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Chitang VI BENH TH O I KHI Do dac diem sinh ly va benh ly cua tre em rat de cam nhiem benh ve thdi khi, da mac benh roi lai bien hoa nit nhanh chong, uy hiep r&'t ldn den stic khoe cua tre, vi vay c^n nghien ctfu dtf phong va dieu tri benh thdi kip thdi, ddc biet phai lam tot cong tac phong benh va cach ly de quan triet phtfdng cham: phong benh la chu yeu s6 i (m a ch a n ) I DAI CUONG Sdi goi la ma chan, sa ttf; la mot nhiing benh thtfdng thay d tre em va cung la mot chtfng chu yeu cua nhi khoa Benh thtfdng ltfu hanh v&o mua dong xuan Tre bi benh toan than xuat hien nhiing diem do, noi hdi cao, sd vao thi vtfdng dtfdi tay, ttfdng tu nhtf hat vtfng cho nen goi la ma chain Tre em bi sdi nhieu nhat ttf den tuoi, dtfdi thang l't mac, tre da bi len sdi lan roi thi sau khong mac lai niia II NGUYEN NHAN B$NH Y kien cua cac co nhan deu cho rang, ben thi bi thai doc tich tu, ben ngoai cam nhilm phai thdi ltfu hanh, ngoai tac dung lan ma phat benh 96 Nguyen nhan ben ngoai va nguyen nhan ben tac dong lan ma tao dieu kien phat sinh benh sdi Vtfdng KhAng Dtfdng noi: "Dau, sdi phat ro rang thuoc thdi ltfu hanh, ttf nong thon den thi truyen nhiem lin nhau, nhe thi deu nhe, nang thi deu nang, du co khac thi 10 ngtfdi cung chi mot vai ngtfdi ma thoi” Theo ong benh co the nguyen nhan thai doc, bdi vi djch le thi co rat nhieu ngtfdi suot ddi khong mac phai, ma dau va sdi thi may khong bi mot lan Mat khac djch le da mac phai lan roi sau van co the mac lai ntfa, ma dau va sdi da mac lan thi sau khong phat lai nuta Sach Ma chan thap di noi: "Bpnh sdi phat phan nhieu le ltfu hanh ttf nha qua nha khac truyen cho kh£p ndi” Sach Trtfdng thi y thong noi : "Benh scli cung la mot loai benh thcJi truyen nhilm " Sach Ma ch^n hoi thong cung n6i: "Sdi khSng phai la thai doc, deu thuoc benh thdi ltfu hanh, hau on nhiet truyen nhiem ma thanh" Cd che benh ly cua sdi chu yeu hoa nhiet d kinh (thu thai am phe va tuc dtfdng minh vi) phat ma benh, phe bi cam thu ta khf nang hdn cho nen co nhan co thuyet "Tang phu bi ton thtfdng chi phe la nang hdn" Tren lam sang thtfdng tha'y sdi phan nhieu xua't hien chiing trang cua tang phe; bien chtfng cung lai viem phoi, ho suyln la nhieu hdn Dong thdi chiing trang chung cua benh scli la nhiing chiing hau hoa vtfdng len, hoa nhiet nhtf: nong, mat do, moi kho, buon phien, vat va, hong do, noi khong ro Co nhan co luan diem: " Chiia benh dau nen dung thuoc a'm, chiia benh scli nen dung thuoc mat" T7- CK NK 97 III BI$N CHONG VA CHAN DOAN Chung trang chung Co the chia thdi ky phat sot, sdi moc va sdi bay Quan sat lam sang thi trtfdc phat sot m£y thtfdng co tri^u chtfng bao trtf6c nhu met moi, hay ngu, khong muon fin, hat hdi, ngap vat, ho hen, so mui giong nhu thUdng phong 1.1 Th&i ky ph6t sdt Sd r6t, phat sot, ngat mui, so mui, hat hdi, ngap vat, ho hen, mi mat hong, nude mat chay rong rong, mi mat stfng hfp, tinh thfin m6i m§t, thich ngu, thich la'y tay dui mat, day miii, dfiu minh n6ng ma tay ch&n lanh, moi ma hdi do, an khdng biet ngon hoac kiem nhiing chtfng non mtfa, ia long, mi§ng khat, tieu ti$n vang ngan, reu ltfdi trang mong hoac trang day hdi vang, mach phu sac, chi tay noi ro ma sac hong Vtfdng Hao Cd' noi: "Tre em tai lanh, vung xtfdng sau tai lanh, chan tay a'm lanh d6 la muon len sdi" Sach Au khoa chuan thang noi: "Roi den ma xem tha'y toan than nhtf boi son, la hien ttfdng s&p len sdi" Sach Ma khoa hoat nhan toan thtf noi: "Muon nhan biet sap co len sdi nen xem xet ky d vung sau tai xuong co gay va tii tren song ltfng th in g xuong den eo ltfng; phai co nam ba diem do, la d&'u hieu sap len sdi" 1.2 Thai ky sa i m gc Chi vai luc not sdi ban d iu xuat hien, cho den sdi moc khap het, thdi ky tf6c chtfng Thdi ky sdi mpc la giai doan chu yeu cua benh (!) thdi ky phat sot, n6i «*hnng minh nong nhe, nhtfng sdi sap moc thi n6ng cao hdn ma ch&n tay cung deu nong ca 98 Han dau sot 1-2 nhung den luc ga gay thi giam sot, chi d vung ngu tam hdi sot, d in d in th iy ho, mui chay ntfdc hoac bung dau, kn uong giam, den chieu lai phat sot trd lai nhtf the den ngay, dung tay sd an vao cho chan toe thi r it n6ng mat co nong k£m hdn 2-3 phin, ho lien tuc, mat kho ma do, mat nhieu ntfdc mat, hat hdi luon ho&c bong nhien chay ntfdc mui Den thti thi sot ca dem, den thti vao buoi sang thi d hai ben phia trtfdc ma phat sinh nhiing diem nho, roi den khoang 12h d tay, lung phia trtfdc eo ltfng va k h ip minh co nhiing diem day kin, sau thi scli phat len kh ip, mui khong chay nude niia, khong hat hdi niia, het thi s ic ma cung nhat din Sdi sot ng&y thi phat ra, la quy lu&t nh&'t dinh; neu thiy thuoc khong biet ma dung thuoc sdm qua, lam hao tan nguyen khi, den scli phat gay tac hai r it nhieu ho&c ho ma bien suyen h o ic sinh di ta dii Sach Ma khoa hoat nhan tokn thtf noi; “Sdi v6n 1k chtfng hoa, khong co nong thi khong moc dtfdc, sdi sip moc thi toan than phat sot hoac buon phien v&t va ho&c dau d iu hoSc minh co rut" Khi sdi da moc k h ip roi thi sot giam din, sdi cung bay din, cho nen tinh hinh phat sot va sdi moc c in phai ty le thuan vdi Neu dang luc sdi moc ma sot giam xuong ho&c sdi da b it d iu bay ma sot khong giam hoSc minh sot cao ma sdi lai bay, la trai quy lu&t cua sdi moc, phin nhieu se sinh cac bien chtfng viem phoi, ho suyln ho&c nhiet doc don xuong chtfng ly ho&c vi cd the htf yeu nen nhiet doc ham lai Sdi moc theo thtf ttf trtfdc, sau va d&y, thtfa theo tting bo vi cung co li£n quan n h it dinh Not sdi len trtfdc moc d sau tai, chan toe, co gay, tiep d6 den vting tran mat, roi xuong vai ltfng, ngtfc bung, chan tay; cho den long ban tay, ban chan deu th iy sdi moc la da moc khip Sdi la dtfdng ta, cho nen not sdi moc b it d iu ttf bo ph&n dtfdng roi den bo ph&n am cua nhan 99 the, la: " TrUdc moc dudng, sau mot- o am", donn thdi sdi moc phai tti thua den day, cac bo phan dudng nhu dau mat, lung, phia ngoai tay chan thi moc day hon Cac bo phan am nhu ngUc, bung, eo lung, phia tay chan thi thua hdn d6 la chting trang binh thudng Not sdi cang moc nhieu d mat, d£y va ro la tot nha't, ngUdc lai la khong tot Cach xem sdi mdi phat phan nhieu d phia sau tai, tren gay hoac phfa eo lung, chan; trudc th&y dinh nhon ma chua dai hinh nho ma deu sach la tot 1.3 Th&i ky sdi bay Sdi moc khoang thudng la khap het, neu khong kem co chting trang khac thi sot giam, an dUdc ngon, tinh thin tinh tao, nhting chting hen va phien khat dan dan giam di m& het han, not sdi cung bay din Sau - ngay, tren mfit da c6 mot ldp vay loc nhu cam, de lai mot ldp seo mau nau sim, 1-2 tu in sau mdi hoan toan ma't han, stic khoe trd l f i binh thudng Hat sdi moc roi lan thudng lay 6h lam chuan, vi du nhu sau gid ty moc thi sau gid ngo lan va ngUdc lai Do la theo sd cua tu nhien dudng sinh am thanh, am sinh dUdng cti nhu the moc ra, lan di la nhe Di chumg Vi tre em bam thu khac nhau, benh tinh nang nhe khac hoac dieu tri khong kip thdi, hoac chtia tri khong dung ma den thdi ky cucfi cua benh co the xuat hien mot so di chting 2.1 Chin /ao Sau sdi moc roi, sot lau khdng giai hoac nong am i xUdng, sot cdn nhu sot r6t, ho khan , phien k h at, ia phan 100 set, hinh the gAy roc, long da kho rap Nguyen nhan vi doc ta chtfa giai ma nguyen da hao ton, lau hien lao phoi 2.2 Khau cam Sau sdi bay, ldi rang Id loet hoac mau, hoac mieng ltfdi deu Id, la vi sau bi benh sdi, nhiet doc lai ket tu d phoi va dan dan len mieng ma gay nen 2.3 C hin doc Trong qua trinh phat benh sdi, vi nhiet doc cua benh chua tha'u phat het, cho nen thdi sau co the xu&'t hien: - Hai mat stfng do, khong dieu tri se gay mil Ida - Hai ma, trudc hoac sau tai sUng trUdng, khong d ilu tri khoi se gay ld lo6t ngoai da , - Khap minh Id lo6t nguy hiem Bien chting thuan nghjch cua benh sdi Chting trang theo lam sang cd the chia loai: Chting thuan, chting hiem, chting nghich Chting thuan la benh phat theo trinh tu binh thtfdng, chting trang nhe ma nhanh; chting hiem la benh tinh nghiem ma co tinh cha't nguy hiem; chting nghich la ngUdc lai chting thuan ma kiem tha'y chting trang cua benh nguy hiem 3.1 Chung thuan Trong qua trinh len sdi, phat sot nhe, tinh than tinh tao, ho nhung hdi thd khong gap rut, 3-4 sdi moc tti tren xuong dtfdi, dau mat moc trtfdc, ltfng ngtfc chan tay moc sau, not sdi phan minh, deu dan, mau sac ttfdi sang, moc khap ca 101 ngtfdi, khong co kiem chtfng kem theo nhu: thuc tich chAng han Not sdi moc la da khap het roi bat dau bay dan, sot giam, cac chtfng trang cung theo ma dtit han, &n ngon, stic khoe binh phuc rat nhanh la sdi thuoc thuan, nh? va het nhanh Sdi moc roi lan d£n dan di la nhe Sdi mau hong nhat ma nhuan, dau mat deu moc nhieu 1& nhe 3.2 Chiing hiem Benh qua thdi ky d&u phat sot roi chuyen sang thdi ky sdi moc nhtfng not sdi moc khdng ro hoac moc ma khong thau suot d&y du la benh nguy hilm Khi sdi moc d d iu mat (1& bo v\ thupc dtfdng) ma thay sot cao, khong c6 mo hoi, ho n$ng, hdi thd to, dai ti?n phfin s#t, sac mat trang b^ch, ntft sdi bim, la hien ttfdng nhipt doc hun dot manh ma ta da nh$p ty Neu not sdi mau xanh nhdt la nguyen htf yeu, khdng du stic day ta khf ngoai Khi sdi moc roi lan qua sdm ho3c chi moc Id md khong chiu noi han len; hoac qua ky ma sdi khong lan, kem theo minh van sot cao; hoac sdi da lan roi ma sot vin cao va kho thd, dong thdi lai co nhieu kiem chting deu la chting nang, vi du: - Dau mat khong moc sdi la nang - Sdi mau hong, tim toi ma kho la nang - Hong stfng dau ma khong an dtfdc la nang; gap gio sdi l£n vao sdm la nang - Scli ma kiet ly la nang, la vi nhi$t truyen xuong d$i trang - Mau sdi den, ham kh6 mpc; mpc rdi lfcn n gay U chet 102 - Canh mui phap phong, mieng ra, mSt khong co th&n la chet - Khi suven soc len ho&c di ngoai phan den cung rat kho dieu tri 3.3 C n g hich Sau benh phat, da den ky sdi moc ma not sdi moc khong ro ngoai, nhu moc mot luc roi lan va thay sot cao, khong co mo hoi, buon phien, vat va khong yen, mach hong dai hoac hoat sac, la ta khong thau dat ngoai, hien tUdng cua nhiet doc cong pha ben Neu thd gap, canh mui phap phong, moi mieng tim xanh, la kiem co chUng viem phoi, ho suyln Neu not sdi tim den, hinh dam ban, lu3i kho rao, slm , noi gai, la doc ta da xam nhap vao phSn dinh, huyet Neu tinh than hon me, noi nham, kinh quy£t, co giat, 1k doc ta da ham vko tam bao, nhflng hien tupng Ky la dudng chUng, thuc chUng, lai co vi chi'nh khf hu yeu, nguyen dudng khong du de d&y doc ta ngoai, xuat hien me man, ham ngu, tay chan lanh buot, not sdi mau xanh nhdt khong hong, reu ludi trying trdn, mach te sac, deu la chUng nghich cua benh sdi IV PHUONG PHAP 0l£U TRI Cach chtia benh sdi, noi chung can xet den qua trinh phat benh cua tting thdi ky phat sot, sdi moc va sdi bay, tti phan biet nguyen t i c dieu tri: giai cd thau bieu, nhiet giai doc va dU5ng am hoa nhiet Giai cd thau bieu Benh sdi d thdi ky phat sot, benh d bieu co xu the day benh ngoai thi nen nhan ma dung thuoc thau dat giup 103 cho cd the day doc ra, lam cho sdi co the moc thau suot ngoai da thit, la qua trinh chua thuan theo tu nhien Tuy nhien c^n can than dung thuoc han ltfdng vi thuoc han ltfdng de lam cho cd bi ngan trd, vi the nhiet ta dong lai d ma sdi khong moc dtfdc Sdi la dtfdng ta, theo nguyen tac dung thuoic tan ltfdng d§ thau dat ngoai, nen dung mot cac bai sau: Bai 1: Thfing ma cat can thang Thang ma 4g Xich thtfdc 6g Cat can 12g Cam thao 3g Ntfdc 1,5 bat, sac 1/2 bat chia lan uong Bai 2: Tha'u ta tien Quy than 4g Kinh gidi 4g Xich thtfdc 4g Phong phong 4g Chi'ch thao 3g T h in g ma 8g i 3: Tuyen doc phat bieu thang Thang ma 3g Chi xac 4g Cat can 12g Kinh gidi 3g Lien kieu 6g Tien ho 4g Ngtfu bang 8g Cat canh 4g Phong phong 3g Dam true diep 6g Bac 2g Moc thong Cam thao 3g Ntfdc 1,5 bat, sac 1/2 bat, chia uoing lAn 104 4g Bai 4: Cat can giai cd thang Cat can 12g Lien kieu 8g Xich thtfdc 6g Boi mAu 6g Thuyen thoai 3g Tang bi 8g Ngtfu bang 6g Tien ho 6g Dang tam 2g Moc thong 4g Kinh gi6i 4g Cam thao 2g Nude 1,5 bat, s ic 1/2 bat, uong lan - Neu co suyen thd thi gia them: ma hoang 4g, hanh nhan 8g- Neu kem theo non mtia thi gia them true nhtf 8g - Neu chay mau cam thi gia: mao c&n 12g, hoang lien 4g, hoang cim 8g - Neu ia chay hoSc tieu it thi gia: xich linh 12g, trach ta 8g- Neu tieu tien khong thong thi gia xa tien tii 8g Bai 5: Ngan kieu tan Ngan hoa 40g Bac 24g Lien kieu 24g Dau si 20g Cat canh 24g Kinh gidi tue 16g True diep 16g Ngtfu bang 24g Cam thao 20g Cac vi tan nho, uong lan, moi lan uong 20g; nUdc m&ng lau ttfdi lam thang, nau th&'y mui thdm boc la dtfdc, khong nau lau qua 105 Phong ky 8g Dinh lich til 2g Xuyen tieu 2g Dai hoang 2g - Neu thuy thung nghiem lai thay thd to suyen d iy, ngoi thd, khong nam dtfdc, mach huyen co ltfc la thung ngtfc btfc bach len phe, phe khong giang dtfdc thi c in phai dung Ngu linh tan va Ngu bi am phoi hdp vdi Dinh lich dai tao ta phe thang de ta phe, hanh thuy - Neu thap nhiet chiem ctf lau, cung co the hoa tao hai am, vtfa thuy thung vtfa co hien ttfdng thtfdng am; mot ben la thuy thap ltfu dong ma sinh thuy thung, mot ben la tan dich suy hao, moi mieng kho, dai tien tao; neu tit am thi ldi cho thuy ta, lai cang hai am; trtfdng hdp cach chfla r£t kho, cin chieu co' ca mat, c6 the sut dung bai Trtf linh thang de tii am, nhiet, ldi thuy Trvt linh 8g Trach ta 8g Phuc linh 8g Ho$t thach 8g A giao 8g - Neu ta thap nhiet don xuong bang quang, hai den huyet lac gay dai buot, dai mau thi gia them cac vi ludng huyet chi huyet nhu: dai ke, mao can, tieu ke B AM THUY Ty dtfdng h i/ 1.1 Trieu chung Minh phu, eo ltfng trd xuong phu nhieu hdn, an de lom, lom vao lau mcli day trd lai, bung trtfdng d iy , &n kem, dai tien long, sac mat vang ai, tinh than met, chan tay lanh, tieu n gln it, chat ltfdi nhdt, reu ltfdi trin g nhdn hoSc trin g trdn, mach trim hoan hoac tram nhtfdc 234 1.2 Phap dieu trj : on van ty dtfdng de ldi thuy thap 1.3 Phuong thuoc: dung bai Thtfc ty am Can khtfdng 2g Thao qua 8g Phu tii 2g Bach truat 8g Cam thao 4g Bach linh 8g Sinh khtfdng 2g Phuc bi 8g Moc qua 8g Phuc linh 8g Moc htfdng 4g Hau phac 6g - Neu doan, tieng noi yeu la htf nhieu thi gia them: dang sam, hoang ky de ich - Neu tieu ngSn It thi gia them: que chi, trach ta de giup cho bang quang hoa Khi chiia can phan biet: ta khi, chinh khi; chu yeu, thut yeu Tren lam sang co vi an uong mat c h to g keo dai, ty vi htf nhtfdc, tinh vi cua thtfc an khong hoa ma sac mat vang ai, mat phu; sang day mat phu nhieu, cii dong thi chan phu hdn; an dtfdc ma stfc yeu, ngtfdi met moi, dai tien long, tieu nhieu, reu ltfdi mong nhdn, mach nhtfdc Chiing khac chtfng thuy thung neu tren, la vi ty htf nhtfdc, khong vtfdn dtfdc, khong van hoa dtfdc thuy thap, vi vay chiia nen kien ty, hoa thap, khong nen ldi tieu vi hai den khi, thtfdng dung bai Sam linh bach truat tan gia them: que chi, hoang ky de ich khi, thong dtfdng; hoac gia: bo cot chi, phu ttf che de on than, trd dtfdng, t&ng tac dung hoa Than htf 2.1 Trieu chung Mat va minh phu, eo ltfng trd xuong phu nhieu hdn, de tay vao phu lom xuong, tam quy, thd gap, vung ltfng lanh dau, 235 than met, sac mat toi tre hoac tring nhdt, chat ludi beu nh