KH CNG Y O VIT NAM

T hc day bm huyt cha bnh

BNH TIM MCH

V HUYT

C NGC

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 BNH TIM MCH

PHN MT
PHN TCH BNH TIM MCH THEO TY Y

1-LON NHP TIM

2-MCH C TAY MT
3-MCH I MT
4-MCH QUAY KHNG U
5-MCH SO LE
6-TING THI TM THU
7-TING THI TM TRNG
8-TIM P CHM
9-TIM P NHANH
10-TIM TO, TIM THNG
11-TNH MCH CNH CNG MU
12-VIM TNH MCH DI CHUYN

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 1-LON NHP TIM

A-Lon nhp tim hon ton (rung nh) :

Nguyn nhn :
Do hp l van hai l, cng tuyn gip, khng c sng
P, nhp tm thu nh nhanh gia cung ng v rung
nh, s dn n suy tim, nghn mch, bnh tim do thiu
mu, do ng mch, do cao p huyt, do qu mp, do
nhim sc t st.

B-Nhp i hoc nhp ba :

Nguyn nhn :
Chng ny thng gp trong qa ti digital, do gim
kali huyt sau khi dng thuc li tiu.
Nhp i : C mi nhp km theo sau mt ngoi tm thu.
Nhp ba : Hai nhp bnh thng ri n mt ngoi tm
thu.

2-MCH C TAY MT

Nguyn nhn :
Ngoi l do ng mch quay b buc li trong phu
thut hoc do d dng bm sinh lm tc ng mch chi
trn, cn l do bnh l gy ra bi :
Tim lon nhp hon ton, hp van hai l, nhi mu c
tim, phnh thnh mch tim, phnh ng mch ch, phnh
thn ng mch cnh tay u, mt mng va ng mch
tch ra tri theo mu, vim ni tm mc nhim khun,
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c huyt khi trong ng mch do ng git mnh vo
ng mch cnh tay hay ng mch nch, sau phu
thut, vim ng mch, nghn mch mu, phu tch
ng mch ch, mch c th mt khi quay u sang mt
bn hoc khi dang tay ra.

3-MCH I MT

Nguyn nhn :
Do hp l van hai l, rung tn nh, nhi mu c tim,
vim ni tm mc nhim khun, mt mng va ng
mch tch ra tri theo dng mu, phu tch ng mch
ch, vim tnh mch ni mu xanh v au, chn ph
xanh tm.
Trong lc khm cng tm c du hiu hp ng mch
ch, c ting thi tm thu ht c vng tim, vng gia vai
tri v ct sng, phu tch ng mch ch, phnh ng
mch ch bng, x va ng mch.

4-MCH QUAY KHNG U

Nguyn nhn :
Do tc ng mch quay bi vt so phu thut, nghn
ng mch cnh tay, hoc ng mch quay do bnh tim,
lon nhp tim, vim mng trong tim, b chn p ng
mch nch, cnh tay hoc khuu tay, khe c nch,
xng sn c, tai bin thn kin do thiu mu cc b
kch pht khi c ng mu n khng , do huyt khi
bnh x va ng mch.
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 5-MCH SO LE

Nguyn nhn :
l du hiu suy tht tri ca bnh ng mch tim,
ng mch ch, bnh van tim, bnh tim thiu mu cc
b, bnh c tim thng km theo ting nga phi v ri
lon tun hon huyt trong bnh cao p huyt.
Mch so le l mch u u ni tip mt ci p mnh
v mt ci p yu.

Mch so le

6-TING THI TM THU

A-Ting thi tm thu mm tim :

Nguyn nhn :
Do h l van tim hai l to nn ting thi ca dng mu
tro ngc, ton tm thu, vi cng thay i m
thanh nh ting x hi lan ra trong nch v sau lng.
Do thp khp, vim mng trong tim do vi khun, nn
ting thi tm thu run run, chim chip nh m nhc.
Hoc do chn thng vim mng trong tim, nhi mu c
tim th nghe nh ting dy thng b t.
Sa van hai l nh, nghe ting clic gia tm thu.

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H l van hai l chc nng, gin n tm tht tri, nghe
ting thi ngn u tm thu lan ra t vi m sc nh,
khng u, l du hiu suy tht tri, bnh cao p
huyt, bnh tim thiu mu cc b.

B-Ting thi tm thu ng mch ch :

Nguyn nhn :
Do va ng mch, bnh thp khp cp. Phnh ng
mch ch, ting thi thay i ty theo ch phnh. Nu
hp ng mch ch, ting thi tm thu xy ra mun
nghe c sau lng.
Do hp van ng mch ch, nghe ting thi u trong
ca khong th hai gian sn phi, ting thi pht gia
tm thu xy ra tr sau ting th nht lan v pha mch
mu c, ting g gh run run cht cha.

C-Ting thi tm thu van hai l (mi c ) :

Nguyn nhn :
H l van ba l thc th do bnh thp khp cp, vim
mng trong tim nhim khun, do t cu, h l van ba l
chc nng, gin tht phi km vi gan to, ph chi di,
nghn mch phi, bnh huyt khi tc mch, khi u
carcinoit rut non hoc ph qun, tng huyt p ng
mch phi, nghe ting thi ca dng mu tro ngc, c
ting thi mnh sau th ht vo su, lan to ngang v bn
phi v tri.

D-Ting thi tm thu phi, u trong gian sn s 2

tri :

Nguyn nhn :

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Thng gp ngi d cm xc, bnh tng nng
tuyn gip, st, thiu mu, thi k mang thai. Nghe
ting thi mnh km vi run run lan v pha mch mu
c do hp phu l ng mch ch. Ting thi tm thu
nghe pht khi ht vo t th ng.

E-Ting thi tm thu gia vng tim, b tri xng c :

Nguyn nhn :
Do thng lin tht, ting thi ton tm thu to, run run,
lan to mi hng trc tim.
Do bnh nhi mu c tim km theo bnh cnh suy tht
phi cp, nghe nh ting t dy.
Do tm tht ph i, thng tim, ting thi pht gia tm
thu ngn, g gh nghe c di b tri xng c,
nu ting thi tm thu ca h l van hai kt hp nghe
nh ting nga phi.

F-Ting thi lin tc tm thu tm trng :

Ting thi mnh, rung nh ting trong ng hm, ti

a phi v vng di n tri.

G-Ting thi tm thu bng :

Nguyn nhn :
Do hp kht l ng mch ch, lng mu to thot chy
ra qua l van hai l, ba l, va ng mch nu c khi u
bng, c th nghe c mt s ting thi tim trong
bng :

Nu vng thng v :
Do ng mch ch bng b phnh, va, tc, vim, nghe
c thn ng mch tng do gn c ca hai ct c
hong chn p, do ung th ty, hoc do khI u sau mng
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bng hoc do hch chn p, do ung th gan, do va
ng mch.

Nu vng quanh rn :
C th do hp ng mch tiu ha, thng au tht
bng, phnh ng mch lch, u mch t bo quanh mao
mch treo rut hoc sau mng bng.

Nu vng cnh gia ng mch thn :

Do phnh ng mch, hp, va, vim, u thn, km vi
bnh cao p huyt.

Nu vng chu :
Do hp hoc va ng mch chu, nghe c ting thi
di theo ng mch ch trong trng hp tng nng
tuyn gip, thiu mu, thi k mang thai.

7-TING THI TM TRNG

A- y tim :

Nguyn nhn :
Do thp khp, vim mng trong tim nhim khun, vim
ng mch ch do bnh giang mai, va ng mch ch
do bnh giang mai, va ng mch km vi ting thi
i, vim cng khp sng, bm mu t ngt, bnh au
trc tim.
Nu h l ng mch ch, u trong ca khoang gian
sn phi th hai, c ting thi ca mu tro ngc
nghe nh ting hp, ht vo, lan v mm tim di theo
xng c v mi c, nghe r hn khi bnh nhn ng.
Ting thi i ng mch ch, km vI mu tro ngc
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 t v c ting thi tm thu km theo, nh hn ting
thi tm trng.

B- mm tim :

Rung tm trng tng cng , thnh ting thi cui

tm trng l ting tc nghn khi u sau ting th hai
mt cht.

8-TIM P CHM

A-Nhp xoang chm :

Nguyn nhn :
Thng gp nhng ngi lm vic nng nh cc vn
ng vin, nhng ngi b bnh nhim trng ang hi
phc li sc. Nhp chm trong lc ng, trong bnh vng
da, thiu nng tuyn gip, tng p lc ni s, nhi mu
c tim vo nhng gi u, trong cn au bng do nhim
c ch, do thuc nh digital, rserpin, morphin,
btabloquant, amiodaron, clonidine.

B-Bloc nh tht hon ton ( 3):

Nguyn nhn :
Nhp tim chm thng xuyn di 40 ln/1pht.
Du hiu lm sng ca phn ly nh-tht nh tim p
chm, tnh mch cnh 70-80 nhp/1pht, mch tim di
40/pht. Ting tim th nht p mnh, cch hi, ting
vang tm thu nghe c th k tm trung, c ting
thI pht tm thu.

C-Tai bin Adam-Strokes :

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Nguyn nhn :
Ngt khng c triu chng bo trc. Cm gic chng
mt mun xu, mn en trc mt, ng xung mt trn
ngc, khng mch, thc phc hi nhanh, mt .
Ngt ko di, th ngy to, tm ti, co git, khng cn
li, nu ngt ko rt di th hn m li di chng s
no, nu nng hn, thiu nng tun hon no, ri lon
tm thn, cht t ngt.

D-Bnh cn ca bloc nh tht :

Nguyn nhn :
Bloc c th do hp l ng mch ch vi ha, h l
ng mch ch (bloc 1), chn thng lng ngc,
phu thut tim h, bnh teo lon trng lc c, nhim
sc t st, 20% do vim cng t sng.
Trn 60 tui, t chc dn truyn b thoi ho, s b bloc
nhnh phi, ri hmibloc nhnh tri trc. Nguyn nhn
do thiu mu, thoi ha c tim, x va ng mch, l
van ng mch ch. Hmibloc phi hp vi bloc nhnh
phi l bo hiu bnh nng.

E-Bloc nh tht cp tnh :

Nguyn nhn :
Thng thy trong cc bnh nhi mu c tim, cc bnh
nhim trng trong thp khp cp, vim c tim do bch
hu, vim c tim do thng hn, do nhim c digital,
thuc chng lon nhp dng qu liu nh cardiorythmine

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 9-TIM P NHANH :

Tim p nhanh, thng thng do cm xc l bnh

thng, nhng p nhanh lin tc l du hiu bnh, do
nhiu nguyn nhn khc nhau :

A-Nhp tim nhanh xoang :

Nguyn nhn :
Tng nng tuyn gip, thiu mu, gim ng huyt, do
ung tr, c ph hoc loi thuc chng trm cm (chng
depression).
Xt in tm th nhp tim nhanh lm hi tm trng,
sng P v phc hp bt bnh thng.

B-Tim p nhanh nh :

Nguyn nhn :
C th do hp l van hai l, tng nng tuyn gip, bnh
c tim.
Tim p nhanh nh lm lon nhp tim hon ton do rung
nh c th ko di trong 24 gi khi kch pht, sau hnh
thnh lon nhp tim lin tc, nhp khng u gia 100 v
140.

Tim p nhanh nh
C-Cung ng nh :

Nguyn nhn :
C th do bnh ca l van hai l, bnh tim to ng
mch, hp l van hai l, nghn mch phi, cao p huyt,
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tng nng tuyn gip. C th l du hiu bo trc sang
qua giai on lon nhp tim hon ton, tim s p nhanh
u vI bloc nh tht chc nng, tnh mch cnh p
nhanh hn tim, nghe c 150-160 ting p u/1 pht.

Cung ng tm nh

D-Nhp tm thu nhanh nh :

Nguyn nhn :
Do hp l van hai l, ng c digital, gim kali huyt.
Km vi bloc nh cung ng nh, m 100-120 ting
p/1 pht, tnh mch cnh p nhanh hn.

E-Nhp tim nhanh b ni :

Nguyn nhn :
Do dng digital qa liu, nhi mu sau honh, bnh tim
bm sinh.
Mch p 180-200/1pht thng xy ra t ngt
ngi tr tui, t vi pht n vi ngy ri ht t ngt,
nu ko di c kh nng suy tim.

F-Tim p nhanh tht :

Nguyn nhn :
C th do nhi mu c tim, nhi mu vch thnh, phnh
mch vch tim, suy ng mch vnh, bloc nh tht
khng hon ton, do ng c thuc, do gy m, hoc do
thng tim.

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Tm tht sai v tr c nguy c rung tht, nhp tim 150-
250/1pht, mt ti xanh, v m hi, p huyt tut, mch
p ca tnh mch cnh chm hn mch tim, sng P
ngc, khong cch xa.

Nhi mu c tim, vim mng ngoi c tim

10-TIM TO, TIM THNG

A-Tim to thng ton b :

V tr mm tim x dch xung pha di v ra ngoi,

ng knh ngang tim ln hn na chiu ngang hai l
phi.
C th chn on sai nhng ngi c lng ngc bin
dng, hoc lc tim to khi th ra, hay tim to bin mt khi
ht vo, hoc trong bnh vo ct sng.

Phn bit tim to v trn dch ngoi mng bao tim :

Khm lm sng :
Nghe tim p nh ting nga phi nhng ngi b bnh
tim to. Ngc li nghe nh hoc khng nghe nhng
ngi c bnh tn dch mng ngoi tim, c thm du
hiu tnh mch cnh cng mu, mch bt thng.

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Chp X-quang :
Tim to thy r ng vin tim, thy tim p. Bnh trn
dch thy ng vin i, cc b tim khng thy p.

in tm :
Tim to th khoang tim phnh to. Trn dch th in th
thp, ri lon ti phn cc.

B-Tim to tng phn :

a-Tim to bn nh tri :

Nguyn nhn :
Do hp hoc h van hai l, bnh tim bn tri.

b-Tim to bn tht tri :

Nguyn nhn :
Do cao p huyt, hp hoc h l van ng mch ch,
bnh c tim tc nghn, hp ng mch ch, tn thng
c tim do thiu mu (cung di tri li v di, mm tim
gn st thnh ngc tri).
c-Tim to bn nh phi :

Nguyn nhn :
Do bnh tim phi cp, tim phi mn, bnh van ba l.

d-Tim to bn tm tht phi :

Nguyn nhn :
Do hp van hai l, bnh tim phi, bnh tim tri giai
on cui, thy hnh mm tim nng ln, ng mch phi
v cc nhnh ng mch phi tng th tch.

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 11-TNH MCH CNH CNG MU

A-Tnh mch cnh cng mu :

Nguyn nhn :
C th do suy tim ton b, suy tim phi, nghn mch
phi, vim mng trong tim lm h l van ba l, trn dch
mng ngoi tim, try tim km vi cng mu tnh mch
cnh tng ng vi sc tim (suy tim cp), vim mng
ngoi tim co tht, tng p huyt ng mch phi, bu
trong ngc, u phi, u tuyn c, phnh mch, bnh sng
hch, tc nghn tnh mch ch trn.

Tim phi cp
12- VIM TNH MCH DI CHUYN

Nguyn nhn :
Do qa trnh nhim khun huyt tnh mch rng hoc
vim amygdal, do ung th ty tng, ung th phi, ung
th bao t, do thot v honh, do thiu mu gim huyt
sc t, do bnh bch cu ty, do bnh gt lm vim tnh
mch km vi xung huyt khp, do vim nghn mch
mu b ghin thuc l nng lm vim tnh mcg c cc
chi di. Vim tnh mch nhiu ni ni tip nhau tng
on nng hoc su, thng xy ra n ng trn 40
tui.

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PHN HAI :

NHNG CHNG BNH CA TIM MCH

PHN TCH THEO NG Y :

Nhng du hiu Bnh v tim mch theo ng y cng c

nhiu im trng hp vi ty y, nhng c sp xp v
phn loi khc nhau theo chng c th p dng ng
vo phng php i chng tr liu trong cha bnh cho
ph hp vi mi chng, s thy c kt qa nhanh
hn, hu hiu hn v trnh b sai lm gy ra phn ng
ph.

C 35 trng hp chnh ca bnh lin quan n tim

mch c phn loi thnh Chng Bnh ty theo nhng
du hiu lm sng khc nhau. Mi chng bnh phi ni
ln c nguyn nhn gy bnh theo tiu chun bt
cng nh : Ti kh hay huyt, h yu hay qa thc
mnh, do lnh hay nng, tnh trng bnh l cp tnh hay
mn tnh.

1-Chng Tm h
2-Chng tm h m khip
3-Chng tm m h
4-Chng tm kh bt ninh
5-Chng tm kh h
6-Chng tm kh thnh
7-Chng tm dng h
8-Chng tm huyt h
9-Chng tm huyt
10-Chng tm thc
11-Chng tm hn
12-Chng tm nhit
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13-Chng tm thc nhit
14-Chng tm ha thng vim
15-Chng tm ha vng
16-Chng tm h cp
17-Chng tm h ch kt
18-Chng tm h nghch mn
19-Chng tm h n n dc th
20-Chng tm hn
21-Chng tm khi
22-Chng tm lao
23-Chng tm sn
24-Chng tm t
25-Chng tm ph kh h
26-Chng tm t h
27-Chng tm thn bt giao
28-Chng tm bo h
29-Chng tm bo thc
30-Chng tm bo nhit
31-Chng tm bo m ho
32-Chng m ha nhiu tm
33-Chng kh thng nghch xung tm
34-Chng huyt quyt

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1-CHNG TM H :

Du hiu lm sng :
Hi hp, on hi, au di tim, c khi ln cn kch
pht, mt ng, mt sc, m hi, suy nhc thn kinh,
bt an, s st, ni xm, mng lung khng ch tm, hay
qun, thiu mu, gai st, chn tay gi lnh, li nht, ru
t.

2-CHNG TM H M KHIP :

Du hiu lm sng :
Hay s do tm huyt bt tc, tm kh suy nhc lin
quan n tinh thn, thng gp bnh h nhc, bn
huyt hoc c nng thn kinh.

3-CHNG TM M H :

Du hiu lm sng :
m h l tn thng ni tng thuc huyt, bun bc,
mt ng, ra m hi trm, bn tay nng, hng kh, li
, t ru, chc nng to huyt suy km.

4-CHNG TM KH BT NINH :

Du hiu lm sng :
L tm khng an do thiu mu, do m nhit quy
nhiu, do thy kh hi tm, do can ha vng, do can
m kh hlm ra hi hp, s st, tm phin, mt ng.

5-CHNG TM KH H :

Du hiu lm sng :

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Tim p nhanh, hi th ngn, ht hi, thiu sc, hI
hp, hay ra m hi, mch v lc, thng gp trong bnh
bn huyt, suy nhc, lon nhp tim.

6-CHNG TM KH THNH ;

Du hiu lm sng :
L tm dng vng khin thn kinh hng phn qa
mc lm mt ng.

7-CHNG TM DNG H :

Du hiu lm sng :
C hai trng hp nng nh khc nhau ;
Trng hp nh ging chng th 5 Tm kh h.
Trng hp nng :
C thm du hiu ngi lnh, chn tay lnh, mi xanh
tm, m hi ra nhiu, hI hp, chong, try mch, nng
hn na th hn m bt tnh, mch v lc, lI nht, ru
trng trn, nguyn nhn do lo suy, mt nc, thiu
nng ng mch vnh lm nh hng n kh huyt.

8-CHNG TM HUYT H :

Du hiu lm sng :
Huyt h, sc mt trng, tim p nhanh, vng u, mt
ng, hay m, hay qun, hi hp, tm phin, li nht do
mt mu hoc s cu to huyt suy gim, thng gp
bnh h nhc, thn kinh chc nng, bn huyt.

9-CHNG TM HUYT :

Du hiu lm sng :

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au vng trc tim lan n vai, chn tay lnh, mt mi
xanh tm, do ting ch kch ng, do m trc lm
huyt tim, hoc do tm kh h, tm dng h li b
gp kh lnh lm tc tun hon tim mch.

10-CHNG TM THC :

Du hiu lm sng :
Mnh nng, m sng, hong lon do vim nhim nng,
mt , hng kh kht, chy mu mi ming, bao t
cng cng lm au ngc, cch m cng y kh chu,
tiu vng, chn tay nng n. li kh, u li ,
nu ang trong giai on thn kinh b nhim c th i
tiu ra mu.

11-CHNG TM HN :

Du hiu lm sng :
M sng, li cng kh ni, huyt h thn mt, tm thn
suy km, kh ut u lm mt ng, kh ut mt lm
nhc mt, kh ut bng lm bng lu huyt. Nu do
hn t thn trn ln th lm y tim n ln sinh au
tim, u ma, l ming, lng bn tay nng d.

12-CHNG TM NHIT :

Du hiu lm sng :
Do tm ha cang thnh lm au tim, au cc t xng,
au sn ngc do m ha tch t, sc mt phng,
phin nhit, ng khng yn, cung di, ni nhm, chy
mu cam, tm nhit hi ng rut sinh giun sn quy
nhiu.

13-CHNG TM THC NHIT :

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Du hiu lm sng :
Trong ngc nng, phin kht, tiu rt, li cht,
sm, hoc ni mn tm trn li, au, chy mu cam, do
tnh ch, do n ung nhiu cht cay nng c nhit kh.

14-CHNG TM HA VNG (THNH) :

Du hiu lm sng :
Bun bc, mt ng, mi kh ming ng, chy mu
cam, ming li l au, u li , do tnh ch, do n
ung thc n cay nng, bo, ung nhiu loi nc c
tnh nhit.

15-CHNG TM H B :

Du hiu lm sng :
Nhit ngn tr vng v qun, nhng n vo vng v qun
khng au. Nu c cm gic chng li l t nhit vi
thy dch ngn tr gi l b ngnh, thng gp bnh
vim bao t mn tnh hay bnh ri lon tiu ho.

16-CHNG TM H CP :

Du hiu lm sng :
Vng v qun hi au trng tc kh chu do t nhit
kt trong bao t y ln khin nn ma, tm phin, b
i tin, thng gp bnh ri lon tiu ha do cm
mo, vim bao t cp.

17-CHNG TM H CH KT :

Du hiu lm sng :
Vng v qun cm nh thy c vt g chng ngi m
khng y hi, khng cng rn, khng au, nhng cm

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thy kh chu, phin mun, do m v tam tiu lm
bnh.

18-CHNG TM H NGHCH MN :

Du hiu lm sng :
Tm b tn thng, vn ha km, thy ng thng tiu
nn v qun b tc, kh xung ngc ln tm lm v qun
b tc trng y.

19-CHNG TM H N N DC TH :

Du hiu lm sng :
Trong v c hn m hoc m nghn tc ngc lm v
qun c cm gic lm lm (n n) mun nn (dc th)
m khng ra c.

20-CHNG TM HN :

Du hiu lm sng :
Gia vng tim ngc ra m hi, do tnh ch t l lm
hi tm t.

21-CHNG TM KHI :

Du hiu lm sng :
Khi ho au ran c vng ngc tim, bng nh c cm gic
vng mc, hu hng sng au.

22-CHNG TM LAO :

Du hiu lm sng :
Mt trong chng lao do tm huyt kh thiu lm tm
phin, mt ng, hi hp, s hi.

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23-CHNG TM SN :

Du hiu lm sng :
Bng di ni hn cc, kh xung ln tm ngc lm tim
au d di, do hn t xm nhp tm kinh.

24-CHNG TM T :

Du hiu lm sng :
L mt trong 5 chng t (au) ca 5 tng. C du hiu
s hi, hi hp, th suyn, th di, phin to, hng kh,
do cm nhim ngoi t lu ngy cha cha khi, t kh
xm nhp n nu vng tm, thm vo lo ngh qu ,
lm tm huyt h tn thnh chng tm t (au tim).

25-CHNG TM PH KH H :

Du hiu lm sng :
Ph kh h gy tm kh h lm ho lu ngy, hi hp, tim
p mnh, mi tm xanh.

26-CHNG TM T H :

Du hiu lm sng :
Hi hp, t ng, hay qun, km n, phn nho lng do
dinh dng km, thng gp bnh suy nhc c th,
cao p huyt, thiu mu, x cng ng mch vnh.

27-CHNG TM THN BT GIAO :

Du hiu lm sng :
Hi hp, hoa mt, mt ng, tai, ming kh, mi lng
gi, tiu nng, di tinh, ra m hi trm, do huyt m h
v thn tinh h lm thm m v tm m h theo.

23
28-CHNG TM BO H :

Du hiu lm sng :
Lng bn tay nng, tim hi hp, bc rt nng ny .

29-CHNG TM BO THC :

Du hiu lm sng :
Mt , sng nch, au tim, sn ngc, co qup chi
trn.

30-CHNG TM BO NHIT :

Du hiu lm sng :
Hn m, nng d, ni xm, phin to, li .

31-CHNG TM BO M HA :

Du hiu lm sng :
m ln vo tm bo gy ri lon thn kinh lm hn m
bt tnh, si bt mp, li bn, ru dy.

32-CHNG M HA NHIU TM :

Du hiu lm sng :
Do thn kh ri lon, c 2 trng hp :
a-m ha nhiu tm : C du hiu s hi, mt ng,
ci ni nh cung.
b-m m tm khiu : C du hiu m kh kh nhiu
trong c hng, t nhin ng ln ra khin ngi ng ngn
n n.

33-CHNG KH THNG NGHCH XUNG TM :

Du hiu lm sng :
24
C th t cm thy c lung kh t bng di xng ln
ngc, do hn t n nu h tiu v kh ca trng v
hoc can v thng nghch ln trn.

34-CHNG HUYT QUYT :

Du hiu lm sng :
B hn m t ng bt tnh do huyt bnh gy nn, c h
thc khc nhau :
Do h :
Thng gp ngi mt huyt nhiu hoc bnh thiu
mu ko di, do no thiu mu t nhin ng ln, sc
mt ti xanh, chn tay quyt lnh, ming h, th chm,
t ra m hi lm mt tn dch.
Do thc :
Thng gp trong bnh huyt bt lp cc khiu, t
nhin ng ln, hm rng nghin cht, mt , mi ti.

Ngoi 34 chng chnh ca bnh tim, theo l

thuyt bin chng truyn kinh ca ng y, tim thuc
hnh ha. Khi hnh ha bnh c 3 nguyn nhn :

A-Chnh kinh b bnh, l ch c mt kinh tm, bnh mi

pht, cn nh, cha truyn kinh, nhng theo chng phi
bit do h hay thc bit cch cha.

a-Nu tm h :
Phi dng huyt b trn ng du huyt ca kinh Tm
iu chnh li chc nng kh ho ng hnh ca ng
kinh. Kinh Tm l kinh ha, m ca ha l mc, nn

25
phi dng huyt mc trn ng du huyt ca ng kinh
tm l huyt Thiu xung day b.

b-Nu tm thc :
Phi dng huyt t trn ng du huyt ca kinh Tm
iu chnh li chc nng kh ha ng hnh ca ng
kinh Tm, con ca ha l th l huyt Thn mn phi
day t.

Nhng mt nh lut khc ca ng y, tr khi

qu tim c thc bnh nh tim nh, tim to, tim thng, h
van tim, hp van tim, dy vch thnh tim.., mi cha
thng vo kinh Tm, cn nu tim b bnh u do nh
hng ca tm bo l mng bao tim, ng mch tnh
mch thuc Kinh Tm bo, th cha trn kinh Tm bo
m khng cn cha trn kinh Tm.

B-Bin chng truyn kinh :

Bin chng truyn kinh l hnh ha b bnh do nh
hung bi hnh m thuc mc l gan, mt hoc bi hnh
con thuc l th thuc t v v.

a-Nhng trng hp nh hng truyn kinh bi hnh

m :

Hnh m l Can mc sinh ha c th lm hi n tim

nh cc chng sau :

1-Chng can thc

2-Chng can dng ha ha
3-Chng can dng vng
4-Chng can dng thng cang
5-Chng can kh thng nghch
6-Chng can phong
7-Chng can phong
26
8-Chng can phong ni ng
9-Chng can kh ut nhit
10-Chng can m ut ha ha
11-Chng can quyt
12-Chng quyt u thng
13-Chng can ha
14-Chng can nhit
15-Chng can nhit thnh
16-Chng can ha vng
17-Chng can huyt nhit
18-Chng cqn thp nhit
19-Chng can m thp nhit
20-Chng can tt bt ha
21-Chng can v bt ha
22-Chng m thc
23-Chng m nhit.

b-Nhng trng hp nh hng truyn kinh bi hnh

con :

Hnh con l t v thuc th, c cc trng hp c th

lm hi tim nh cc chng sau :

1-Chng v kh khng ging

2-Chng v kh nghch
3-Chng v thc nhit
4-Chng v nhit ch nghch
5-Chng v nhit ng thnh
6-Chng v thng (tm h thng)
7-Chng t thc
8-Chng t nhit
9-Chng t thp nhit
10-Chng t khng nhip huyt

27
PHN BA

CCH CHA BNG KH CNG VUT HUYT

Cch cha ca ng y l da vo chng p dng i

chng tr liu, lp li qun bnh s kh ha v c s (tn
thng tng ph) hay v chc nng ca tng ph theo
tiu chun bt cng (8 yu t cn bn khm v cha
bnh) nh : m (huyt), dng (kh), h (thiu), thc
(d), hn (lnh), nhit (nng), biu (bnh nh), l (bnh
nng). Da vo bt cng, nu bnh thuc m (huyt)
ly dng (kh) cha, v ngc li. Nu bnh h th
b, bnh thc th t, bnh hn th lm m (n), bnh
nhit th lm mt (thanh), kh nghch th cho ging h,
tc nghn th khai thng, ut kt th gii, xut th cm
lim gi li, b hm th cho tit xut ra
Do cch cha ca kh cng ch vut trn nhng on
kinh mch c ng hnh trn Mch Nhm-c, Bi du
huyt trn lng, trn Du-M huyt, v trn tit on ng
du huyt ca 12 chnh kinh nh dng b on cho bnh
h, t on cho bnh thc, thng on cho bnh tc
nghn, nhit on cho bnh hn, khc-du on cho bnh
au nhc.
Phng php vut huyt ch trong n vic iu chnh
h, thc, hn, nhit, kh, huyt, c s, chc nng nh
tm h, tm thc, tm hn, tm nhit, tm huyt h, tm
huyt thc, tm kh h, tm kh thc, tm t thc, tm t
h, tm can thc, tm can h, tm thn bt giao
C nhiu cch cha, hc vin cn l lun v sng to,
chn mt trong nhng cch cha cho thch hp v hiu
qa an ton nht, va cha c ngn, va nga c
bin chng truyn kinh va cha c gc bnh.

28
Cc phng php hng dn di y ch c tnh cch
l thuyt, khi cha cn phi l lun v phi hp theo
cch l lun bnh chng.

1-PHNG PHP TH NHT :

Tm nguyn nhn :

Mt tng bnh, c 4 nguyn nhn :

Th d Tm bnh, gi l Bn Bnh (k hiu BB) c 4
nguyn nhn xy ra :

a-Do m truyn bnh, l Can mc thc sinh Tm ha

vng, Kinh Can gi l kinh Sinh Bnh (k hiu SB)

b-Tm ha bnh truyn sang T th gi l Bnh Sinh

(k hiu BS).

c-Tm ha bnh truyn khc cho Ph kim, gi l Bnh

Khc (k hiu BK).

d-Do b Thn thy suy, khng khc ch c tm ha,

gi l Khc bnh (k hiu KB).

Cch cha :
C 3 cch cha khc nhau :
29
a-Trng hp bnh cp tnh :
Vut nghch vng trn tng sinh :

Nguyn nhn do Bn Bnh l Tm :

T tng Bn Bnh (BB) vo tng Sinh Bnh (SB), ri x
thng kh ra huyt Tnh c s ca kinh Sinh Bnh (SB).

Cng thc : BB-SB-x tnh huyt SB

X tnh huyt Can

Tm thc nhit
Day bm au huyt i
Vut t Tm du xung
n cho t kh thot ra
Can du 6/9 ln

Nguyn nhn do m truyn bnh l Can, i li gi Can

l Bn bnh, cng theo cng thc trn :

Can thc
Vut t Can du xung X huyt Dng tuyn hai
Thn du bn
Nguyn nhn do T thc (lm Tm ha d), nn gi T
l BB, cng theo cng thc trn :
30
 T thc
Vut t T du ln Tm du X huyt Thiu xung bn
tri

b-Trng hp bnh mn tnh :

Vut theo ngi sao tng khc :
T chga ngn m khng cha gc, khng nga bin
chng, khng bi b kh huyt.

Nguyn nhn do Bn bnh l Tm :

Vut t tng Khc bnh (KB) sang tng Bn bnh (BB),
ri x t kh ra huyt tnh c s ca kinh Bn bnh.

Cng thc : KB-BB- x tnh huyt BB

Tm thc nhit huyt x t nhit Thiu

Vut t Thn du ln Tm xung bn tri.
du.
Trn nguyn tc vut t Thn du ln tm du iu ha
tm thn, nhng tm qa nhit phi x nhit tm.

31
c-Trng hp bnh lo suy :
p dng trong trng hp bnh mn tnh c du hiu
cp tnh, va h va thc, h thc thc tp.
Vut theo quy lut phi hp hai trng hp trn, mn
tnh trc, cp tnh sau (ging nh hnh mc cu).

Vut t tng Khc bnh (KB) sang tng Bn bnh (BB),

ri t BB n Sinh bnh (SB), ri x t kh ra huyt tnh
c s ca kinh SB.

Cng thc KBBBSB--x tnh huyt SB

Th d nguyn nhn do Tm lo suy :

Tm lo suy
Vut t Thn du ln Tm
du 6/9 ln, ri t Tm du X huyt tnh i n
xung Can du 6/9 ln

Th d nguyn nhn do Can thc h (lo suy):

Gi Can l BB, vut theo cng thc trn :

32
 Can lo suy
Vut t Ph du xung Can
x tnh huyt Dng tuyn
du 6/9 ln, ri t Can du
hai bn
xung Thn du 6/9 ln.

Th d nguyn nhn do T lo suy :

Gi T l BB, p dng cng thc trn :

T lo suy
Vut t Can du xung T X tnh huyt Thiu xung
du 6/9 ln, ri vut t T bn tri.
du ln Tm du 6/9 ln.

Quy lut vut 6/9 :

Vut 6 ln :
L lo m hay cc m, huyt s chuyn ha thnh kh.

Vut 9 ln :
L lo dng hay cc dng, kh s chuyn ha dng
trp thnh huyt, dch cht, thy cht.
33
2-PHNG PHP TH HAI :

Quy lut sinh ha, chuyn ha t ng trong b t.

a-B h :

Vut t kinh m SB n kinh bnh BB l kinh con 6/9 ln

l cha ngn gip kinh bnh mnh tm thi, nhng kinh
m h li mt thm nng lng, cn phi b sung
nng lng t kinh KB cho kinh m na mi l cha
gc, ngoi ra, khng cho kinh khc bnh d tha
nng lng hi kinh bn bnh l cch ngn nga
bin chng.

Th d kinh tm can u h :

Kinh tm can u h

Cha ngn :
Vut t Can du ln Tm du 6/9 ln.
Cha gc :
Vut t Thn du ln Can du 6/9 ln.
Nga bin chng :
Vut t Ph du xung Thn du 6/9 ln.

34
b-T thc :

Vut t BB sang BS lm mt thc ca BB l cha gc.

Va lm mt thc ca BB phi t con BB l BS lm mt
i nng lng, di chuyn nng lng sang BK, dng BK
chuyn nng lng b KB l nga bin chng.
Bn bnh thc nhit, phi b KB ri mi dng KB t
BB.l cha ngn.

Th d Tm thc nhit :

Vut t Tm du xung T du 6/9 ln (cha gc).

Vut t T du ln Ph du 6/9 ln, t Ph du xung Thn
du 6/9 ln (nga bin chng).
Vut t Thn du ln Tm du 6/9 ln thanh tm ha
(cha ngn).

3-PHNG PHP TH BA :

Quy lut vut chuyn ho ch ng trc 6/9 ln, ri

vut sinh ha 18 ln trong nhng bnh h .

35
 Tm h hn

Sinh ha :
Vut t Can du ln Tm du 6/9 ln .
Chuyn ha :
Vut t Thn du ln Can du 18 ln, can mc s d tha
nng lng chuyn ha sang con l Tm lm cho tm
ha mnh hn.

4-PHNG PHP TH T :

Theo vng lin hp m-con, dng kh cha huyt, hoc

dng huyt cha kh (t dng vo m hay t m ra
dng).

Th d 1:
Bnh thuc Tm-t :

Nhit nhp th, nh n t v

36
Chn ha sinh thc nhit :
Vut t Mch dng trn Bi du huyt trc, ri mi
vut trn mch m l Nhn mch sau :
Chn ha l Tm kh, nhit l Tm bo kh. Vut t
Tm Bo du n T du, nhng vut nghch t T du ln
Tm du thuc m trong dng, iu ha t v nhit.
T Tam tiu du ln V du thuc dng trong dng,
cha v hn.

Mch Nhm

Vut t Trung qun xung Thch mn, thuc m trong

m, iu trung l kh, n nh ni tng.

Ha nhp th

Vut t T du ln Tm du, m trong dng.

37
T Tiu trng du ln V du, dng trong dng,
iu tm t.

Mch Nhm

Vut t C khuyt xung Trung qun.

Th d 2 :
Bnh thuc Tm-can :

Mc sinh ha :
Vut t Can du ln Tm du (m trong dng).
Vut t m du xung Tiu trng du cho ha nhp
mc, iu tm can.

Mc sinh nhit :
Vut t Can du ln Tm bo du.
Ch can, dn nhit ha nhp can :

38
Vut t Can du ln Tm bo du, mc nhp nhit, iu
ha tm can, ch ha kch can. Hoc t Tam tiu du ln
m du, iu tm can dng,

Mch Nhm

Vut t Trung qun xung Thch mn thuc m trong

m, iu ha hn nhit cho ni tng.

Vut t Cu V xung Quan nguyn

Mch Dng Kiu : Bm C Liu ri Nhu du.

39
Trn Mch Nhm : Vut nghch t Thch mn.ln Cu
v , nghch ng kinh iu tm can.

Vut nghch t C Khuyt ln Cu v ch bt mc.

Th d 3 :
Bnh thuc Tm-Ph :

Thanh kim, ch ha kin kim (cho ha nhp kim) :

40
Vut t Tm du ln Ph du thuc m trong dng lm
mt phi.
Vut t Tiu trng du ln i trng du thuc dng
trong dng, cho nhit i trng v Tiu trng
iu tm ph.

Nhit nhp kim thanh ph tn hn :

Vut t Tm bo du ln Ph du, m trong dng, cn
bng hn nhit cho ph.
Vut t i trng du ln Tam tiu du, dng trong
dng, cn bng nhit i trng.

Mch Nhm

41
Vut t Thin t xung C khuyt, thuc m trong m,
trong trng hp tn thng ph do nhit, iu tm ph
gip cho chn ha hot ng tt.

Mch Nhm

Vut nghch t Thch mn ln Thng qun l kim

nhp nhit, iu ha hn nhit cho ni tng.

Th d 4 :
Bnh thuc Tm-Thn

Thy nhp ha ch ha : giao ha tm-thn

Vut t Thn du ln Tm du thuc m trong dng
ch ha.

Thy nhp nhit thanh nhit :

42
Vut t Bng quang du ln Tm bo du, thuc dng
vo m trong dng, thanh nhit.
Vut t Bng quang du ln Tiu trng du, thuc dng
trong dng, iu tm-thn.

Ha ha ch thy :
Vut t Thn du ln Tm du thuc m trong dng, hay
t Bng quang du ln Tam tiu du, thuc dng trong
dng, cho thy nhp nhit, iu tm thn v chnh
hn nhit c th.

Mch Nhm

Vut t C khuyt xung Trung cc cho ha nhp thy,

m trong m, giao ha tm thn, em ha xung h
tiu.

Mch Dng Kiu : Day bm Thn mch ri Nhu du,

cha ngoi nhit, hn m, co git, nga bin chng.

43
 T Thn tng xung Kh huyt

Mch Nhm
T m Giao xung Trung Cc

12 HUYT TNH (Dng x t kh)

44
45
5-PHNG PHP TH NM :
Theo vng ng hnh sinh trn Bi du huyt :

1-Cha Tm hn :
Vut t T du ln Tm du :
Tr nhit ca T v Tm, cha T thc nhit, Tm hn.

2-Cha chc nng tm t :

Vut t T du ln Tm bo du (Quyt m du) :
iu ha chc nng ca tm t.

3-Cha tm hn sinh v hn :
Vut t Tam tiu du ln V du :
Dng tng ha lm m v dng tm ha, cha tm
hn sinh v hn.

4-B Tm dng :
Vut t Tiu trng du ln V du :
tng nhit tng chc nng T dng b tm
dng.

5-Cha tm ha suy :
Vut t Thn du ln Can du :
Gip mc sinh ha thn thy khng d tha lm hi
tm ha, v ngc li mc mnh gip cho tm thm ha.
Mc ch iu can thn.
6-Cha tm dng h :
46
Vut t Bng quang du ln m du :
iu can dng gip tm dng vng.

7-Cha tm huyt h :
Vut t Can du ln Tm du :
sinh ha cho tm, cha tm hn, tng chc nng to
huyt.

8-Cha tm ha suy :
Vut t Can du ln Tm bo du (Quyt m du) :
Gip ha sinh nhit.

9-Cha tm can dng h :

Vut t Tiu trng du ln m du :
iu tm can dng.

6-PHNG PHP TH SU :
Theo vng ng hnh khc trn Bidu huyt.

1-iu ha hn nhit ni tng :

Vut t Thn du ln Tm du :
Giao ha thy ha iu ha hn nhit ni tng.

2-Cha tm thn dng :

Vut t Bng Quang du ln Tiu trng du :
iu tm thn dng.

3-Cha Tm thc nhit :

Vut t Bng quang du ln Tm bo du (Quyt m du)
Dng thanh nhit cho tm.

4-Cha tm ha vng :
Vut t Thn du ln Tm bo du :

47
Dng h ha (p dng trong bnh cao p huyt, tiu
ng).

5-Cha tm nhit :
Vut t Bng quang du ln Tm bo du :
chnh hn nhit c th.

6-Cha tim mch xo trn :

Vut t T du ln Can du :
iu can t thc l nguyn nhn hi tm gy xo trn
tim mch.

7-Cha tm dng thc :

Vut t V du ln m du :
iu Can v thc lm cho tm dng thc.

8-Cha tm m nhit :
Vut t Thn du ln T du :
bt t nhit, gin tip cha tm m nhit.

9-Cha tm kh thc :
Vut t Bng quang du ln V du :
iu V nhit, gin tip cha tm kh thc.

48
7-PHNG PHP TH BY :

49
Cha theo tit on ng hnh trn Mch Nhm.

1-Cha tm kh suy :
Vut t Thin t xung C Khuyt :
Cho kim nhp ha, iu tm ph, gip chn ha mnh.

2-Cha tm huyt :
Vut t Cu v xung C Khuyt :
Cho mc nhp ha iu tm can.

3-Cha tm m, tm dng :
Vut t Cu v xung Trung qun :
Cho mc nhp th iu can t, can v, gin tip cha
tm m, tm dng.

4-Cha tm can hn :
Vut t Cu v xung Thch mn :
Cho mc nhp nhit (dng ha), iu tm can hn.

5-Cha tm ha suy :
Vut t Cu v xung Quang nguyn :
Cho mc nhp dng ha sinh ha cho tm.

6-Cha tm hn :
Vut t Cu v xung Trung Cc :
Cho mc nhp thy dng, iu Can thn hn, gin tip
cha tm hn.

7-T tm ha :
Vut t C khuyt xung Trung qun :
Cho ha nhp th, bt tm ha sang t iu tm t.

8-Ging tm ha :
Vut t C khuyt xung Trung cc :
Cho ha nhp thy giao ha tm thn (ging ha).
50
9-Chnh chc nng tm dng :
Vut t Thng qun xung Trung qun :
Cho mc nhp th iu can v bt ha, gin tip chnh
chc nng cho tm dng.

10-iu kh hn nhit :
Vut t Thng qun xung Thch mn:
Cho mc nhp nhit, iu hn nhit ni tng.

11-Cha tm t nhit :
Vut t Trung qun xung Trung cc :
Cho th nhp thy lm h nhit cho t cha t nhit,
iu t thn, gin tip cha tm nhit do t nhit.

12-Cha tc tim ngc :

Vut t Trung qun xung Thch mn :
Cho th nhp nhit l trung ch kh, iu trung tiu,
gii ut thng tiu.

13-Chnh hn nhit c th :
Vut t m giao xung Trung cc :
Cho ha tam tiu nhp thy, chnh hn nhit c th.

51
 Mch Nhm
8-PHNG PHP TH TM :
Theo hai cch :
52
a-Vut 6/9 huyt Khch-Du, thng, b, kh hay huyt.
b-Vut 6/9 huyt Khch-Du, t, thng, kh hay huyt.
Trn kinh m, khng c huyt du, thay bng huyt
nguyn.

a-Vut on huyt t Khch huyt n Du huyt

khai thng b tc trn ng kinh trc. Sau , nu
thuc bnh h th phi dng thng on cng hnh vi
ng kinh thng ng kinh, ri mi dng b on
l hnh m ca ng kinh b cho ng kinh mnh
ln.

1-Thng b Tm bo :
Dng cha au do tc nghn ng mch v tnh mch
cc loi :

2-Thng b Tam tiu :

53
Thng cc h thng ng mch, cha au nhc, kh th,
nght tim do cholesterol

3-Thng b kinh Tm :
Thng c s qu tim, tm nh, tm tht, xoang.

54
4-Thng b Tiu trng :
gip mnh tm ha.

5-Thng b Can gip tm ha :

55
6-Thng b m gip tm dng :

56
7-Thng b T dng tm m .

8-Thng b V dng tm dng :

57
9-Thng b thn khc ch tm m ha vng.

58
10-Thng b Bng quang khc ch Tm dng :

b-Vut on huyt t Khch huyt n Du huyt

khai thng b tc trn ng kinh trc. Sau , nu

59
thuc bnh thc th phi dng t on hnh con ca
ng kinh t bt thc cho ng kinh, ri mi dng
thng on l on cng hnh vi ng kinh khai
thng ng kinh hot ng bnh thng.

1-T thng Tm bo:

Thng tc nghn ng mch lm sng au, ph mch.

2-T thng Tam tiu :

Cha phnh tc ng mch, tnh mch.

60
3-T thng Can thc lm tm thc :

4-T thng m bt tm kh dng qa vng :

61
5-T thng T cha tm m thc :

62
6-T thng V cha tm dng thc :

7-T thng thn thc lm mt tm ha :

63
64