i c6 tac dung giai bieu nen l a i chUa

dupfc cam so't

Cdch dung: Gitog tuoi (sinh khucrng) 4-8g 1 ngay

Gitog kho (can khuong) 0,6-4g 1 ngay

Sac uong hoac gia nho ngam rUcfu uong Dung xoa bop t h i gia

oho GUng tuoi xoa bop dap len cho dau hoac pha vdi rUpu lam cho

Giifng ngam nhanh vao ch6 dau

Cdch che bien: Chpn nhufng cii GUng c6 nhieu mau, dem u rom

cho len mam roi dem trong vao mua thu va thu hoach vao dip

TA^t: / U i / » (Z/Uiu / ^ C / v / v • 71

te't de CO Gitog non lam murt; muon c6 Gitog gia t h i de sang mua

xuan K h i cay gan tan lui dao lay cu ve cSt bo r l con, rufa sach

phori kho, ta c6 Gitog xam, neu cao v6 phori kho, ta c6 GiJfng trang

de xuat khau Con de dung hang ngay t h i de ngay tren nen dat

trong nha cho den k h i trdng vu sau Co the lui xuong 1 Idp cat kho

mong, bao quan to't horn

6 - cue HOA

Ten khdc: Cue hoa trang Bach cue hoa, Cam cue hoa, cue diem

vang, Hoang eiic, K i m cue

Ten khoa hgc: Chrysanthenum Simense Sabine

Cue hoa trang: Chrysanthenum Morifolium

Cue hoa vang: Chrysanthenum Indicum L i n n , thuoe ho cue

(Asteraeeae)

Thanh phdn hoa hgc: Trong hoa cue c6 adenin, cholin,

stachydrin, vitamin A, tinh dau va sac to'

Cong dung: Chffa cam mao, nhiife dau, dau mat, cao huyet ap,

chfifa mun nhot

Cdch dung: Moi ngay 9-15g sac uong, hoae dimg ngoai de nla

vet thifong, dap mun nhot

Cdch chebien: Thiromg trdng bang canh, hoae gieo hat, trdng

vao thang 5, thu hoach hoa vao thang 9 Co the trdng vao thang

3 den thang 6 chat trui di cho nay mam l a i , thu hoach hoa vao

thang 10, hai hoa ve dem say diem sinh do 2-3 gior k h i hoa chin

mem t h i dem nen do 1 dem k h i thay nifdc den chay ra la duac

Dem phori 3-4 nang, ne'u trori khong nang t h i dem phai say diem

sinh K h i phori gd ra ditog cho dong cue, phori kho Bao quan cho'ng

Cong diing: Chufa cam so't, giup tieu hoa to't, Icfi tieu, sat

trung, cho'ng dau nhufc, lam chat thorm dimg trong cong nghiep

Cdch dung: M6i ngay 15-30g than r l hoae la t\i&\c uong hoae nau nifdc xong giai cam

Cdch chebien: Trong bang than re vao miia xuan Thu hai quanh

nam lam thudc, rang vcfi muoi lam thufe an va cat lay tinh dau

8 - KIM NGAN

Ten khdc: K i m ngan hoa, day Nhan dong

Ten khoa hgc: Lonicera, japonica Thumb, thuoe ho k i m ngan

(Capri Joliaeeae)

Thanh phdn hoa hgc: Mot so tac gia tim thay inozit, glucozit

la lonixerin va saponozit, ngoai ra chifa thay hoat chat gi dac biet

Cong dung: Co tac dung khang khuan, dimg chiJa cae benh nhigm t r i m g nha mun n h p t , ta, ly, triJc t r i m g , thiTcfng han, viem

dUcfng ho hap, giai doc, giai di iJng dung t r o n g cac benh di ufng,

ndi me day ngufa ngay

Cdch dung: Dimg hoa, la hoae

ca than canh phoi kho sac uong Moi ngay 5-lOg hoa hoae 10-20g l a ,

canh, CO the dung tori 80g 1 ngay,

khong doe

Cam ky: Ngifcfi yeu met suy nhiforc (ty v i hif han) va khong c6 nhiet doc khong nen dimg

Ti^c -n«.,v e/ u ? « « ^ ^ » / v • 73

f )6na r sTrt atgu

Cdch chebien: La loai cay moc hoang tren niii doi thap, v i la

loai thuo'c c6 gia t r i nen dem ve trong trong vUcfn, trdng bang

than day vao miia xuan va mua thu Thu hoach hoa vao dau mua

he, canh va la thu hoach quanh nam Hoa, la va canh lay ve phcfi

kho hay say kho la difcfc, bao quan cho'ng am moc, hoa de rieng,

tranh lam nat vun

9 - SAI DAT

Ten khdc: Hung tram Cue nhap, Cue giap, NgS mui, Hoa muc

Ten khoa hQc: Wedelia Calendulaceae, thuoc ho cue

(Asteraceae)

Thanh phdn hoa hoc: Hoat chat chinh chifa xac dinh diTgrc,

mdi thay eo 1 chat lacton vifa la 1 Flanovit vijfa la 1 Cumarin,

ngoai ra eo nhieu muo'i v6 cof va tinh dau

Cong dying: Chufa mun nhot, viem ca, viem vii, rom say, lof

loet

Cdch dung: Lay cay la tiTori gia nho vat lay nirdfc uo'ng moi

ngay 25-30g Ba dap len cho viem dau, nau lay mrdre tam rufa mun

nhot, ghe sai La kho sac uo'ng hoac tam riifa nhif tren Co the

pho'i horp vdi cac vi khae nhu K i m ngan, Bd cong anh

Cdch che bien: Cay moc hoang ncfi dat am, mat, lay canh c6

r i dem trdng chd dat am mat hoac tu6i luon, thu hai canh la

quanh nam, dung tirai hoac phori kho

10- BO CONG ANH

Ten khdc: Mui mac, Diep dai, Mui cay Mot met, Bd coc

Ten khoa hgc: Lactuca India Linn, thuoc ho cue (Compositae)

Thanh phdn hoa hgc: Loai Bd cong anh eua ta chiTa c6 ai

nghien ciJu Mot so' tai lieu mrdfc ngoai nghien cufu cac loai Bd cong

anh khae thay c6 chat lactuxerin va mot so' chat dang nhi/ axit

lacturic, lactueopicrin va lactuxin

74 • 't/^^y\^ejui«.J^4,j^

Cong dung: ChOa viem tuyen vu, tac tia sOfa, mun nhot, dinh

rau, viem diJcfng tie't nieu, an uo'ng kho tieu, dau da day

Cdch dung: Dung la tuori 20-40g gia nho vat lay nudc uo'ng, ba

^Ip len ehd sung dau

H - K E D A U N G ^ A

Ten khdc: Thirang nhi

Ten khoa hpc: Xanthium Strumarium L i n n , thuoc ho cue

(Compositae)

Thanh phdn hoa hgc: ngoai mot so' chat thong thiTofng c6

thay 1 glucozit la xanthostrumarin, ehu'a thay hoat chat dac biet,

ma dac biet la eo ham lifcfng io't khd eao, I g la hoac than c6 khoang 200 mierog, trong qua c6 220-230 microg io't

Cong dung: Co tac dung giai cam, chOfa sot, trir phong thap,

dau nhiirc te moi chan tay, ehOa di ufng, mun nhot lof ngufa, dau

nhiirc rang, chOfa h\idu cd do thie'u io't

Cdch dung: Dimg qua, canh la kho ngay 4-20g sac uo'ng, dimg

chOfa dau rang t h i sac ngam nhieu Ian

Cdch che bien: Cay moc hoang khap nori Co the lay hat

trdng vao mua xuan Thu hai la canh vao mua he, qua vao mua thu, dem ve phcfi hoac say kho Bao quan cho'ng am, moc

12-MA BE

Ten khdc: Ma de thao, Xa tien

Ten khoa hgc: Plantagor asiatia L i n n , thuoc ho ma de

(Plantaginaceae)

Thanh phdn hoa hgc: Toan cay eo ehu'a 1 glucozit goi la

ancubin hay rinantin Ngoai cac thanh phan thong thi/cfng, trong

hat CO ehiia axit plantenolic, adenin va eholin

Cong dung: Co tac dung lofu tieu, ha huye't ap, t r i ia chay, ly,

chufa ho, long dorm

T/uaff yXtu^ (Lluiu i^4.,J^ •:• 75

Cdch dung: D u n g hoa phcfi kho, sac uo'ng

ngay 6-12g, c6 the dung M tuai nau canh

a n Igri t i e u

Cdch che Men: Cay moc hoang, lay h a t

dem ve gieo t r o n g vao mua t h u , t h u h a i qua

c h i n vao t h a n g 7-8 Cay la t h u h a i quanh

n a m , dung l a tUcri hay phcfi kho Qua c h i n

p h o i k h o , dap lay h a t r d i phcfi k h o l a i Bao

quan cho'ng a m moc

1 3 - K H O S A M

Ten khdc: Sau dau ritag, Sau dau cuft chuqt, N h a d a m tuf, h a t

K h o sam, K h o luyen tijf, Chu m e n , Sam duc, Cuft c6 H a t b i n h ,

Xoan rirng

Ten khoa hgc: Brucea javanica M e r r , thuoc ho T h a n h t h a t

(Simarubaceae)

Thanh phdn hoa hgc: H a t SAu dau rirng chiifa chat dau long

m a u t r a n g , t r o n g qua c6 1 glucozit gpi la k o s a m i n C h a t nay k h a

doc, CO tac d u n g d i e t t r i m g va d i e t giun san D u n g l i e u cao se b i

ngo doc chet ngudi Ngoai ra con c6 1 so' m e n n h u a m i d a l i n , m o t

so' chat khac nhif t a n i n , quasin va saponin

Cong diing: L a 1 v i thuoc chijfa l y a m i p da di/cfc dung t i f thofi

Tue T i n h , c6 tac dung diet k y s i n h t r u n g a m i p or d a n g h o a t dong,

con dang k e n t h i i t cong hieu Ngoai ra con dung de chiJa so't r e t ,

tieu chay va u n g thiT

Cdch diing: M6i ngay diing 10-14 qua (c6 the t d i 20 qua), t a n

t h a n h bot hoac l a m t h a n h v i e n de uo'ng, uo'ng l i e n t r o n g 1 t u a n

le Co t h e d i m g n h a n h a t da loai bo dau (loai bo tac dung gay n o n

va d i long) b a n g each khijt dau hoac ep bo dau Co the dung de t h u t

vao h a u m o n , l a y 20-30 qua gia nho n g a m vao t r o n g 2 0 0 m l nirdc

bicabonat N a 1% sau 1-2 giof gan loc l a y nudc t h u t giijf

76 • T/iw-^: ;%u« eA

$)6nfl Y gTrt SLi$u

Cam ky.: NgUofi suy nhuofc ( t i v i h u nhirac) n o n mufa k h o n g n e n

dung- P h u nuf c6 t h a i vSn dung duofc

Cdch che bien: Cay moc hoang k h a p n o i , t h u h a i qua c h i n

v^o t h a n g 8-12, dem ve p h a i k h o

1 4 - H O A C H a d N G

Ten khdc: Quang hoac hucfng, Tho hoac hucfng

Ten khoa hgc: Pogostemon c a b l i n (Blanco) B e n t h , thuoc ho

hoa m o i (Labiatae)

Thanh phdn hoa hgc: T h a n h p h a n chu ye'u la t i n h dau c6

nhieu chat n h u con patchouli (goi la l o n g nao) v.v

Cong dung: ChOfa r o i loan tieu hoa, a n k h o t i e u , dau bung,

tieu chay, ngoai r a dung de chffa cam cum

Cdch dung: M 6 i ngay dung 6-12g difcJi dang bot, hoac sac

uo'ng, CO t h e pho'i hgrp v d i cac v i khac

Cdch che bien: cay ducfc t r o n g n h i e u nofi t r o n g nufdc, t r o n g

bang each g i a m c a n h vao mua x u a n T h u h a i canh va l a sau 3 thang, phcfi hoac say k h o d i i n g l a m thuo'c N g o a i r a con cat l a y

t i n h dau, l a 1 nguyen lieu quy t r o n g k y nghe nudfc hoa

1 5 - R I E N G

Ten khdc: Cao lucfng khuorng, Tieu liTcfng khucfng, Phong khucfng Ten khoa hgc: A l p i n i a o f f i c i n a r u m H a n c e , thuoc ho g i t o g

(Zingiberaceae)

Thanh phdn hoa hgc: T h a n h p h a n chu ye'u l a t i n h dau l o n g

sen set, m a u v a n g x a n h , t r o n g do eo chat xineola va m e t y l x i n a m a t Ngoai r a c6 1 chat dau v i cay la galangola va m o t so' chat t i n h the dan chat ciia plavon

Cong dying: ChOra r o i loan tieu hoa: a n k h o t i e u , day b u n g ,

tieu chay, dau bung, dau da day Ngoai r a eon d u n g de ehtta cam sot, l a m gia v i cho cac m o n t h i t ea t a n h

Xiu^c '^?<*A 77

Cdch dung: M6i ngay uong 3-lOg bot rieng kho hoac thai

mong sac uong - •' •

Cdch trong, thu hdi va chebien: Trong bang cu v a than vao

dong xuan, thu hai quanh nam Dao cu rijfa sach cat bo r e con, cat

thanh titog doan ngan phoi kho hoac do chin roi phoi kho Khi

diing t h i ngam nUdc, thai lat phofi kho tan bot hoac sac uong

16 - M O T A M T H E

Ten khdc: Day Mo long, day Mo tron, cay Tho'i dit

Ten khoa hqc: Paederia Tomentosa Linn, thuoc ho ca phe

(Rubiaceae)

Thanh phdn hoa hgc: Cay c6 chiifa 1 t i n h dau rat trang c6

miii bisunfua cacbon NgiTcfi ta da chiet ditcfc 2 ancaloit la paederin

anpha va be ta

Cong dy,ng: ChiJa ly triTc trung, or Philippin ngifofi ta con dung

de chiifa bi tieu tien, soi than

Cdch dung: Dung 30-50g la tiroi rufa sach, thai nho, tron vdi 1

qua triJng ga goi vao la chuo'i niTdng chin hoac cho vao chao

(khong cho m d ) bac len bep cho chin de an Diing lien tuc 1 tuan

Cdch che bien: Cay moc hoang khap bui bor, lay tiTng doan

day dem ve trong nhiT trong khoai lang, an chat dat, t\i6i nifcJc

luon de chong ben r l K h i cay leo cao t h i cam choai hoac lam gian

cho no bo Co the thu hai la tifcfi quanh nam

17-Mac H O A T R A N G

Ten khdc: Moc hoa trang, MiJc long, Mird'c, Thitag mUc, cay

Stfng trau

Ten khoa hgc: Holarrhena antidysenterica Wall, thuoc ho

true dao (Apocynaceae)

Thanh phdn hoa hgc: Ngu&i ta d a chie't diTdc cac ancaloit

nhir: conesin, norconesin, conesimin conkurchin v a holarhenin

78 • n««v'e/«j«

t)6ng Y gfrt

Conesin i t doc c6 tac dung diet amip tot hcfn ametin v i no diet di/cfc ken amip ' ' ••

Cong dung: Chffa ly amip cap va man tinh (the ken)

Cdch dung: Co the dung cac dang sau:

- Bot v6 cay ngay uong lOg Bot hat cay ngay uong 3-6g Cao long ngay uong l-3g Con hat (ty le 1/5) ngay uong 2-6g

Cdch che bien: Thi/ofng thay hat roi xuong va t u moc hoac ta

lay hat de gieo, trong vao mua xuan Boc lay v6 cay k h i cay rung

la (vao mua dong), khong nen boc het de cay khoi chet va c6 the boc Ian khac Thu hoach qua gia vao mua thu dong Qua hoac v6 deu di/cfc phofi hay say kho ngay, khong phori kip se bi tho'i

I S - C O S Q A N H O L A

Ten khdc: Thien can thao

Ten khoa hgc: Euphorbia thymifolia Burm, thuoc ho thau dau

(Euphorbiaceae)

Thanh phdn hoa hgc: Chira thay c6 t a i lieu nghien cufu

Cong dving: Chflfa ly triTc trung v i c6 tac dung khang sinh,

ngoai tac dung chiJa ly con chiifa cac nhiem trung khac nhir ho, viem phe quan, cac viem n h i l m mun nhot khac va t r i bang huye't

Cdch dung: Diing cay va la ti/cri hoac kho sac uo'ng m6i ngay

25-30g CO the dimg tdi 50g ThiTofng pho'i hdp vdfi rau sam de chiia

ly Neu dimg de cam mau t h i sao den, sac dac

Cach trong, thu hai va che bien: Cay moc hoang d cac ncfi c6

soi da, cac ke san gach, cac bof thanh ao ho Co the dem ve trong

va thu hai quanh nam Dimg tiTcri phoi kho hoac say, sao vang

Bao quan cho'ng am moc

Ti^^ n « « v C^kcu i^p^ 79