A BAO CAO K H O A HOC
Nhan xet dac diem bien doi y thiJrc cua trang thai len dong 6 cac \k hpi vung Nam Dinh
ThS. Tran Manh C i r ^ g Wen Sdc khoe Tam than
I. DAT VAN DE
Len dong (LO) la mpt tap t u c , tin ngudng pho bien cua nhieu dan toe, nhieu nJdc tren the gidi CO tCf xa xda va hien nay van ton tai d nhieu noi nhU: Mot so niTdc chau Phi, Brazil, Haiti, Trung Q u o c V i e t N a m v.v...
Trang thai LO (estat de transe) du'gc nhieu tac gia nhan dinh khac nhau:
-Theo bang phan loai benh Qudc te lan thiJ 10 (ICD 10) LO la mpt trang thai trong do doi tUpng mat tam thcJiy thu'c ve dac tinh ca nhan cung n h u y thtirc day du ve xung quanh.
-Theo DSM4 cung co nhan dinh tUOng t i i : Trang thai nay neu xuat hien ngoai le hpi thi goi la trang thai LO phan ly (Dissociative transe disorder).
-Theo Stokvis va cpng sii: M o n Hoa tam hpc (Sophrologie) cua Caycedo chuyen nghien ciiu cac trang thai bien doi y thufc, xem trang thai LO thong t h u d n g la m p t trong nhOng trang thai bien doi y thiic dac biet chu yeu do am thj va t U a m thi gay ra {Thoi mien, t h u gian, thien. Yoga v.v...).
- CJ nu'6c ta trang thai LO du^pc gpi la Hau dong.
Hau dong dapc xem n h i i mpt nghi le trong tin ngucfng Oao Mau va dac biet trong cac djp le hpi.
II. TONG QUAN
1 . Y thuTc va b i e n d o i y thuTc
7.1. Quan niem vey thUc trong Tdm thdn hgc - y t h i i r c l a v a n d e t r u n g t a m v a c o b a n c u a T r i e t hpc, Tam ly hpc, Tam t h a n hpc va nhieu nganh khoa hpc khac.
- Tam than hpc khu t r u hu'ctng vao thiic tien lam sang, xem y thCfc la hoat d p n g t o n g hpp cOa nhieu qua trinh tam ly (tri giac, siichu y.tuduy, tri nhd, cam xuc v.v...).
- Trong thiic hanh lam sang khi quan sat ve bieu hien cua y thirc, thay thuoc t h u d n g chCi y den nhCmg nhan cam co he t h o n g cua doi tuong ve cac hien t i i p n g dang song. Theo Lian thay thuoc can quan sat va nhan djnh ve:
+ Kha nang djnh h i i d n g ci!ia doi tupng.Trong trang thai LO, ICDIO va DSM4 chu y nhieu den kha nang djnh h u d n g ban than nhat la hien t u o n g thay the y thiic ve cac dac tinh ca nhan mdi cua cac vi Thanh da nhap vao ngUdi HO
-I- Kha nang chu y den cac hien t u p n g dang song cua doi t u o n g . Trong trang thai LO, ICDIO va DSM4 chu trpng nhieu den hien t u o n g y thdc bj t h u hep
+ T i n h c h i u a m t h i va t i i c h j u a m t h j c O a d o i t u o n g , cac tac gia n g h i e n cUu t r a n g t h a i LO nhan m a n h hien t u p n g nay.
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BAO CAO K H O A HOC k.
1.2. Quan hi giCta y thUc vd vo thdc - Trong hoat d p n g Tam than nham phan anh ngoai m o i va npi t a m , ngoai y thdc ra con hoat dpng cua vo thdc, khi hoat dpng y thUc bi t h u hep thi hoat d p n g vo thdc chiem Uu the theo Henry Ey vo thdc bieu hien bang nhdng hoat dpng t u d p n g , cac phan xa co dieu kien, cac xung dpng cam xuc, ban nang tiem tang va cac hoat dpng cua he TK thuc vat.
2 . A m t h | v a t i r a m t h j
- Am t h i (Suggestion, gpi y) dupc m p t ngudi la gpi cho ngudi do m p t y nghT bang mpt thai dp hay m p t p h u o n g t h d c gay tin t u d n g va ngddi do chap nhan de dang, s i n sang thdc hien y nghT do du y nghi cd phu h o p vdi thUc te. Theo N g u y i n Viet, ngudi chiu de dang s u a m thi gpi la ngudi cd tinh de bj am t h j hay ngUdi cd tlnh am thj cao, so vdi am thj t h i t U a m thj cd vai tro quyet dinh.
3. Tmh hmh nghien cuTu tap tuc LD trong va ngoai niidc
3.1. Nghien ahi ngoai nUcfc Cac nghien cdu co nhdng nhan dinh sau LO la trang thai t h o i mien {Dieu Chu Huy) LO la trang thai phan ly (Lechmann) LO la trang thai phan ly neu xuat hien ngoai le hpi(ICD10,DSM4)
LO la trang thai bien doi y thdc dac biet do AT va t u AT gay ra (Caycedo)
3.2. Nghiin cUu&nUcfcta
-Theo Ngo Ode Thjnh va cpng sU nghien cdu ve Oao Mau d V i e t Nam, HO la nghi thdc chinh va quan t r p n g va cung cd nhan dinh ngUdi HO t d thoi mien m j n h khi HO
III. DOI lUDNG VA PHUDNG PHAP NGHIEN CllU
1 . 0 6 i tUtfng nghen cihi
7 . 1 . Thugn lgi va kho khan nghien cUu 1.2. Th&i gian vd dia diem nghien cUu
1.3. Nhom doi tugng NC: 31 ngUdi - Ngudi HO 10, NgUdi Hau dang 04, Cung van 04, Ngudi than ngudi HO 05, Khan gia (ia con nhang d e t d ) 08.
2. Phucmg phap nghien cufu 2.1. Thuthdpsoliiu Ap d u n g PP quan sat mo ta buoi HO Phong van cac doi tuong theo mau PV Kham benh C o t h e v a T a m than Nghiem phap Tam ly
2.2. Phan tich cdc so lieu dd thu thgp dugc Phan tich theo muc kham bien doi y thdc cua Lian (chu trpng tinh chju ATva tUAT).
Phan tfch theo cac tieu chuan xac djnh va loai t r d c u a l C D 1 0 v a D S M 4
2.3. Nhdn xet tdng hdp bieu hien vd ccf the cua bie'n doi y thdc trong LDIi hgi viing ND
Dua tieu chuan chan doan ICDl 0,DSM4 DUa vao quan niem Hoa Tam hpc ve co che phat sinh trang thai LO
IV. KET QUA NGHIEN COU
•. M d ta cac dac diem bien doi y thdc cua trang thai L£> le hoi vung N€>
Chiing toi sap xep cac ket quci quan sat va phdng van theo 4 muc chinh cua tieu chuan chan doan.
- Hanh vi va dpng tac dinh hinh -Thu hep y thdc va moi trudng trudc mat - Bien doi dac tinh ca nhan
- Quen toan bp hay mot phan cac hien tuong 7.1 Cdc sdlieu lien quan den tfnh AT, tUAT Ngddi H O d i i l e hpi L O t U b e 10/10 Tin Than Thanh cd the nhap vao ngudi - H a u dong 31/31
Nghiem phap 3 lp 5/5 {+)
-Tat ca NHO t d be da bj AT v a t u AT v e s i i t o n tai va CO siitham nhap cua than thanh vao ngudi LO.
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1.2. Cdc sd lieu mo td hdnh vl vd dgng tdc dinh hinh ciia ngUcri HD
10/10 thiic hien cac nghi thdc theo truyen thong, do la cac trang phuc, d p n g tac, net mat, dieu bp v.v...
7.3. Cdc sdlieu liin quan den trang thdi thu hep y thdc ve moi trUdng trUdc mdt
Nhin ludt khan gia khong chu y den ngudi nao 10/10.
Chii y chpn Ipc vao tieng nhac, Idi hat van khi miia 10/10.
- Cac ket qua nghien cdu cho thay y thdc cua tat ca NHO deu cd su thu hep, doi vdi moi trudng trUdc mat deu chi nhin ludt, m o ho chii y chi hudng vao nhdng kich thich can thiet khdi dpng vao cac dpng tac djnh hinh phu hpp vdi t d n g vj thanh.
1.4. Cdcsdliiu liin quan den trgng thai bien doi cdc ddc tinh cd nhdn
Bien doi net mat, tinh each theo tCmg vj Thanh 10/10.
Bien doi dieu bp, tac phong theo tUng vj Thanh nhap 10/10.
Bien doi each phat am theo t d n g vi Thanh (Tieng keu) 10/10.
- Trong 10 trddng hpp tat ca cac doi t d p n g deu lam vao trang thai LO cd Thanh nhap deu bien doi dac tfnh ca nhan theo t d n g giai doan buoi Hau dong.
7.5. Cdcsdliiu cd lien quan den quin sau khi LB
Quen cac hien tUpng xay ra trudc khi Thanh nhap 0/10.
Quen toan bp cac hien t u p n g xay ra khi Thanh nhap 0/10.
Chi nhd mpt phan cac hien t u o n g xung quanh khiThanhnhap 10/10.
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- Ket q u i cho thay LO la m o t trang thai thu hep y thdc (gidng n h u t r a n g thai phan ly).
1.6. Cdc so liiu lien quan khde
Khong cd ai trong so ngUdi HO mac cac benh lyTT, hoac nhiem dpc thuoc hudng than
Cac nhan t o phu trp buoi HO
- Cac nhan t o thuc day: Cau tao Oen, Oien, t u p n g Thanh mau s^c rUc rd, nhjp dieu go, lan dieu chau van, chum khan quay dao dau.
- Cac nhan t o duy t r i : Nhdng bai hat van dac trUng, le phuc dac trUng cho t d n g vj Thanh, thai dp d o n g cam va hudng dng, t o n kinh (nhu cau ndi lay Chau, lay Co...).
2. Nhan xet chung ve cac dac diem bien doi y thdc trong trang thai LO le hoi vung ND qua ket qua nghien cdu
2.1. LD li hgi viing ND Id mdt tin ngUdng cd cdc bleu hiin cua trgng thdi LD md td trong ICDIO vdDSM4
Cd hanh vi va d p n g tac djnh hinh theo nghi thdc tin ngUdng truyen t h o n g .
Co t h u hep y thdc ve moi trddng trudc mk, tap trung chu y chpn Ipc vao cac kfch thich cd lien quan den trang thai LO.
Khi Thanh nhap cd sd thay t h e y thdc ve cac dac t i n h ca nhan t h d n g t h u d n g bang cac dac tinh mdi t u o n g dng vdi t d n g vi Thanh.
Trong hien t d p n g LO co thanh nhap cd hien t u p n g quen m p t phan hien tUpng xay ra.
2.2. Theo cdc tdc gid LD li hdi gidng LD ngodi li hgi, nhtAig theo nguyin tdc tdn trgng tin ngUdng ddn gian cda To chdc Y te The Gidi va cdc tdc gid mgt so nUdc, LD li hgi khdng phdn logi theo cung mptmd sdvdi LD ngodi li hgi cOa ICDIO vdDSM4
2.3. Cd the phdn logi LD nhumgt trgng thdi bien doi y thdc ddc biit bin cgnh nhCtng trgng
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thdi bien ddi y thUc khac nhU thoi miin, thU gidn, Thien, Yoga v.v...
2.4. Qua sdlieu thu thgp dugc, LD le hdi vung ND Id mgt trgng thdi bien ddi y thdc do nhdn td ATvdtUATgdyra.
2.5. DUdi hinh thdc sdn khdu Tdm linh cda LD li hgi, nhieu nhdn to phu trgcd vai tro thuc day vd tgo thugn tgi cho trgng thdi bien doi y thdc.
V. KET LUAN
- LO le hpi vung NO la mot tap tuc tin ngUdng dong thdi la mpt hoat dpng van hda truyen
thong. Cac nghi thdc trong buoi HO theo diing md hinh co dien dupc thuc hien d nhieu noi trong va ngoai nudc.
- LO xuat hien theo co che AT va tU AT, co che PX cd dieu kien va co che hoat dpng vd thdc, dudi tac dpng cua nhan to phu trp, khdng cd ngUdi HO nao thay hinh anh Than Thanh xuat hien trddc matva nhap vao minh.
- LO khdng phai trang thai gia tao, mpt trang thai thdi mien hay RL phan ly. Nd chi la trang thai bien doi y thdc vdi dac trung y thUc bj thu hep, cac dac tinh ca nhan dupc thay the dac tfnh Than Imh da duoc md phdng djnh hinh trong cac l§ hdi
TAILI$UTHAMKHAO
1 Ngo Bdc Thjnh. Dao mau 6 Viet Nam. Nha xuat ban VHTT1996
2. To chdc y te the gidi. Bang phan loai benh quoc te lan thiJ X ve cac roi loan tam than va hanh vi. Geneva 1992.
3. Nguyen Viet Benh vien tam can hysteria. Tam than hpc. NXB y hpc 1990 (tri 00-106).
4. Nguyen Viet. Lieu phap tam ly. Tam than hpc. NXB y hoc 1984 {tr 84-89)
5. Nguyen Viet. Y thdc v a v o y thdc. Bai gilng, Bp mon tam than hoc Bai hoc Y Ha Npi 1980.
6. Nguyen Viet. PhUOng phap chda benh bang thoi mien. Bai gang, Bp mon tam than hgc Bai hpc Y Ha Noi 1998.
7. Leopold Cadriere. Ve van hoa va tin ngUdng truyen thong ngUdi Viet. NXB van hoa thong tin 1997-ND; Bo Trinh Hue, 37-38.
8. L Chertok.Th6i mien va am thj. NXB the gidi 1997. ND: Pham Nguyen Pham.
9. Dieu Chu Vi. Vu thuat than bf. NXB VHTT 1996. ND: Le Huy Tieu, Do Ddc Sam, DuangThu Ai.
10. DSM4 (Diagnostic and statistical Manual of Mental Disioder) Americain pyschiatric Association 1994.
11. Heinz E. Lehmann- Voodoo and other possession states unusual psychiatric disorder- comprehensive textbook of psychiatry 4"' Ed- Americain psychiatric Association 1995 (CTP- 4'^ Edi 995). 1236.
12. LLian- Disorders of consciousness- Clinical Manifestation of psychiatric disorders- CTP- 4 * Ed 1995 (565- 566).
13. Zohn C.Nemiah- Other Dissociative States- Dissociative disorders-S20.6- CTP- 4"' Ed 1995 (950-951).
14. Schott- Billmann, Corps et Possession, Gauthier Villars Paris 1997,111-171.
15. Stokvis et ol introduction a I'hypnose et a la Sophrologie Libraine- Maloine, Paris 1976.5-19,87-108.
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