Hướng dẫn Quy trình kỹ thuật khám bệnh, chữa bệnh chuyên ngành Châm cứu

B Y T

S: 792 /Q-BYT

CNG HA X HI CH NGHA VIT NAM c lp- T do- Hnh phc

H Ni, ngy 12 thng 3 nm 2013

QUYT NH

V vic ban hnh Hng dn Quy trnh k thut khm bnh, cha bnh chuyn ngnh Chm cu

B TRNG B Y T Cn c Ngh nh s 63/2012/N-CP ngy 31/8/2012 ca Chnh ph quy

nh chc nng, nhim v, quyn hn v c cu t chc ca B Y t; Xt Bin bn hp ca Hi ng nghim thu Hng dn Quy trnh k thut

khm bnh, cha bnh chuyn ngnh Chm cu ca B Y t; Theo ngh ca Cc trng Cc Qun l Khm, cha bnh,

Quyt nh:

iu 1. Ban hnh km theo Quyt nh ny 468 Hng dn Quy trnh k thut khm bnh, cha bnh chuyn ngnh Chm cu. iu 2. Cc Hng dn Quy trnh k thut khm bnh, cha bnh chuyn ngnh Chm cu ny p dng cho tt c cc c s khm bnh, cha bnh c iu kin thc hin theo quy nh hin hnh. iu 3. Quyt nh ny c hiu lc t ngy k v ban hnh. iu 4. Cc ng, B: Chnh Vn phng B, Cc trng Cc Qun l Khm, cha bnh, Chnh thanh tra B; cc V trng, Cc trng cc V, Cc ca B Y t; Gim c cc Bnh vin, Vin c ging trc thuc B Y t, Gim c S Y t cc tnh, thnh ph trc thuc trung ng; Th trng Y t cc B, ngnh v Th trng cc n v c lin quan chu trch nhim thi hnh Quyt nh ny./. Ni nhn: - Nh iu 4; - B trng ( bo co); - Lu: VT, KCB.

KT. B TRNG TH TRNG

k

Nguyn Th Xuyn

B Y T CNG HA X HI CH NGHA VIT NAM c lp - T do- Hnh Phc

DANH MC HNG DN QUY TRNH K THUT KHM BNH, CHA BNH CHUYN NGNH CHM CU

(Ban hnh km theo Quyt nh s 792/Q-BYT ngy 12 thng 3 nm 2013 ca B trng B Y t)

S TT

DANH MC QUY TRNH K THUT

A. K THUT CHUNG (14) 1. Mai hoa chm 2. Ho chm 3. Mng chm 4. in chm 5. Thy chm 6. Cy ch 7. n chm 8. Cu 9. Chch l 10. Laser chm 11. T chm 12. Quy trnh in chm, xoa bp bm huyt kt hp ko gin ct sng c 13. Quy trnh in chm, xoa bp bm huyt kt hp ko gin ct sng tht lng 14. Quy trnh xoa bp bm huyt kt hp xng- tm tho dc

B. CHM T PHU THUT (85) 15. Chm t phu thut ct polip mt on i trng phi ct on i trng pha trn lm

hu mn nhn to 16. Chm t phu thut cng dui khp gi n thun 17. Chm t phu thut ct ton b tuyn gip v vt hch c 2 bn 18. Chm t phu thut ct ton b tuyn gip, mt thy c vt hch c 1 bn 19. Chm t phu thut ct ung th gip trng 20. Chm t phu thut ct tuyn v m rng c vt hch 21. Chm t phu thut ct u tuyn nc bt mang tai 22. Chm t phu thut glaucoma 23. Chm t phu thut ly th thy tinh trong bao, ngoi bao, ra ht cc loi cataract gi,

bnh l, sa, lch, v 24. Chm t phu thut lc thng thng 25. Chm t phu thut ct u x vm mi hng 26. Chm t phu thut ct u cun cnh 27. Chm t phu thut ct u tuyn mang tai 28. Chm t phu thut tai xng chm trong vim tc tnh mch bn 29. Chm t phu thut xoang trn 30. Chm t phu thut ct u thnh sau hng 31. Chm t phu thut ct ton b thanh qun 32. Chm t phu thut so hp thanh - kh qun 33. Chm t phu thut trong mm sn thanh qun

34. Chm t phu thut ct dy thanh 35. Chm t phu thut ct dnh thanh qun 36. Chm t phu thut vng chn bm hm 37. Chm t phu thut vch ngn mi 38. Chm t phu thut ct polyp mi 39. Chm t phu thut no xoang trit trong vim xoang do rng 40. Chm t phu thut ct u nang gip mng 41. Chm t phu thut ct u nang cnh c 42. Chm t nh rng khn mc lch 900 hoc ngm di li, di nim mc, phi chp

phim rng chn on xc nh v chn phng php phu thut 43. Chm t phu thut ly ty chn rng mt chn hng lot 2 - 3 rng, ly ty chn rng

nhiu chn 44. Chm t phu thut ct hch lao to vng c 45. Chm t phu thut no p xe lnh h chu 46. Chm t phu thut no p xe lnh h lng 47. Chm t phu thut ct 2/3 d dy do lot, vim, u lnh 48. Chm t phu thut ct ti tha t trng 49. Chm t phu thut tc rut do dy chng 50. Chm t phu thut ct u mc treo c ct rut 51. Chm t phu thut ct on i trng, lm hu mn nhn to 52. Chm t phu thut sa trc trng khng ct rut 53. Chm t phu thut ct b tr vng 54. Chm t phu thut ni v trng 55. Chm t phu thut ct u mc treo khng ct rut 56. Chm t phu thut ct tr t 2 b tr ln 57. Chm t phu thut m thng d dy 58. Chm t phu thut dn lu p xe rut tha 59. Chm t phu thut ct rut tha v tr bnh thng 60. Chm t phu thut tht tr c km bc tch, ct mt b tr 61. Chm t phu thut ni nang ty - hng trng 62. Chm t phu thut ct ton b thn v niu qun 63. Chm t phu thut ly si m b thn trong xoang 64. Chm t phu thut ct mt na bng quang v ct ti tha bng quang 65. Chm t phu thut n lu thn qua da 66. Chm t phu thut dn lu nc tiu bng quang 67. Chm t phu thut ct dng vt khng vt hch, ct mt na dng vt 68. Chm t phu thut dn lu vim ty quanh thn, p xe thn 69. Chm t phu thut dn lu p xe khoang retzius 70. Chm t phu thut p xe tuyn tin lit 71. Chm t phu thut ct u si u ming so 72. Chm t phu thut ct hp bao quy u 73. Chm t phu thut ct ti tha niu o 74. Chm t phu thut m rng l so 75. Chm t phu thut ct ct c t cung 76. Chm t phu thut treo t cung 77. Chm t phu thut khu vng c t cung 78. Chm t phu thut iu tr hp mn v ph i 79. Chm t phu thut ng hu mn nhn to 80. Chm t phu thut ly si niu o 81. Chm t phu thut phu thut bn chn thung 82. Chm t phu thut c nh np vt gy hai 2 xng cng tay 83. Chm t phu thut phu thut vt thng khp

84. Chm t phu thut ni gn gp c chn 85. Chm t phu thut ly b ton b xng bnh ch 86. Chm t phu thut ct ct cng chn 87. Chm t phu thut khu vt thng phn mm vng u - c 88. Chm t phu thut ct u lnh dng vt 89. Chm t phu thut ct u nang thng tinh 90. Chm t phu thut trn dch mng tinh hon 91. Chm t phu thut ct u nang tuyn gip 92. Chm t phu thut ct u tuyn gip 93. Chm t phu thut ct u lnh phn mm 94. Chm t phu thut ct polip t cung 95. Chm t phu thut ct u thnh m o 96. Chm t phu thut bc nhn tuyn gip 97. Chm t phu thut ct u da u lnh, ng knh trn 5 cm 98. Chm t phu thut ct u da u lnh, ng knh t 2- 5 cm 99. Chm t phu thut qum

C. IN MNG CHM (53) 100. in mng chm iu tr hi chng tht lng- hng 101. in mng chm iu tr bo ph 102. in mng chm iu tr lit na ngi do tai bin mch mu no 103. in mng chm iu tr hi chng- d dy t trng 104. in mng chm iu tr sa d dy 105. in mng chm iu tr tm cn suy nhc 106. in mng chm iu tr tr 107. in mng chm phc hi chc nng vn ng cho tr bi lit 108. in mng chm iu tr lit do bnh c tr em 109. in mng chm iu tr lit do tn thng m ri thn kinh cnh tay tr em 110. in mng chm iu tr sa t cung 111. in mng chm iu tr hi chng tin mn kinh 112. in mng chm iu tr i dm 113. in mng chm iu tr thng kinh 114. in mng chm iu tr ri lon kinh nguyt 115. in mng chm iu tr hi chng tin nh 116. in mng chm iu tr hi chng vai gy 117. in mng chm iu tr hen ph qun 118. in mng chm iu tr huyt p thp 119. in mng chm iu tr lit dy thn kinh VII ngoi bin 120. in mng chm iu tr tc tia sa 121. in mng chm iu tr au dy thn kinh lin sn 122. in mng chm iu tr tht vn ngn 123. in mng chm iu tr au thn kinh V 124. in mng chm iu tr lit t chi do chn thng ct sng 125. in mng chm iu tr ri lon thn kinh chc nng do chn thng s no 126. in mng chm iu tr khn ting 127. in mng chm iu tr lit chi trn 128. in mng chm iu tr lit chi di 129. in mng chm iu tr au h mt 130. in mng chm iu tr vim kt mc 131. in mng chm iu tr gim th lc 132. in mng chm iu tr 133. in mng chm h tr iu tr nghin ma ty 134. in mng chm h tr iu tr nghin thuc l

135. in mng chm h tr iu tr nghin ru 136. in mng chm iu tr to bn ko di 137. in mng chm iu tr vim mi xoang 138. in mng chm iu tr ri lon tiu ha 139. in mng chm iu tr au rng 140. in mng chm iu tr vim a khp dng thp 141. in mng chm iu tr vim quanh khp vai 142. in mng chm iu tr gim au do thoi ha khp 143. in mng chm iu tr au lng 144. in mng chm iu tr di tinh 145. in mng chm iu tr lit dng 146. in mng chm iu tr ri lon tiu tin 147. in mng chm iu tr b i c nng

D. IN NH CHM (69) 148. in nh chm iu tr hi chng tin nh 149. in nh chm iu tr hi chng vai gy 150. in nh chm iu tr hen ph qun 151. in nh chm iu tr huyt p thp 152. in nh chm iu tr lit dy VII ngoi bin 153. in nh chm iu tr tc tia sa 154. in nh chm iu tr thiu nng tun hon no mn tnh 155. in nh chm iu tr au au u, au na u 156. in nh chm iu tr mt ng 157. in nh chm iu tr hi chng stress 158. in nh chm iu tr nn 159. in nh chm iu tr nc 160. in nh chm iu tr cm mo 161. in nh chm h tr iu tr vim Amidan 162. in nh chm iu tr bo ph 163. in nh chm iu tr lit na ngi do tai bin mch mu no 164. in nh chm iu tr hi chng d dy-t trng 165. in nh chm phc hi chc nng cho tr bi lit 166. in nh chm iu tr gim thnh lc 167. in nh chm iu tr hi chng t k tr em 168. in nh chm iu tr chm pht trin tr tu tr bi no 169. in nh chm iu tr phc hi chc nng tr bi no 170. in nh chm iu tr cn au qun thn 171. in nh chm iu tr vim bng quang 172. in nh chm iu di tinh 173. in nh chm iu tr lit dng 174. in nh chm iu tr ri lon tiu tin 175. in nh chm iu tr b i c nng 176. in nh chm iu tr cn ng kinh cc b 177. in nh chm iu tr sa t cung 178. in nh chm iu tr hi chng tin mn kinh 179. in nh chm iu tr tht vn ngn 180. in nh chm iu tr au dy thn kinh V 181. in nh chm iu tr lit t chi do chn thng ct sng 182. in nh chm iu tr ri lon thn kinh chc nng sau chn thng s no 183. in nh chm iu tr khn ting 184. in nh chm iu tr ri lon cm gic u chi 185. in nh chm iu tr lit chi trn

186. in nh chm iu tr lit chi di 187. in nh chm iu tr thng kinh 188. in nh chm iu tr ri lon kinh nguyt 189. in nh chm iu tr au h mt 190. in nh chm iu tr vim kt mc 191. in nh chm iu tr vim thn kinh th gic sau giai on cp 192. in nh chm iu tr gim th lc 193. in nh chm h tr iu tr nghin ma ty 194. in nh chm iu tr to bn ko di 195. in nh chm iu tr vim mi xoang 196. in nh chm h tr iu tr nghin thuc l 197. in nh chm iu tr i dm 198. in nh chm iu tr ri lon tiu ha 199. in nh chm iu tr au rng 200. in nh chm iu tr nghin ru 201. in nh chm iu tr vim khp dng thp 202. in nh chm iu tr vim quanh khp vai 203. in nh chm iu tr au do thoi ha khp 204. in nh chm iu tr au lng 205. in nh chm iu tr tai 206. in nh chm iu tr gim khu gic 207. in nh chm iu tr lit r, m ri dy thn kinh 208. in nh chm iu tr ri lon cm gic nng 209. in nh chm iu tr ri lon thn kinh thc vt 210. in nh chm iu tr gim au do ung th 211. in nh chm iu tr gim au do Zona 212. in nh chm iu tr vim a r, a dy thn kinh 213. in nh chm iu tr chng tc c mt

. CY CH (56) 214. Cy ch iu tr lit na ngi do tai bin mch mu no 215. Cy ch iu tr tm cn suy nhc 216. Cy ch iu tr vim mi d ng 217. Cy ch iu tr sa d dy 218. Cy ch chm iu tr hi chng d dy- t trng 219. Cy ch iu tr my ay 220. Cy ch h tr iu tr vy nn 221. Cy ch iu tr gim thnh lc 222. Cy ch iu tr gim th lc 223. Cy ch iu tr hi chng t k 224. Cy ch iu tr lit do tn thng m ri cnh tay tr em 225. Cy ch iu tr chm pht trin tr tu tr bi no 226. Cy ch chm iu tr phc hi chc nng vn ng tr bi no 227. Cy ch iu tr hi chng tht lng- hng 228. Cy ch iu tr au u, au na u 229. Cy ch iu tr mt ng 230. Cy ch iu tr nc 231. Cy ch iu tr hi chng tin nh 232. Cy ch iu tr hi chng vai gy 233. Cy ch iu tr hen ph qun 234. Cy ch iu tr huyt p thp 235. Cy ch iu tr lit dy thn kinh VII ngoi bin 236. Cy ch iu tr thiu nng tun hon no mn tnh

237. Cy ch iu tr au thn kinh lin sn 238. Cy ch iu tr tht vn ngn 239. Cy ch iu tr lit t chi do chn thng ct sng 240. Cy ch iu tr ri lon thn kinh chc nng sau chn thng s no 241. Cy ch iu tr hi chng ngoi thp 242. Cy ch iu tr khn ting 243. Cy ch iu tr lit chi trn 244. Cy ch iu tr lit chi di 245. Cy ch iu tr h tr cai nghin ma ty 246. Cy ch iu tr h tr cai nghin thuc l 247. Cy ch iu tr h tr cai nghin ru 248. Cy ch iu tr vim mi xoang 249. Cy ch iu tr ri lon tiu ha 250. Cy ch iu tr to bn ko di 251. Cy ch h tr iu tr vim khp dng thp 252. Cy ch iu tr vim quanh khp vai 253. Cy ch iu tr au do thoi ha khp 254. Cy ch iu tr au lng 255. Cy ch iu tr i dm 256. Cy ch iu tr cn ng kinh cc b 257. Cy ch iu tr ri lon kinh nguyt 258. Cy ch iu tr au bng kinh 259. Cy ch iu tr sa t cung 260. Cy ch iu tr hi chng tin mn kinh 261. Cy ch iu tr di tinh 262. Cy ch iu tr lit dng 263. Cy ch iu tr ri lon tiu tin khng t ch

E. IN CHM (48) 264. in chm iu tr hi chng tin nh 265. in chm iu tr huyt p thp 266. in chm iu tr thiu nng tun hon no mn tnh 267. in chm iu tr hi chng stress 268. in chm iu tr cm mo 269. in chm iu tr vim amidan 270. in chm iu tr tr 271. in chm iu tr phc hi chc nng cho tr bi lit 272. in chm iu tr h tr bnh t k tr em 273. in chm iu tr lit tay do tn thng m ri cnh tay tr em 274. in chm iu tr chm pht trin tr tu tr bi no 275. in chm iu tr phc hi chc nng vn ng tr bi no 276. in chm iu tr cn au qun thn 277. in chm iu tr vim bng quang 278. in chm iu tr ri lon tiu tin 279. in chm iu tr b i c nng 280. in chm iu tr sa t cung 281. in chm iu tr hi chng tin mn kinh 282. in chm iu tr lit t chi do chn thng ct sng 283. in chm iu tr ri lon thn kinh chc nng sau chn thng s no 284. in chm iu tr hi chng ngoi thp 285. in chm iu tr khn ting 286. in chm iu tr ri lon cm gic u chi 287. in chm iu tr lit chi trn

288. in chm iu tr chp lo 289. in chm iu tr au h mt 290. in chm iu tr vim kt mc 291. in chm iu tr vim thn kinh th gic sau giai on cp 292. in chm iu tr lc c nng 293. in chm iu tr ri lon cm gic nng 294. in chm h tr iu tr nghin thuc l 295. in chm h tr iu tr nghin ru 296. in chm iu tr vim mi xoang 297. in chm iu tr ri lon tiu ha 298. in chm iu tr au rng 299. in chm iu tr au do thoi ha khp 300. in chm iu tr tai 301. in chm iu tr gim khu gic 302. in chm iu tr lit do tn thng m ri dy thn kinh 303. in chm iu tr ri lon thn kinh thc vt 304. in chm iu tr gim au do ung th 305. in chm iu tr gim au do zona 306. in chm iu tr lit do vim a r, a dy thn kinh 307. in chm iu tr chng tic c mt

G. THU CHM (73) 308. Thu chm iu tr hi chng tht lng- hng 309. Thu chm iu tr au u, au na u 310. Thu chm iu tr mt ng 311. Thu chm iu tr hi chng stress 312. Thu chm iu tr nc 313. Thu chm iu tr cm mo, cm 314. Thu chm iu tr vim amydan 315. Thu chm iu tr bo ph 316. Thu chm iu tr lit na ngi do tai bin mch mu no 317. Thu chm iu tr hi chng d dy t trng 318. Thu chm iu tr sa d dy 319. Thu chm iu tr tr 320. Thu chm h tr iu tr bnh vy nn 321. Thu chm iu tr my ay 322. Thu chm iu tr bnh vim mi d ng 323. Thu chm iu tr tm cn suy nhc 324. Thu chm iu tr bi lit tr em 325. Thu chm iu tr gim thnh lc 326. Thu chm iu tr lit tr em 327. Thu chm iu tr bnh t k tr em 328. Thu chm iu tr lit do tn thng m ri cnh tay tr em 329. Thu chm iu tr chm pht trin tr tu tr bi no 330. Thu chm iu tr phc hi chc nng vn ng tr bi no 331. Thu chm iu tr cn ng kinh cc b 332. Thu chm iu tr sa t cung 333. Thu chm iu tr hi chng tin mn kinh 334. Thu chm iu tr thng kinh 335. Thu chm iu tr ri lon kinh nguyt 336. Thu chm iu tr i dm 337. Thu chm iu tr hi chng tin nh 338. Thu chm iu tr au vai gy

339. Thu chm iu tr hen ph qun 340. Thu chm iu tr huyt p thp 341. Thu chm iu tr thiu nng tun hon no mn tnh 342. Thu chm iu tr lit dy thn kinh VII ngoi bin 343. Thu chm iu tr au dy thn kinh lin sn 344. Thu chm iu tr tht vn ngn 345. Thu chm iu tr au dy V 346. Thu chm iu tr au lit t chi do chn thng ct sng 347. Thu chm iu tr lon chc nng do chn thng s no 348. Thu chm iu tr hi chng ngoi thp 349. Thu chm iu tr khn ting 350. Thu chm iu tr ri lon cm gic u chi 351. Thu chm iu tr lit chi trn 352. Thu chm iu tr lit hai chi di 353. Thu chm iu tr sp mi 354. Thu chm h tr iu tr nghin ma ty 355. Thu chm h tr iu tr nghin thuc l 356. Thu chm h tr iu tr nghin ru 357. Thu chm iu tr vim mi xoang 358. Thu chm iu tr ri lon tiu ha 359. Thu chm iu tr au rng 360. Thu chm iu tr to bn ko di 361. Thu chm h tr iu tr vim khp dng thp 362. Thu chm iu tr au do thoi ha khp 363. Thu chm iu tr vim quanh khp vai 364. Thu chm iu tr au lng 365. Thu chm iu tr sp mi 366. Thu chm iu tr au h mt 367. Thu chm iu tr vim thn kinh th gic sau giai on cp 368. Thu chm iu tr lc c nng 369. Thu chm iu tr gim th lc 370. Thu chm iu tr vim bng quang 371. Thu chm iu tr di tinh 372. Thu chm iu tr lit dng 373. Thu chm iu tr ri lon tiu tin 374. Thu chm iu tr b i c nng

H. XOA BP BM HUYT (71) 375. Xoa bp bm huyt iu tr lit chi trn 376. Xoa bp bm huyt iu tr lit chi di 377. Xoa bp bm huyt iu tr lit na ngi do tai bin mch mu no 378. Xoa bp bm huyt iu tr hi chng tht lng- hng 379. Xoa bp bm huyt iu tr lit do vim no 380. Xoa bp bm huyt iu tr chm pht trin tr tu tr bi no 381. Xoa bp bm huyt phc hi chc nng vn ng tr bi no 382. Xoa bp bm huyt iu tr cng khp chi trn 383. Xoa bp bm huyt iu tr cng khp chi di 384. Xoa bp bm huyt iu tr chong, ngt 385. Xoa bp bm huyt iu tr bnh t k tr em 386. Xoa bp bm huyt iu tr chng tai 387. Xoa bp bm huyt iu tr gim khu gic 388. Xoa bp bm huyt iu tr lit do bnh ca c 389. Xoa bp bm huyt h tr iu tr nghin ru

390. Xoa bp bm huyt h tr iu tr nghin thuc l 391. Xoa bp bm huyt h tr iu tr nghin ma tu 392. Xoa bp bm huyt iu tr tm cn suy nhc 393. Xoa bp bm huyt iu tr hi chng ngoi thp 394. Xoa bp bm huyt iu tr au u, au na u 395. Xoa bp bm huyt iu tr mt ng 396. Xoa bp bm huyt iu tr hi chng stress 397. Xoa bp bm huyt iu tr thiu nng tun hon no mn tnh 398. Xoa bp bm huyt iu tr tn thng r, m ri v dy thn kinh 399. Xoa bp bm huyt iu tr tn thng dy thn kinh V 400. Xoa bp bm huyt iu tr lit dy thn kinh s VII ngoi bin 401. Xoa bp bm huyt iu tr sp mi 402. Xoa bp bm huyt iu tr vim thn kinh th gic sau giai on cp 403. Xoa bp bm huyt iu tr lc c nng 404. Xoa bp bm huyt iu tr gim th lc 405. Xoa bp bm huyt iu tr hi chng tin nh 406. Xoa bp bm huyt iu tr gim thnh lc 407. Xoa bp bm huyt iu tr vim mi xoang 408. Xoa bp bm huyt iu tr hen ph qun 409. Xoa bp bm huyt h tr iu tr tng huyt p 410. Xoa bp bm huyt iu tr huyt p thp 411. Xoa bp bm huyt iu tr au thn kinh lin sn 412. Xoa bp bm huyt iu tr hi chng d dy- t trng 413. Xoa bp bm huyt iu tr nc 414. Xoa bp bm huyt iu tr vim khp dng thp 415. Xoa bp bm huyt iu tr au do thoi ho khp 416. Xoa bp bm huyt iu tr au lng 417. Xoa bp bm huyt iu tr vim quanh khp vai 418. Xoa bp bm huyt iu tr hi chng vai gy 419. Xoa bp bm huyt iu tr chng tic c mt 420. Xoa bp bm huyt iu tr ri lon cm gic u chi 421. Xoa bp bm huyt iu tr tc tia sa 422. Xoa bp bm huyt iu tr ri lon kinh nguyt 423. Xoa bp bm huyt iu tr au bng kinh 424. Xoa bp bm huyt iu tr hi chng tin mn kinh 425. Xoa bp bm huyt iu tr to bn 426. Xoa bp bm huyt iu tr ri lon tiu ho 427. Xoa bp bm huyt iu tr ri lon cm gic nng 428. Xoa bp bm huyt iu tr b i c nng 429. Xoa bp bm huyt iu tr ri lon thn kinh thc vt 430. Xoa bp bm huyt iu tr bo ph 431. Xoa bp bm huyt iu tr ri lon chc nng vn ng do chn thng s no 432. Xoa bp bm huyt iu tr lit t chi do chn thng ct sng 433. Xoa bp bm huyt iu tr gim au sau phu thut 434. Xoa bp bm huyt iu tr gim au do ung th 435. Xoa bp bm huyt iu tr i dm 436. Xoa bp bm huyt iu tr hi chng phn ly

I. CU (30) 437. Cu iu tr hi chng tht lng- hng th phong hn 438. Cu iu tr au u, au na u th hn 439. Cu iu tr nc th hn 440. Cu iu tr ngoi cm phong hn

441. Cu iu tr khn ting th hn 442. Cu iu tr ri lon cm gic u chi th hn 443. Cu iu tr lit chi trn th hn 444. Cu iu tr lit chi di th hn 445. Cu iu tr lit na ngi th hn 446. Cu iu tr lit dy thn kinh s VII ngoi bin th hn 447. Cu iu tr au vai gy cp th hn 448. Cu iu tr gim thnh lc th hn 449. Cu h tr iu tr bnh t k th hn 450. Cu iu tr chm pht trin tr tu tr bi no 451. Cu iu tr di tinh th hn 452. Cu iu tr lit dng th hn 453. Cu iu tr ri lon tiu tin th hn 454. Cu iu tr b i th hn 455. Cu iu tr sa t cung th hn 456. Cu iu tr au bng kinh th hn 457. Cu iu tr ri lon kinh nguyt th hn 458. Cu iu tr i dm th hn 459. Cu iu tr au lng th hn 460. Cu iu tr gim khu gic th hn 461. Cu iu tr ri lon thn kinh thc vt th hn 462. Cu iu tr cm cm th hn 463. Cu iu tr ri lon tiu ha th hn 464. Cu h tr iu tr nghin ma ty th hn

K. GIC HI (4) 465. Gic hi iu tr ngoi cm phong hn 466. Gic hi iu tr ngoi cm phong nhit 467. Gic hi iu tr cc chng au 468. Gic hi iu tr cm cm

Tng s: 468 Hng dn quy trnh k thut chuyn ngnh chm cu

1

1.MAI HOA CHM 1. I CNG

Mai hoa chm l phng php dng kim hoa mai (5 7 chic kim nh

cm vo u mt cn g) g trn mt da, nhm mc ch cha bnh hoc

phng bnh. y l mt hnh thc pht trin ca chm cu.

2. CH NH Ni chung l g kim hoa mai c th dng cha tr cc bnh nh

ho chm vn thng lm. Phng php ny t ra thch hp nht i vi cc

loi bnh: suy nhc thn kinh, au u mt ng, au dy thn kinh lin

sn, lit dy thn kinh VII, cn au d dy t trng, tiu ho km, au bng

kinh, i dm, sa trc trng, sm da, mn nga ngoi da...

3. CHNG CH NH

Nhng trng hp sau y khng c g kim hoa mai: va n no,

say qu, i qu, ang v m hi, ph n c thai, bnh ngoi da b vim lot

chy nc vng, chy m.

4. CHUN B 4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Phng tin - Kim hoa mai: ngy nay ngi ta thng dng 2 loi kim l + Kim chm.

+ Kim xo hnh gng sen.

- Bng cn st trng.

4.3. Ngi bnh - Ngi bnh c khm v lm h s bnh n theo qui nh.

- T th ngi bnh nm nga, nm sp hoc ngi.

2

5. CC BC TIN HNH 5.1. Phc huyt

Mai hoa chm khng s dng phc huyt nh th chm m iu tr

theo vng, khu iu tr trn c th. Ngoi cch phn chia mt da lm 12 khu

theo kinh in, ngi ta cn quy c mt s phn chia khc tin hnh

iu tr, theo c th c chia ra cc vng:

- Vng u mt gm: khu trn, khu trc nh u v hai bn u, khu nh

u, khu u sau, khu mt, khu mi, khu mi, khu g m, khu tai v khu thi

dng.

- Vng c gm: khu sau gy, khu trc c, khu c c n chm.

- Vng chi trn gm: khu trong cnh tay, khu trong khuu tay, khu trong

cng tay, khu trong c tay, khu gan bn tay, khu ngoi cnh tay v khu ngoi

cng tay, khu mu bn tay v khu ngn tay.

- Vng chi di gm: khu trc i, khi trc cng chn, khu sau i v

vng khoeo chn, khu sau cng chn, khu m trong i v cng chn, khu

m ngoi i v cng chn, khu trc c chn v mu chn, khu gan bn

chn, khu xng bnh ch, khu mt c trong v mt c ngoi.

- Vng ngc gm: khu xng c, khu lng ngc.

- Vng bng gm: khu bng trn, khu bng di, khu np bn.

- Vng lng gm: khu lng trn, khu lng gia, khu lng di, khu xng

b vai, khu c thang v trn vai.

5.2-Th thut - Cch cm kim hoa mai: ngn tay ci v ngn gia cm cht 1/3 cn kim,

ngn nhn v ngn t thn cn vo lng bn tay, ngn tr t ln cn

kim. Lc g ch yu l c ng nhp nhng c tay, trc tip b kim tip xc

thng gc vi mt da.

- Th thut g kim hoa mai: c 3 cch g l g nh, ng va v g mnh.

3

+ G nh: g rt nh nhng trn mt da, hon ton khng au. Ngi bnh

cm thy thoi mi, d chu, th thut ny c tc dng t b, tng sc kho

cho Ngi bnh, thng dng cho chng h hn.

+ G va: sc khng nh, khng mnh, c tc dng bnh b bnh t, thng

dng trong cc chng bn biu bn l, khng h khng thc.

+ G mnh: g mnh sc hn, sc bt ca c tay kho hn, tuy nhin Ngi

bnh vn sc chu ng, th thut ny c tc dng t, p dng vi cc

chng thc nhit.

- Trnh t g kim hoa mai: cn g theo mt th t nht nh, trc ht g

vng thng quy ri g khu trng im sau g khu kt hp.

Trng hp trong cng thc iu tr khng c thng quy m ch c

khu trng im v khu kt hp th g khu trng im trc, khu kt hp sau.

Nu g theo vng th g vng u, vng lng trc, g vng ngc,

bng, chn sau. G vng u th g khu trn trc, ri g khu thi dng,

khu nh u v cui cng l khu chm.

- Thi gian: 20- 30 pht cho mt ln g mai hoa chm

5.4. Liu trnh iu tr

- G kim mai hoa ngy mt ln.

- Mt liu trnh iu tr t 10 - 20 ln.

6. THEO DI V X TR TAI BIN 6.1. Theo di: Ton trng Ngi bnh.

6.2. X TR TAI bin 6.1. Vng chm: Ngi bnh hoa mt chng mt, v m hi, mch nhanh,

sc mt nht nht. X l: lau m hi, m, ung nc ch ng nng, cho

ngi bnh nm ngh ti ch. t Ngi bnh nm sp, g nh khu tht

lng mi ng g 10 ln theo hng ngc t di ln trn. Theo di st

mch, huyt p.

4

6.2. Ni nhng nt trn da: do da ngi bnh qu bn, lc g li khng

st trng bng cn. X l: tm ngh iu tr vi ba ngy, v sinh c th sch

s, xoa cn vo vng ni mn.

5

2.HO CHM 1. I CNG

Ho chm l phng php s dng kim nh (ho kim, 4-6cm)

chm vo huyt trn c th nhm mc ch phng v tr bnh.

Ho kim l loi kim c thn kim rt nh, mi kim nhn, c nhiu loi

di ngn khc nhau. Loi kim ny c s dng iu tr nhiu loi bnh

v c dng ph bin hin nay.

2. CH NH - Bnh c nng v triu chng ca mt s bnh nh ri lon thn kinh tim,

mt ng khng r nguyn nhn, km n, y bng, tiu chy, to bn, cm

cm, b tiu chc nng, nc,...

- Cc chng au cp v mn tnh: au do ng gip, chn thng, au sau

m, au cc khp hoc phn mm quanh khp, au trong cc bnh l v

thn kinh...

- Mt s bnh do vim nhim nh vim tuyn v, chp, lo....

3. CHNG CH NH - C th suy kit, sc khng gim, ph n c thai.

- Trnh chm vo nhng vng huyt c vim nhim hoc l lot ngoi da.

- Tt c nhng cn au nghi do nguyn nhn ngoi khoa...

4. CHUN B 4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh,

cha bnh.

4.2. Phng tin: - Kim ho chm v khun dng mt ln.

- Khay men, km c mu, bng, cn 700

4.3. Ngi bnh

6

- Ngi bnh c khm, lm h s bnh n theo quy nh.

- Ngi bnh nm t th thoi mi, chn t th sao cho vng c

chm c bc l r nht.

5. CC BC TIN HNH 5.1. Th thut: - Bc 1: + Xc nh v st trng da vng huyt

+ Chn kim c di ty thuc dy ca c vng chm

- Bc 2: Chm kim vo huyt theo cc th sau:

Th 1: Tay tri dng ngn tay ci v ngn tr n, cng da vng huyt;

Tay phi chm kim nhanh qua da vng huyt.

Th 2: y kim t t theo huyt o, kch thch kim cho n khi tc

kh (Ngi bnh c cm gic cng, tc, nng va phi, khng au vng

huyt va chm kim, Ngi thc hin cm gic kim mt cht ti v tr

huyt).

- Bc 3. Rt kim, st khun da vng huyt va chm.

5.4. Liu trnh Chm ngy 1 ln, thi gian 25- 30 pht/ln.

6. THEO DI V X TR TAI BIN 6.1. Theo di Theo di ti ch v ton thn

6.2. X TR TAI bin - Vng chm: Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc

mt nht nht. X l: rt kim ngay, lau m hi, m, ung nc ch ng

nng, nm ngh ti ch. Theo di mch, huyt p.

- Chy mu khi rt kim: dng bng v khun n ti ch, khng day

7

3. MNG CHM 1. I CNG Mng chm l hnh thc kt hp gia trng chm v c chm c in trong

Thin Cu Chm (sch Linh Khu).

K thut mng chm l k thut dng kim to, kim di chm theo huyt o

tc l chm xuyn t huyt ny sang huyt kia trn cng mt ng kinh

hoc trn hai ng kinh khc nhau c tc dng iu kh nhanh, mnh hn

nn c tc dng cha cc chng bnh kh nh chng au, chng lit...

Kim chm trong s dng Mng chm l kim c di t 15 cm, 20 cm, 30

cm c th ti 60 cm, v ng knh t 0, 5 n 1 mm. Ty tng huyt o

trn c th m ta c th s dng cc kim chm c di tng ng.

2. CH NH - Cc chng lit (lit do ti bin mch mu no, di chng bi lit, lit cc

dy thn kinh ngoi bin...)



thn kinh...

- Chm t phu thut.




4. CHUN B: 4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Phng tin:

8

- Kim mng chm v khun


- My in chm hai tn s b t

4.3. Ngi bnh - Ngi bnh c khm, lm h s bnh n theo quy nh


chm c bc l r nht.

5. CC BC TIN HNH 5.1. Th thut: - Bc 1: + Xc nh huyt o v st trng da vng huyt

+ Chn kim c di ty thuc dy ca c vng chm




Th 2: y kim t t theo huyt o, mt tay y mt tay n u kim sao

cho hng kim i ng theo ng huyt o c xc nh, kch thch

kim cho n khi tc kh (Ngi bnh c cm gic cng, tc, nng va

phi, khng au vng huyt va chm kim, Ngi thc hin cm gic kim

mt cht ti v tr huyt).

- Bc 3. Kch thch huyt bng my in chm

Ni cp dy ca my in chm vi kim chm vo huyt theo tn

s b- t ca my in chm:

- Tn s (t tn s c nh): Tn s t t 5 - 10Hz, Tn s b t 1 - 3Hz.

- Cng : nng dn cng t 0 n 150 microAmpe (tu theo mc

chu ng ca ngi bnh).

+ Thi gian: 20- 30 pht cho mt ln in mng chm.


9

5.3. Liu trnh iu tr - Mng chm ngy mt ln

6. THEO DI V X TR TAI BIN 6.1. Theo di

Theo di ti ch v ton thn 6.2. X TR TAI bin - Vng chm: Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc




10

4. IN CHM

1. I CNG in chm l phng php cha bnh phi hp gia tc dng cha

bnh ca chm cu vi kch thch bng dng in.

Hin nay thng s dng my pht ra xung in c tnh nng n nh,

an ton, iu chnh thao tc d dng, n gin. Kch thch ca dng xung

in c tc dng lm gim au, kch thch hot ng cc c, cc t chc,

tng cng dinh dng cc t chc, gim vim......

2. CH NH - Cc chng lit (lit do ti bin mch mu no, di chng bi lit, lit cc

dy thn kinh ngoi bin, cc bnh l au nh au u, au lng, au thn

kinh ta, bnh ng quan nh gim th lc, gim thnh lc, tht ngn, chm t

trong phu thut...)



thn kinh...

- Bnh c nng v triu chng ca mt s bnh nh ri lon thn kinh tim,

mt ng khng r nguyn nhn, km n, y bng, tiu chy, to bn, cm

cm, b tiu chc nng, nc,...

- Mt s bnh do vim nhim nh vim tuyn v, chp, lo....

- Chm t phu thut




4. CHUN B 4.1. Ngi thc hin:

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Bc s, Y s, Lng y c o to v chuyn ngnh y hc c truyn c

cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin: - Kim chm cu v khun dng mt ln


- My in chm hai tn s b t



chm c bc l r nht.

5. CC BC TIN HNH 5.1. Th thut: - Bc 1: + Xc nh v st trng da vng huyt

+ Chn kim c di ty thuc dy ca c vng nh chm.




Th 2: y kim t t theo huyt o, kch thch kim cho n khi tc

kh (Ngi bnh c cm gic cng, tc, nng va phi, khng au vng

huyt va chm kim, Ngi thc hin cm gic kim mt cht ti v tr

huyt).


Ni cp dy ca my in chm vi kim chm vo huyt theo tn

s b- t ca my in chm:

- Tn s (t tn s c nh): Tn s t t 5 - 10Hz, Tn s b t 1 - 3Hz.

- Cng : nng dn cng t 0 n 150 microAmpe (tu theo mc

chu ng ca ngi bnh).

12

+ Thi gian: 20- 30 pht cho mt ln in mng chm.


5.2. Liu trnh Chm ngy 1 ln, thi gian 25- 30 pht/ln.

6. THEO DI V X TR TAI BIN 6.1. Theo di Theo di ti ch v ton thn

6.2. X TR TAI bin - Vng chm: Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc




13

5. PHNG PHP THY CHM (Tim thuc vo huyt)

1. I CNG Thy chm (hay tim thuc vo huyt) l mt phng php cha bnh

kt hp ng- Ty y, phi hp tc dng cha bnh ca chm kim theo hc

thuyt kinh lc ca YHCT vi tc dng cha bnh ca thuc tim.

C nhng loi thuc tim c tc dng ton thn, c nhng loi thuc

ch c tc dng tng cng v duy tr kch thch ca chm kim vo huyt

nng cao hiu qu cha bnh.

2. CH NH Ging nh ch nh ca chm cu. Thy chm c dng cha

mt s bnh mn tnh nh: thp khp, au d dy, hen ph qun, au u,

mt ng, au thn kinh ta

3. CHNG CH NH Ging nh chng ch nh ca chm cu: Ngi bnh au bng cn

theo di ngoi khoa, bnh tim nng, trng thi tinh thn khng n nh, va

mi lao ng mt, i.

Khng c dng nhng thuc m ngi bnh c mn cm, d ng,

cc loi thuc c tc dng kch thch gy x cng, hoi t cc vng c dy

thn kinh v cc cKhng thy chm vo nhng huyt vng c mng,

pha di l tng ph, khp, dy chng, gn c, dy thn kinh, mch mu...

4. CHUN B 4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Phng tin

- Bm tim v trng 5 10ml, dng ring cho tng ngi bnh.

14

- Khay men, kp c mu, bng, cn 70 .

- Thuc tim: Thuc c ch nh tim bp, theo ch nh ca bc s

iu tr.

- Hp thuc cp cu sc phn v.

4.3. Ngi bnh: Ngi bnh c khm v chn on theo YHH v YHCT.

T th nm nga hoc nm nghing ty theo v tr nh tim.

* Trc khi iu tr cn gii thch cho Ngi bnh hiu r c im ca phng php iu tr ny v nhng phn ng thng thng c th xy ra

nh: au, cng tc, nng, n vng tim

4.4. H s bnh n: Ngi bnh c khm v lm h s bnh n theo qui nh.

Chn huyt v thuc thch hp. Nn chn nhng huyt c phn ng r

rt lm huyt chnh (A th huyt) v chia nhm huyt mi ln tim khng

qu nhiu huyt lm Ngi bnh au, thng chn 5 - 6 huyt cho mt ln

thy chm.

5. CC BC TIN HNH 5.1. Kim tra h s

Xem h s c ng vi ngi bnh khng ? Cc ch nh cn lm ?

5.2. Kim tra ngi bnh Kim tra tnh trng ngi bnh hin ti, t th nm, bc l cc vng nh thy chm.

5.3. Thc hin k thut Bc 1. Ly thuc vo bm tim

Bc 2. Th phn ng thuc theo quy nh

Bc 3. Tin hnh thy chm theo cc th sau:

Th 1: St trng da vng huyt,

15

Tay tri: Dng hai ngn tay n v cng da vng huyt

Tay phi: Chm kim nhanh qua da, y kim ti huyt, Ngi bnh thy cm

gic tc nng ti v tr kim chm

Th 2: t t bm thuc vo huyt, mi huyt t 0,5- 3 ml thuc.

Th 3: Rt kim nhanh, st trng v tr tim.

5.3 Liu trnh iu tr : Thy chm mt ngy mt ln, mi ln thy chm vo 2- 5 huyt.

6. THEO DI V X TR TAI BIN 6.1. Theo di

Theo di ti ch v ton thn 6.2. X TR TAI bin - Sc phn v: X trtheo phc

- Vng chm:

Triu chng: Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc

mt nht nht.

X l: rt kim ngay, lau m hi, m, ung nc ch ng nng, nm ngh

ti ch. Day bm cc huyt Thi dng, Ni quan. Theo di mch, huyt p.

- Chy mu khi rt kim: dng bng v khun n ti ch, khng day.

16

6. CY CH

1. I CNG Cy ch phng php chm cu kt hp c truyn v hin i, c tin

hnh bng cch dng mt loi protein l (ch catgut) vi vo huyt phng

v cha bnh. Ch cattgut l ch t tiu c bn cht l mt protein, do

trong qu trnh t tiu n lun to ra kch thch c hc ln huyt, pht huy

tc dng cha bnh ca huyt .

2. CH NH - Cc bnh mn tnh


- Da vng huyt b vim nhim hoc mc bnh ngoi da.

- D ng vi ch Catgut.

4. CHUN B: 4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Phng tin: - Panh, ko, bng, cn st trng, gc v trng, cn it, bng dnh.

- Kim chc ng sng c G18, ch Catgut s 2/0 dng cho ngi ln. Kim,

ch m bo v trng.

- Kim chc ng sng c G20, ch Catgut s 3/0 dng cho tr em; kim, ch

m bo v trng.

- Khay men, kp c mu, bng gcbng dnh

- Hp thuc chng chong .

4.3. Ngi bnh

17

- Ngi bnh c khm, lm h s bnh n theo quy nh.

- Ngi bnh nm t th thoi mi, chn t th sao cho vng huyt.

cy ch c bc l r nht.

5. CC BC TIN HNH 5.1. Th thut : - Ra tay sch, i gng tay v trng.

- Ct ch Catgut thnh tng on khong 1cm. Lun ch vo nng kim.

- Xc nh chnh xc huyt nh cy ch. St trng vng huyt

- Chm kim nhanh qua da v y t t ti huyt.

- y nng kim ch nm vo huyt, t gc v trng ln huyt va cy

ch, n tay ln ri rt kim ra, dn bng dnh ln gi gc.

Ch nhiu huyt chm vng mt nn cn thn trng khi lm th thut

trnh gy tn thng nhn cu hoc chy mu.

5.3 Liu trnh iu tr : - Mi ln cy ch Catgut c tc dng trong khong 7 10 ngy , sau thi

gian ngi bnh n iu tr liu trnh tip theo.

6. THEO DI V X TR TAI BIN 6.1. Theo di : Ton trng Ngi bnh trong thi gian mi ln lm th thut

6.2. X TR TAI bin : - Chy mu: Dng bng gc kh v khun n ti ch, khng day

- au sng ni cy ch: chm nng, thuc chng ph n hoc khng sinh

ung nu nghi ng nhim khun

18

7. N CHM 1. I CNG n chm l va chm va cu trn cng mt huyt.

2. CH NH Bnh l c nguyn nhn h hn.

3. CHNG CH NH - Cc trng hp bnh l c nguyn nhn thc nhit (c st cao...).

- Khng nn tin hnh n chm cc vng c nhiu gn, da st xng, vng

mt ...v c th gy bng, c bit l nhng vng b mt cm gic.

4. CHUN B 4.1. Ngi thc hin Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin - Kim chm cu v khun dng mt ln.


- Mi ngi hoc iu ngi.

- La (dim, bt la...).


- Ngi bnh nm t th thoi mi.

5. CC BC TIN HNH 5.1. Th thut - Chm kim vo huyt theo phc iu tr

- C th dng ba cch lm nng kim n chm:

19

+ Xuyn kim qua mi ngi cu gin tip trn huyt.

+ Ln g mt on iu ngi vo cn kim ri t.

+ H iu ngi gn cn kim cho kim nng ln, sc nng theo kim.

truyn vo su.

5.4. Liu trnh n chm ngy 1 ln, thi gian 25- 30 pht

6. THEO DI V X TR TAI BIN 6.1. Theo di: Ton trng ca ngi bnh.

6.2. X TR TAI bin - Bng (thng gy bng I) + Triu chng: ngi bnh thy nng rt sau khi cu, trn mt da vng

huyt c cu xut hin phng nc.

+ X tr: dng thuc m bi v dn bng trnh nhim trng.

- Chy: do mi ngi ri khi ngi Ngi bnh vng vo qun o hoc

chn m gy chy. Cn ch theo di st Ngi bnh khi thc hin k

thut cu.

- Vng chm :

+ Triu chng: Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc

mt nht nht.

+ X l: rt kim ngay, lau m hi, m, cho ung nc ch ng nng.

Nm ngh ti ch. Theo di mch, huyt p.

- Chy mu khi rt kim: Dng bng kh v khun n ti ch, khng day.

20

8. CU

1. I CNG Cu l dng sc nng tc ng ln huyt d kch thch to nn phn ng ca

c th phng v iu tr bnh. Cu thng dng l ngi cu kh ch

thnh ngi nhung ri lm mi ngi hay iu ngi cu.

- Cu bao gm cu trc tip, cu gin tip. Cu gin tip bao gm cu cch

gng c tc dng n trung tn hn, cu cch ti c tc dng tiu vim tr

c, cu cch mui c tc dng hi dng c thot....

2. CH NH Bnh l c nguyn nhn h hn.

3. CHNG CH NH - Cc trng hp bnh l c nguyn nhn thc nhit (c st cao...).

- Khng nn cu cc vng c nhiu gn, da st xng, vng mt ...v c

th gy bng, c bit l nhng vng b mt cm gic.

4. CHUN B 4.1. Ngi thc hin Bc s, Y s, Lng y c o to v chuyn ngnh y hc c truyn c cp

chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin - Mi ngi hoc iu ngi.

- La (dim, bt la...).

- Gng, ti, mui (s dng khi cu gin tip).

- Dao loi nh, sc, Khay men ng dng c.

4.3. Ngi bnh - Ngi bnh c khm, lm h s bnh n theo quy nh.

21

- Ngi bnh nm t th thoi mi, huyt c cu hng ln trn,

mt da nm ngang mi ngi t ln da c vng vng, khng b ri.

5. CC BC TIN HNH 5.1. Th thut - Ty bnh tt v huyt cn cu m chn cch cu trc tip hay gin tip.

- Cu trc tip: Dng mi ngi t vo huyt ri t. Khi mi ngi chy s

sinh nhit tc ng ln da vng huyt c cu. Khi mi ngi chy c 1/3

n 2/3, ngi bnh c cm gic nng, rt ni cu th nhc mi ngi ra sau

thay bng mi ngi khc. Sau khi cu xong ch cu thy m v c qung .

- Cu gin tip: l cch cu dng lt gng, ti hoc mui... lt vo gia da

v mi ngi. Trong khi cu, nu ngi bnh thy nng nhiu th nhc lt

gng, ti ln gim nng sau tip tc cu. Cng c th lt thm mt

lt gng, ti khc gim sc nng ca mi ngi. Ty theo bnh m chn

th ny hay th khc lt mi ngi.

- Th t trong khi cu: Huyt trn trc - huyt di sau, huyt kinh dng

trc - huyt kinh m sau, huyt ch tr trc - huyt phi hp sau.

5.2. Liu trnh - Mi huyt c cu t 1- 3 mi ngi, trung bnh 15 pht/huyt, tr em v

ngi gi th thi gian cu ngn hn.

- Cu ngy 1 ln.

6. THEO DI V X TR TAI BIN 6.1. Theo di Ton trng ca ngi bnh

6.2. X TR TAI bin - Bng (thng gy bng I) + Triu chng: ngi bnh thy nng rt sau khi cu, trn mt da vng

huyt c cu xut hin phng nc.

22

+ X tr: dng thuc m bi v dn bng trnh nhim trng.

- Chy: do mi ngi ri khi ngi Ngi bnh vng vo qun o hoc

chn m gy chy.

+ phng: Khng cu nhiu huyt v trn nhiu Ngi bnh mt lc.

Theo di st, khng c ri Ngi bnh khi cu.

23

9.CHCH L 1. I CNG Chch l l phng php cha bnh khng dng thuc c cha ng ta

s dng t ngn xa. Chch (cn gi l Trch) l dng kim tam lng hoc

kim ho chm m nh vo huyt hoc ch m nht ca vng da ng

huyt hoc vng ng huyt (ni c mu c ng), khi rt kim mu t

vt chy ra ngoi. L (cn gi l Nh) l vo da ln, dng kim m nh vo

ng im t huyt hoc xut huyt, mu khng t chy ra m phi dng tay

nn cho mu ra. y l phng php trc tip loi b cc cht c v mu

c ra khi c th khai thng cc kinh mch, gip cho kh huyt c

iu ho.

2. CH NH Chch l c ch nh iu tr mt s bnh ton thn cng nh ti

ch, t cc bnh ni thng n cc chng ngoi cm, cc bnh cp tnh v

mn tnh. Hin nay, chch l c ch nh trong mt s chng bnh nh

sau:

- Trng phong (giai on cp), cn tng huyt p (khi khng c sn trong tay

thuc h p).

- Mt s trng hp ph n cc chi do vim tc ng mch, vim tc tnh

mch.

- Mt s chng au cp: au lng, au thn kinh toa...

- Tc tia sa.

- Chp lo.

- au u do ngoi cm.

3. CHNG CH NH

+ Ngi bnh c ch nh cp cu ngoi khoa.

+ Ngi bnh ang st ko di hoc mt nc, mt mu.

24

+ Suy tim, lon nhp tim.

+ Bnh a chy mu, Ngi bnh suy gim min dch.

4. CHUN B 4.1. Ngi thc hin Bc s, Y s, lng y c o to v chuyn ngnh y hc c truyn c

cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha

bnh.

4.2. Phng tin - Kim tam lng v khun, kim chm cu v khun loi 4 - 6 cm, dng ring

cho tng ngi bnh.

- Khay men, km c mu, bng, cn700, gng tay v khun



5. CC BC TIN HNH 5.1-Phc huyt Tu theo tng chng bnh m Ngi thc hin chn phc huyt

khc nhau, di y xin nu mt s phc chnh.

- Trng phong (giai on cp): Thp tuyn, Nhn trung, Thi dng, n

ng.

- Chp lo: Ph du, Nh tim (Can nhit huyt).

- Tc tia sa: Kin tnh, Thiu trch.

- au lng cp: Nhn trung, Hu kh, U trung.

- au u do ngoi cm: Khc tr, Thi dng, n ng.

5.2-Th thut Xc nh v st trng da vng huyt cn chch l. Nn dn cho mu

tp trung v vng huyt. Dng ngn tay ci v ngn tr tay tri vo bp

25

mnh da vng huyt; ngn ci v ngn tr tay phi cm kim mt cch chc

chn, chm kim thng gc, mnh v dt khot qua da ng gia vng huyt.

Rt kim ra v nn mu t t, n m su vo y im au lm cho mu c

tro ra l chch l. Nn ht mu c (mu bm) th st trng li vt

chch l.

5.3. Liu trnh iu tr - Bnh cp tnh: mi ngy chch l 1 2 ln, mi liu trnh iu tr t 5 10 ngy.

- Bnh bn cp v mn tnh: mi ngy chch l mt ln, mt liu trnh iu tr

t 10 20 ngy, ngi bnh ngh 5 7 ngy iu tr liu trnh tip theo.

6. THEO DI V X TR TAI BIN 6.1. Theo di: Ton trng Ngi bnh.

6.2. X TR TAI bin 6.1. Vng chm: Ngi bnh hoa mt chng mt, v m hi, mch nhanh,

sc mt nht nht. X l: rt kim ngay, lau m hi, m, ung nc ch

ng nng, cho ngi bnh nm ngh ti ch. Day bm cc huyt: Thi

dng, Ni quan. Theo di st mch, huyt p

6.2. Mu chy qu nhiu khi rt kim: dng bng kh v khun n ti ch,

khng day, sau dng ming gc v khun bng p li bng bng dnh.

6.3. Nhim trng vt chch l: biu hin bng sng au tai ch chch l. X

l: tm ngng vic chch l, st trng vng da b sng bng dung dch cn

Iod, dng khng sinh ng ung.

26

10.LASER CHM

1.I CNG Mt trong hai ng gp to ln cho khoa hc k thut ca ngnh vt l

trong th k 20 l laser. Nm 1960, chic my laser u tin ra i do nh

bc hc Maiman (M) ch to, v t thnh tu ny c ng dng rng

ri trong cc chuyn ngnh khc nhau trong c y hc. Hin nay laser

c ng dng rng ri trong cc chuyn ngnh khc nhau ca y hc bi n

c cc tnh cht rt c bit, l: tnh n sc, nh hng v chi

ph rt cao. Vic s dng nh sng n sc pht ra t mt thit b laser cng

sut thp (

27

- Ngi bnh sau khi iu tr vi cc thuc c ch min dch, corticoid liu

cao ko di.

- Ngi bnh ng kinh.

- Ngi bnh suy tim mt b, lon nhp, suy mch vnh.

- Ngi bnh cng gip.

- Khng chiu laser vo vng thp, u cc xng di ca tr v thnh nin,

cnh cc tuyn ni tit (tuyn gip, tinh hon...)

4. CHUN B

4.1. Ngi thc hin Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng

ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin - My pht laser cng sut thp: thng s dng laser He Ne, laserdiode hng ngoi .

- Knh bo h cho Ngi thc hin v Ngi bnh.

- Quy trnh iu tr laser cng sut thp.



5. CC BC TIN HNH 5.1-Phc huyt

Cc huyt c s dng trong iu tr bng laser chm cng tng t

nh cc huyt trong phc ca chm cu truyn thng. Tuy nhin, s

huyt c chn trong laser chm t hn, thng t 4 n 10 huyt.

5.2-Th thut Xc nh chnh xc vng huyt, dng k thut chiu im (chiu tia

thng gc vi huyt), u pht tia cch mt da 0,5cm. Gi u pht ti ch

28

cho n khi ht thi gian iu tr, khi my s pht ra tn hiu m thanh v

u chiu t ng ngng pht tia.

Chiu ln lt tng huyt cho n khi ht cc huyt theo phc .

5.3. Liu iu tr Liu iu tr ph thuc vo tng loi huyt v tnh trng ca bnh

(bnh cp tnh dng liu thp, bnh mn tnh dng liu cao). Liu iu tr

c tnh bng J/cm2.

Loi huyt Liu

A th huyt 1 2 J / cm2

Huyt gip tch 2 4 J / cm2

Huyt chm cu ngi ln 1 3 J / cm2

Huyt chm cu tr em 0,5 1,5 J / cm2

Thi gian iu tr tu thuc vo liu iu tr v s huyt c la chn.

Thng thng thi gian iu tr bng laser chm t 5 10 pht/ln.

5.4. Liu trnh iu tr - Bnh cp tnh: mi ngy iu tr 1 2 ln, mi liu trnh 5 10 ngy.

- Bnh bn cp v mn tnh: mi ngy iu tr 1 ln, mi lit trnh iu tr t

2 - 4 tun. Bnh mn tnh c th iu tr cch ngy.

6.1. Theo di: Ton trng Ngi bnh.

6.2. X TR TAI bin Ngi bnh xut hin cc nt da, mn nga (do c a qu mn

cm vi nh sng), tt my laser, tm dng iu tr 1 3 ngy cho n khi

ht cc nt .

6.3. Ch khi iu tr bng laser chm

- Khng c chiu thng gc tia laser vo mt v c th lm tn thng

vng mc.

29

- Da trn cc vng huyt khng c bi du, m hay cc loi kem, gell v

s lm tia laser b phn x mt phn v nh hng n mc m xuyn

ca tia.

30

11.T CHM 1.I CNG T xa xa, con ngi bit s dng nam chm t nhin (t trng) vo mc ch cha bnh. Ngy nay, t trng v ang c ng dng c

hiu qu trong rt nhiu lnh vc lm sng nh: ni khoa, ngoi khoa, vt l

tr liu v cc chuyn khoa khc.

ng hnh vi y hc hin i, y hc c truyn cng s dng nam

chm vnh cu thay cho cy kim chm cu truyn thng phng v iu tr

rt nhiu chng bnh bnh, gp phn ng k trong vic bo v v nng cao

sc kho cho nhn dn. y l mt trong nhiu phng php kt hp gia

Y hc c truyn vi Vt l tr liu v c gi l t chm.

2. CH NH T trng chm l mt phng php tr liu an ton, t c hi v c hiu qu. Mt s ch nh ca t chm l:

- Gim au: au c gy, au quanh khp vai, vim mm trn li cu, hi

chng ng c tay, au lng hng, au thn kinh to...

- Chng vim: cc vng vim nh, nng (mn, nht), cc vim ni tng

(vim i trng co tht, vim lot d dy hnh t trng.

- iu ho trng lc thn kinh: hi chng thn kinhh suy nhc, au u,

mt ng, ri lon thn kinh thc vt.

- iu ho v n nh huyt p. 3. CHNG CH NH - Khng s dng t chm trong cc trng hp sau:

- Nhng Ngi bnh c my to nhp tim.

- Ph n trong thi k mang thai, ph n trong thi k kinh nguyt: khng

iu tr vo vng bng, vng tht lng v xng cng.

- Ngi bnh sau nhi mu c tim cp.

31

- Bnh h thng v bnh mu (mu chm ng...).

- Cc vng ang chy mu hoc c nguy c chy mu.

4. CHUN B

4.1. Ngi thc hin Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng

ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin - Vin nam chm vnh cu cc loi vi cc thng s cng t trng

khc nhau (t 10 50 mT).

- Bng dnh.

- Bng cn.



5. CC BC TIN HNH 5.1-Phc huyt

Cc huyt c s dng trong iu tr bng t chm cng tng t

nh cc huyt trong phc ca chm cu truyn thng. Tuy nhin, s

huyt c chn trong t chm t hn, thng t 2 n 6 huyt.

5.2-Th thut Xc nh chnh xc vng huyt, lau sch b mt da vng huyt bng

bng cn, ch cho b mt da kh th t cc vin nam chm ln v tr ca cc

huyt theo phc iu tr, dng bng dnh dn cht li.

Cng nh chm cu truyn thng, tu theo yu iu ho kinh kh

trong c th m ngi ta s dng cc th thut b v t. Khi s dng vim

nam chm gn ln cc huyt th cc Nam (k hiu l S) tng ng tc dng

t (nu gim au, nn dng cc Nam thng c mu ), cc Bc (k hiu

32

l N thng c mu en) tng ng tc dng b (nu dng iu ho

trng lc thn kinh , nn dng cc Bc).

Nam chm vnh cu c th s dng 5 10 nm vn cha b suy gim

t tnh. Khi iu tr xong nn ct i c th dng li ln sau.

5.3. Liu iu tr Liu iu tr ca t chm chnh l tr s ca cng t trng, n v tnh ca cng t trng l dng trong t chm l millitestla (mT).

Cng t trng khi p dng t chm nn dng liu thp v trung bnh

(10 40 mT).

Thi gian lu cc vin nam chm trn vng u mt c khng qu 20

pht. Cc huyt khc lu vin nam chm 30 40 pht.

5.4. Liu trnh iu tr. - Bnh cp tnh: mi ngy iu tr 1 ln, mt liu trnh 5 10 ngy.

- Bnh bn cp v mn tnh: mi ngy iu tr 1 ln, mt liu trnh t 15 -

20 ngy.

6. THEO DI V X TR TAI BIN 6.1. Theo di Ton trng Ngi bnh.

6.2. X TR TAI bin Mt s t trng hp c cm gic mt mi, vng vt khi iu tr t

trng, hoc b d ng vi vin nam chm (do cht liu lm v bc vin nam

chm). Cho Ngi bnh tm ngh 1 2 ngy cho ht tnh trng vng vt

hoc d ng. Nu bnh s dng li t chm m Ngi bnh vn c cc triu

chng trn th khng tip tc iu tr bng t chm m chuyn phng php

iu tr khc.

33

12.QUY TRNH KO GIN CT SNG C 1. I CNG

Hi chng au ct sng c thng gp trn lm sng v do nhiu

nguyn nhn khc nhau. Ngi bnh au ct sng c v tht lng ch yu

c iu tr theo phng php ni khoa (90%), ch 10% c ch nh phu

thut.

Phng php ko gin iu tr hi chng au ct sng c bng my

ko gin c lp trnh vi tnh chng minh c hiu qu iu tr trong thc

t. Ngi thc hin trc khi ch nh phng php ny ngoi vic nh gi

trn lm sng cn phi c y cc kt qu cn lm sng, phim chp Xq

thng thng v MRI, o mt xng xc nh nguyn nhn, mc

bnh tt ca Ngi bnh.

2. CH NH

- Thoi ha ct sng

- Li, phnh, thot v a m

- Sai khp ct sng mc nh (giai on u)

- Hi chng ct sng c

- au lng thng thng

- Cong vo ct sng (c nng)

3. CHNG CH NH

- C tn thng ty sng, bnh ng sng

- Lao, ung th ct sng

- Vim ty, abces vng ct sng

- Long xng III

- Tng HA

- Chn thng ct sng

34

4. CHUN B

4.1. Ngi thc hin Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Ngi bnh Kim tra cn nng, tho ai np, dy chuyn, hoa tai, kp tc v chun b

tinh thn trc khi thc hin ko gin.

4.3. Phng tin My ko gin, ai ko c trong tnh trng hot ng tt.

5. CC BC TIN HNH

- Gii thch cho Ngi bnh.

- Sp t t th cho Ngi bnh trn ging ko gin.

- Kim tra v lp ai ko cho Ngi bnh.

- Bt my, xc nh lc v thi gian ko gin (cng thc: ct sng c bng

1/3 trng lng 10kg).

- Tt my khi hon thnh quy trnh ko gin, Ngi thc hin t t tho b

ai ko c cho Ngi bnh.

- Hng dn Ngi bnh nm ngh t nht 2 pht sau ko gin v cch

nghing ngi ngi dy ra khi ging ko gin.

- Liu trnh iu tr: Ngy 01 ln x 10 15 pht, iu tr theo liu trnh 10 20 ln ko gin lin tc.

6. THEO DI X TR TAI BIN y l mt phng php iu tr rt an ton khi tun th ng ch

nh, ng quy trnh ko gin. Trong qu trnh thc hin ko gin ct sng

lun cn c Ngi thc hin theo di ton trng Ngi bnh, theo di tnh

trng hot ng ca thit b ko gin v c y cc phng tin h tr khi

xy ra cc vn ngoi . Trong khi ko gin, Ngi bnh cm thy ai

35

ko khng va cn tt my v lp li ai, nu Ngi bnh xut hin trng

thi kh chu, au vng c gy, cm gic kh th Ngi thc hin cn dng

ngay ko gin, Ngi bnh nm ngh trn ging ko, kim tra mch,

HA, ng vin Ngi bnh v c cc x tr tip theo

36

13.QUY TRNH KO GIN CT SNG THT LNG

1. I CNG Hi chng au ct sng tht lng thng gp trn lm sng v do

nhiu nguyn nhn khc nhau. Ngi bnh au ct sng tht lng ch yu

c iu tr theo phng php ni khoa (90%), ch 10% c ch nh phu

thut.

Phng php ko gin iu tr hi chng au ct sng tht lng bng

my ko gin c lp trnh vi tnh chng minh c hiu qu iu tr trong

thc t. Ngi thc hin trc khi ch nh phng php ny ngoi vic

nh gi trn lm sng cn phi c y cc kt qu cn lm sng, phim

chp Xquang thng thng v MRI, o mt xng xc nh nguyn

nhn, mc bnh tt ca Ngi bnh.

2. CH NH - Thoi ho ct sng.

- Thot v a m ct sng mc nh v va.

- Cc chng au lng thng thng.

- Vo ct sng (c nng).

3. CHNG CH NH

- Cc trng hp bnh l ct sng gy chn p tu, bnh ng tu.

- Lao, ung th ct sng.

- Vim ty, p xe vng lng.

- Chn thng ct sng c gy xng.

- Vim khp dng thp.

- Hi chng ui nga.

- Thot v a m vo trong thn t (thot v Schmorl).

- Long xng III.

37

- Ph n c thai.

4. CHUN B

4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Ngi bnh: Kim tra cn nng, b tho ai np v chun b tnh thn trc khi thc hin ko gin.

4.3. Phng tin: My ko gin, ai ko trong tnh trng hot ng tt.

5. CC BC TIN HNH

- Gii thch cho Ngi bnh.

- Sp t t th cho Ngi bnh trn ging ko gin.

- Kim tra v lp ai ko tht lng cho Ngi bnh.

- Bt my, xc nh lc v thi gian ko gin (ct sng tht lng bng 2/3

trng lng 10kg).

- Tt my khi hon thnh quy trnh ko gin, tho b ai tht lng cho

Ngi bnh.

- Hng dn Ngi bnh nm ngh t nht 2 pht sau ko gin v cch

nghing ngi ngi dy ra khi ging ko gin.

- Liu trnh iu tr: Ngy 01 ln x 10 15 pht, iu tr theo liu trnh 10 20 ln ko gin lin tc.

6. THEO DI X TR TAI BIN y l mt phng php iu tr rt an ton khi tun th ng ch

nh, ng quy trnh ko gin. Trong qu trnh thc hin ko gin ct sng

lun cn c Ngi thc hin theo di ton trng Ngi bnh, theo di tnh

trng hot ng ca thit b ko gin v c y cc phng tin h tr khi

xy ra cc vn ngoi . Trong khi ko gin, Ngi bnh cm thy ai

ko khng va cn tt my v lp li ai, nu Ngi bnh xut hin trng

38

thi kh chu, au lng, au bng, cm gic kh th Ngi thc hin cn

dng ngay ko gin, Ngi bnh nm ngh trn ging ko, kim tra

mch, huyt p, ng vin Ngi bnh v c cc x tr tip theo

39

14. QUY TRNH TM DC THO

1. I CNG Tm dc tho l phng php chm sc phc hi sc khe v cha

bnh c truyn c lch s hng ngn nm. Hin nay, vi mc ch chm

sc ton din, ngi ta kt hp xng hi, ngm thuc, tm dc tho,

chm ngi cu, xoa bp bm huyt nhm pht huy ti u tc dng ca cc

phng php ng thi em li nhng gi tr c bit cho ngi bnh.

2. CH NH - Cc chng au, chng lit.

- Cm cm do phong hn.

- Hi chng cng thng tm l, mt mi,...

3. CHNG CH NH - St nhit.

- Bnh l tim mch, huyt p.

- ng kinh, tm thn, say ru bia, kch ng,...

- ph n ang rong thi k c thai, hnh kinh.

- Trng thi qu no hoc qu i.

4. CHUN B 4.1. Ngi thc hin Bc s, Y s, Lng y c o to v chuyn ngnh y hc c truyn

c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh,

cha bnh.

4.2. Phng tin - Bn ngm, nc m, nc tho dc m, cc loi tho dc c tinh du,

ti chm...

4.2. Ngi bnh

40

- Ngi bnh c kim tra mch, huyt p... trc khi tm thuc.

5. CC BC TIN HNH Ngi bnh tm sch trong 2 pht bng nc m tip

5.1.Ngm ngi trong bn g (th tch t 250 300 lt) bng nc tho dc nhit ngang bng nhit c th (37-400C), trong thi gian t 7 -10

pht.

Tc dng: gii cm, chng mt mi, chng au lng, cha thn kinh ta.

5.2.Ngm bn sc bng nc m sch trong thi gian 5 - 7 pht. Tc dng: cha cc bnh ngoi da, lm sn chc da, tiu vim, tnh thn.

5.3.Xng hi kh hoc t bng l tho dc trong vng 5 7 pht, tip ngm chn nc gng.

Tc dng: gii cm, gii c t v gim au.

5.4.Tm trng gii cm trong thi gian 3 pht. 5.5. Ngi bnh c k thut vin p ti chm ngi m cha dc tho,

kt hp day n cc im au ti vng tht lng, c gy v vai, hai tay v hai

chn.

Tc dng: tng cng gin cc khi c su cc vng b au.

Thi gian thc hin ton b quy trnh nu trn l 30 pht. Liu trnh: 2 ngy lm 1 ln, mt liu trnh iu tr t 5 n 7 ln.

6. THEO DI X TR TAI BIN y l mt phng php an ton khi tun th ng ch nh, ng quy

trnh. Trong qu trnh thc hin cn c Ngi thc hin theo di ton trng

Ngi bnh v c y cc phng tin h tr khi xy ra cc vn ngoi

.

1

100. IN MNG CHM IU TR H I CH NG THT NG H NG 1. I CNG - c t t do u uy c v t c t y ra :

do , t ot v a m, v m m, k u c p...

- T eo y c c truy c t t g hng c m u t tro p m v c

t v b da yu cc t , uy t do p o , , t p, t

xm p m vo k B qua v k m y ra.

2. CH NH

au t k ta do p o t p, do t o a c t s .

3. CHNG CH NH au t k ta km t eo m tr t c .

4. CHUN B

4.1. Ngi thc hin: Bc s, Y s c o to v c uy y c c truy c cp c c t eo quy ca p p ut v k m b , c a b .

4.2. Phng tin

- My c m a t s b, t.

- K m c m c u v k u , o : 6-10-15cm, d r c o t .

- Khay men, kp c mu, b , c 70 .

4.3. Ngi bnh - c t v , t c trc k vo u tr. - c k m v m s b t eo quy . - T t b m a, cao oc .

5. CC BC TIN HNH 5.1. Phc huyt C m t b au:

Gip tch L2 - 3 xuyn L5- S1

Trt b xuyn Hon khiu

n mn xuyn T a p

2

Tt d qua xuyn P o t

uy c u xuyn D tuy

T a s xuyn y tru

5.2. Th thut :

- Bc 1: Xc v st k u da v uyt

- Bc 2: C m k m vo uyt t eo cc t sau:

Th 1: Tay tr d tay c v tr , c da v uyt;

Tay p c m k m a qua da v uyt.

Th 2: y k m t t t eo uyt o, kc t c k m c o k tc kh

(b c cm c c , t c, va p , k au v uyt va

c m k m, t y t uc cm c k m mt c t t v tr uyt).


N cp dy ca my c m v k m c m vo uyt t eo t s b- t ca

my c m:

- T s (t t s c ): T s t t 5 - 10 z, T s b t 1 - 3Hz.

- C : d c t 0 150 m croAmpe (tu t eo m c c u

ca b ).

+ T a : 20- 30 p t c o m t mng chm.


5.3. iu trnh iu tr - m c m y m t

- M t u tr u tr t 15 - 30 .

6. THEO DI V X TR TAI BIN 6.1. Theo di Theo di t c v to tr ca b .

6.2. X tr tai bin

3

- Vng chm: N b oa mt, c mt, v m , mc a , sc mt

t t. X tr: rt k m ay, au m , m, u c c , m

t c . T eo d mc , uyt p.

- Chy mu khi rt kim: d b v k u t c , k day.

4

101. IN MNG CHM IU TR BO PH 1. I CNG - T eo Y c : Bo p t tr c t tc tr qu u m m

xu s c k o.

BMI (Body Mass I dex) = tr c t (k ) / b p ca c u cao

(cm)

- Nu BMI t u c k o t 20-25: b t

- Nu BMI > 25: t a c

- Nu BMI > 30: Bo p

+ T 30 34,99: Bo p I

+ T 35 39,9: Bo p II

+ > 40: Bo p III

- Theo Y c c truy : Bo p t tr tr k qua c m m.

- Mc c ca c m c u m c , a c s BMI d v b t .

2. CH NH Cc tr p t a c , bo p do c u , s ot.

3. CHNG CH NH - Bo p , t a c do cc b t t: T u tuy p, to cc c ,

Cushing.

- Bo p sau d m t s t uc (cort co d, t uc u tr tm t , t uc a

t a )

4. CHUN B 4.1. Ngi thc hin: Bc s, Y s c o to v c uy y c c truy c cp c c t eo quy ca p p ut v k m b , c a

b .

4.2. Phng tin - My c m a t s b, t.

- K ay me , kp c mu, b , c 70 .

5

- K m c m c u v k u , o 10- 15- 20cm, d r c o t b .


5. Cc bc tin hnh 5.1. Phc huyt

- C m t:

C m xuyn mc C u xuyn Hon khiu

Thin khu xuyn T u o Trt b xuyn T a p

Phong long xuyn Tc tam l Tt d qua xuyn P o t

- C m b:

uyt xuyn m lim Tam m giao xuyn m tuy

5.2. Th thut :










my chm:



ca b ).


6



- M t u tr u tr t 15 - 30 .

6. THEO DI V X TR TAI BIN 6.1. Theo di: T c v to tr ca b

6.2. X tr tai bin - Vng chm: N b oa mt, c mt, v m , mc a , sc mt

t t: rt k m ay, au m , m, u c c , m


- Chy mu khi rt kim: d b k v k u t c , k day.

7

102. IN MNG CHM IU TR IT NA NGI DO TAI BIN MCH MU NO 1. I CNG

Ta b mc mu o ( t qu o) s xy ra t t cc t u st c c

t k t k u tr a ta, t t qu 24 oc y t vo

tro 24 . Cc k m xt o tr uy c t . T eo Y c c truy B t bt to , t u c c tr p o .

Mc c ca quy tr y: N m d c o N t c cc

tuy p d u tr.

2. CH NH N b t a sau a o cp ta b mc mu o ( t qu

no); mc , uyt p, p t .

3. CHNG CH NH N b a m, cc c s mc , uyt p, p t c a .

4. CHUN B 4.1. Cn b thc hin: Bc s, Y s c o to v c uy y c c

truy c cp c c t eo quy ca p p ut v k m b ,

c a b .

4.2. Phng tin:


- K m c m c u v k u , o 6 - 20cm, d r c o t b .

- K ay me , b , c 70 , kp (p ce) c mu.

4.3. Ngi bnh - c t v , t c trc k vo u tr. - c k m v m s b t eo quy . - T t b : m

8

4.4. H s bnh n B c k m v m b t eo quy .

5. CC BC TIN HNH 5.1. Phc huyt o: - T t , c m t cc uyt:

- Bc - T m tuy v c

- N o k m t - N o c dc - mn

- L t mt, c m t cc uyt:

- Quy u qua

- a t Gip xa

- T a t - P o .

- L t tay, c m t cc uyt o:

- Gip tch C4 C7 - c y Tch trung

- Kin ngung Khc tr - Kin trinh Cc tuy

- Khc tr N o qua - p cc Lao cung

- Bt t

- L t c , c m t cc uyt o:

- Gip tch D12 L5 - Tch trung Yu d quan

- Hon khiu T a p - Trt b T a p

- T a s U tru - D tuy uy c u

- L k u B qua - P d Cn ln

- G k K u k - a

C m b:

- T du Bc o du - Thi kh Trc tn

- Tam m giao m cc - uyt m lim

5.2. Th thut :



9








my c m:



ca b ).




- M t u tr u tr t 15 - 30 .

6. THEO DI T eo d to tr v d b ca b .

7. X TR TAI BIN - Vng chm: N b oa mt c mt, v m , mc a , sc mt

t t.

X tr: Tt my, rt k m ay, au m , m, oc m t o

mt, u c , m t c . K m tra mc , uyt p.

- Chy mu sau khi rt kim: D b v k u p t c , k day.

10

103.IN MNG CHM IU TR H I CH NG D DY - T TRNG

1. I CNG Lot d dy t tr m t b c t t ot m mc, m

mc t m c t c p c ca d dy hnh t trng.

T eo Y c c truy , c v qu t , t p a t ca

k p m v oc t v .

Mc c : Lm m au c o b b ot d dy t trng.

2. CH NH N b b au do ot d dy t trng.

3. CHNG CH NH Tr p c c ca t p o k oa.



c a b ..


- K m c m c u v tr o 6 - 20cm, d r c o t b .

- K ay me , kp c mu, b , c 70 .



5. CC BC TIN HNH 5.1. Thc hin k thut + Phc huyt o:

11

- Th Can kh phm V, chm t: - T y p C k uyt - K m Thin khu

- N qua G a s - Tc tam l c

- uy c u D tuy

- Th T V h hn, chm b: - qu C k uyt - C m L m

- G a s N qua - Tc tam l c

- T du V du T du - Tam m giao m tuy

5.2. Th thut :










my c m:



ca b ).




- M t u tr u tr t 15 - 30 .

6. THEO DI V X TR TAI BIN

12

6.1. Theo di T eo d t c v to t




- Chy mu khi rt kim: d b v k u t c , k day

13

104. IN MNG CHM IU TR SA D DY 1. I CNG

Sa d dy m t c b xy ra c b d dy m t ,

do u k u , m o m c v c c ay, ay do t

c b kc t c , ca k b ut kt mt k s t t m r o k c ca t

v, m c o k m, k c c c c y ra.

2. CH NH B sa d dy c c u tr k oa.

3. CHNG CH NH B sa d dy c c o k oa.

4. CHUN B 4.1. Cn b thc hin

Bc s, Y s c o to v c uy y c c truy c cp c

c t eo quy ca p p ut v k m b , c a b .



- K ay me , kp b c mu, b , c 70 .



5. CC BC TIN HNH 5.1. Phc huyt o: (chm b)

- Bc T - Bt du Thin Khu

- Tru qu C k uyt - Quan nguyn K

14

- Tc tam l c - Tam m giao m tuy

- T du V du Bc o du.

5.2. Th thut :










my c m:



ca b ).



5.3. iu trnh iu tr - m c m y m t - M t u tr u tr t 15 - 30 .

6. THEO DI V X TR TAI BIN 6.1. Theo di T eo d t c v to t





15

105. IN MNG CHM IU TR TM CN SUY NHC 1. I CNG Cc r tm c m t m u r o c c uy tm tro g

b tm t , c m 3-5% d s, v mt tr u c , t tr ko

d v p c tp do p t u c vo u t ( cc , stress, m tr x

). Tro tm c suy c b t p t, v cc b u

mt , c u v m tr , 60% p ao tr c, t 30-

50 tu , t t v am u .

T eo Y CT, b c m u t tro p m v u c , ty t eo tr u

c bt k qu (t m p p t c), c xu (t m p i

p ko d ), k vo ( ay qu ), u t ( c u), d t , t t m (mt

)

2. CH NH B c c o tm c suy c

3. CHNG CH NH B tm t k p tc u tr.

4. CHUN B 4.1. Cn b thc hin

Bc s, Y s c o to v c uy y c c truy c cp c

c t eo quy ca p p ut v k m b , c a b .



- Khay me , kp b c mu, b , c 70 .


16


5. CC BC TIN HNH 5.1. Phc huyt o: - Th can kh ut kt (t p t ): C m t cc uyt o

- T t T - T Bc u

- T d t u - Phong tr Phong tr

- N quan G a s - Tam m giao m tuy

- T m T u - Can du Tam tiu du

- Thi xung Hnh gian

- Th can thn h (t c c m) c m b cc uyt o:

- u Bc T - t u T d

- Phong tr Phong tr - N qua G a s

- Thng l T m - Can du T du

- Thi kh m cc - Tam m giao m tuy

- Th m dng u h (t p v c c u m) c m b cc uyt

o :

- u Bc T

- T dng t u - Quan nguyn k

- T du Bc o du - Phong tr Phong tr

- M m Tch trung - Tam m giao m tuy .

5.2. Th thut :





17






my c m:



ca b ).




- M t u tr u tr t 15 - 30 .

6. THEO DI , X TR TAI BIN 6.1. Theo di :T eo d to tr v d b ca b .


t t.

X tr: rt k m ay, au m , m, u c c , m


- Chy mu khi rt kim: d b k v k u t c , k day.

18

106. IN MNG CHM IU TR TR 1. I CNG Tr m t b m t do cc mc trc tr u m b v xu

uyt. T mc xu uyt t m t b oc u b , ty v tr t mc

trc tr ay u m , c p c a tr m s t tr ay tr o .

N uy y ra tr c u: V m tr m t y to b

t xuy t r u, v m a , x a m t y xu uyt t

mc , cc b p do u, u, ma vc , p

u , c c a m tr c c b , t t mc b m y

t mc v.v...

V xu uyt d y t ot qu , c y mu, m b t u mu, v

b m b c tr u c m tr . Tr m s , c c vo

t tr cc b tr, xut uyt v m tr p o t b v cc c a

b .

2. CH NH B tr c a c c o k oa.

Tr t uyt v t t p t.

3. CHNG CH NH B tr c c o k oa.

B k p tc u tr.



c a b .



- K ay me , kp b c mu, b , c 70 .

19



5. CC BC TIN HNH 5.1 Phc huyt o:

- Bc T - Trt b Bc o du

- tr du T u tr du - T u Bc o du

- B c C m so so u m

- Tc tam l G kh - Tam m giao T a s .

5.2. Th thut :










my c m:



ca b ).



20


- M t u tr u tr t 15 - 30 .

6. THEO DI To tr v d b ca b .

7. X TR TAI BIN - Vng chm: N b oa mt, c mt, v m , mc a , sc mt

t t.

X tr: rt k m ay, au m , m, u c c , m


- Chy mu khi rt kim: dng b k v k u t c , k day.

21

107. IN MNG CHM PHC HI CH C NNG VN NG CHO TR BI IT

1.I CNG: B t b m tr cp t , c t c t y a t eo t u o, do

v rus b t y ra. V rus c t c b t v t bo t k v s

trc tu xm. c m t t t mm m t c oc m t m c.

2. CH NH B c c u o d c b t v c m a o cp

t t t, c c u c , t mm, k u, k

x , k r o cm c, tr t c b t . Xt m uyt t a p

p v rus d t , c t y mt oc m tc d truy t k ca

dy t k b t t .

3. CHNG CH NH B d c b t a b m k u cp t : a c y, v m p .



c a b .


4.3. Phng tin - My c m 2 t s b, t .

- K m c m c u 6cm, 8cm, 10, 12cm.

- K ay, kp c mu, b , c 700

- p t uc c c o

5. CC BC TIN HNH

22

5.1. Phc huyt: tu v tr t t , t c cc m c, cc o c b t t c m t k c, t c c c, a teo c co rt b d

v duy tr tm ot k p, c m to t b T , Ca , T, t c

u d c - c - ct k p.

T: K u xuy t u T tam K c tr

Kin trinh Cc tuy , K t

K c tr xuy T tam T m m,

p cc xuy Lao cu

G p tc C3 D1 , L1 L5, Trt b o k u, m T a p ,

T a s T a c , D tuy D ao, P c t B qua ,

B: T du, Tam m ao, uyt , Tc tam .

5.2. Th thut :










my c m:



ca b ).



5.3. iu trnh iu tr

23

- m c m y m t

- M t u tr u tr t 15 - 30 .






24

108. IN MNG CHM IU TR IT DO BNH C TR EM 1.I CNG B o d c Duc e e (Teo c p ) tr em b t b e y t u t 1 o prote m t bo c v , a t o a c v teo

c. B xut c 2 3 tu , c c co tra , t tr d teo c to

th , t t c c p, c t m.

B t vo do suy p, suy t m, m tr .

2. CH NH B c c o o d c Duc e e v cc b u

m s v cc xt m c u: CK uyt t a t , c t y t t

u c s c, c t y t o a c v t s t c c kt.

3. CHNG CH NH B o d c a b m k u cp t oc a o

cu ca b .



c a b .


4.3. Phng tin - My c m 2 t s b, t.

- K m c m c u v k u 6cm, 8cm, 10cm, 12cm.

- K ay, kp c mu, b , c 700

- p t uc c c o .

25

5. CC BC TIN HNH 5.1. Phc huyt 2 bn: - T th nm nga:

Chm T: Bch , K t , K u xuy T u xuy T

xuy K c tr, K c tr xuy T tam xuy T m xuy m,

p cc xuy Lao cu , P c t xuy B qua , D tuy xuy

D ao xuy uy c u , Xu d xuy G kh .

Chm B: N o qua xuy c cu, Tc tam xuy T , Tam

m ao xuy m tuy .

- T th nm sp:

Chm T: Gip tch C4 xuyn C7, D1 xuyn D10, L1 xuyn L5, K tr

xuy Cc tuy , K c tr Xc trc , Bt t, Trt b Hon khiu, n mn

xuy T a p , T a s T a c y tru .

Chm B: T du, uyt xuy m m.

5.2. Th thut :



Th 1: Tay tri dng ngn tay ci v tr , c da v uyt;







my c m:



ca b ).

26




- M t u tr u tr t 15 - 30 .






27

109. IN MNG CHM IU TR IT DO TN THNG M RI THN KINH CNH TAY TR EM

1. I CNG T t m r t k c tay xy ra tro c s oc do ta s ot, ta ao t y t oc m v , cm c ca cc c c

tay. N uy do t o oc m t oc tt c cc dy t k tr,

quay, a t m r t k c tay do t t ut ko tay, va k y t a oc

y x , dp do ta

2.CH NH B c o t t m r t k c tay:

L t dy quay: b tay r c c.

L t dy tr: b tay vut tr.

L t dy t k a: b tay k .

c t y mt oc m tc d truy t k ca dy b t t .

3. CH NG CH NH - B t tay do t t m r t k c tay a b cc b

m k u cp t : a c y, v m p ....

- Cc t t : Trt k p va , y x , y x c tay c a c

quyt o k oa tr t .



c a b .


28

4.3. Phng tin - My c m 2 t s b, t .

- K m c m c u v k u 6cm, 8cm, 10cm.

- K ay, kp c mu, b , c 700

- p t uc c c o .

5. CC BC TIN HNH 5.1. Phc huyt T: Bc , P o tr, G p tc C3 D1, K u, K tr xuy Cc

truy , K u xuy T u xuy T xuy K c tr.

K c tr xuy T tam xuy T m xuy m, p cc

xuyn Lao cung, Bt t

B: Tam m ao, uyt , T xu .

5.2. Th thut :










my c m:

- T s (t t s c ): T s t t 5 - 10Hz, T s b t 1 - 3Hz.


ca b ).



29


- M t u tr u tr t 15 - 30 .






30

110. IN MNG CHM IU TR SA T CUNG 1. I CNG Sa t cu ay c sa s dc m t b mc p p do cc b

p ca b my s dc tt t p k v tr ba u.

B t t cu c t c do t cu t t p trc, trc t cu

v m o k so so v au, d p c ca b k b sa

xu . N o ra t cu c c b cc dy c v t c c x to t

m t v a c o t cu v c t cu k b tt xu , cc c t s

m c o t m o k b sa xu .

Sa s dc c t p c p c a s do t tr yu, dy c m ,

yu, t cu t t tru a k c p c m tro b s y t

cu sa d xu . C s u , cc dy c yu,

t s m rc ay m , d s t p c b , t m o b sa

v ko t cu sa t eo.

- T eo y c c truy sa t cu c m u t tro p m v c "t h h

hn". T c v c c v c v t c k t k s y ra cc c sa

tro c sa t cu .

2. CH NH

Sa t cu cc (t 1 4)

3. CHNG CH NH Sa t cu km t eo m tr t c .

4. CHUN B

4.1. Cn b thc hin: Bc s, Y s c o to v c uy y c c


c a b .

4.2. Phng tin


31

- K m c m c u v k u , o : 10-15cm, d r c o t .

- Khay men, kp c mu, b , c 70 .

4.3. Ngi bnh: - c t v , t c trc k vo u tr. - c k m v m s b t eo quy . - T t b m a, cao oc .

5. CC BC TIN HNH 5.1. Phc huyt: chm cc huyt o sau: T cu xuy t cu

Quan nguyn - k c ct

Tam m giao -> Tru

K -> K c ct

5.2. Th thut :










my c m:



ca b ).

+ T a : 20- 30 p t c o

Hướng dẫn Quy trình kỹ thuật khám bệnh, chữa bệnh chuyên ngành Châm cứu

Health & Medicine

Transcript of Hướng dẫn Quy trình kỹ thuật khám bệnh, chữa bệnh chuyên ngành Châm cứu