【作者】 胡友樾；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 研究背景近年来,随着社会的不断发展。运动医学正逐渐受到体育界和医学界的重视。这不仅为防治运动性疾病,保障运动员健康,提高运动成绩等方面发挥着重大的作用。同时,为医学的发展和运用提供依据。现代社会,有关消除运动性疲劳的研究多集中在体育界,实际上,消除运动性疲劳的研究对象应该更关注普通大众。因为慢性疲劳综合症,亚健康状态等疾病常常困扰着我们身边的很多普通人。消除运动性疲劳不仅是运动员、教练员的需要,更是现代普通大众的需要。疲劳的产生,主要是运动过程中体内能源物质大量消耗而又得不到及时补充所导致的。体内能源物质的消耗,包括高能磷酸物的消耗、血糖、糖原等物质的消耗。在高强度运动中,主要依靠ATP-CP供能,而ATP-CP下降,可能是导致此类运动疲劳的主要原因。在中低强度运动过程中,主要依靠糖的有氧氧化供能,而长时间运动,糖类物质大量消耗,血糖浓度降低,直接影响神经系统的机能,使大脑工作能力降低,进而产生身体疲劳。疲劳的产生是由于运动过程中,某些代谢产物大量堆积,又得不到及时清除所导致的。其中乳酸的堆积,是最主要的因素。乳酸是体内葡萄糖在缺氧条件下氧化分解的物质,随着运动强度的加大,乳酸大量的堆积,从而抑制糖酵解,使ATP合成速度变缓。运动中氨的积累与疲劳的产生密切相关。氨的积累可以影响动作的协调性和对运动技能的控制能力。一般认为短时间激烈运动中,血氨的升高反映机体无氧供能系统失衡,骨骼肌能量代谢和肌细胞膜的生理特性受到干扰,从而影响肌肉做功能力,产生运动性疲劳。运动性疲劳属于祖国医学的劳倦、虚损、劳役、劳伤等范畴。认为“气为血之帅,血为气之母。”气与血是生命活动的物质基础,过劳后无论损伤的是气还是血,依据阴阳互根理论,会导致另一方的亏损,所以,消除疲劳时,往往气血并治。此外,运动性疲劳的发生大致与脏腑有关。祖国医学认为脾为后天之本,气血生化之源,脾主四肢肌肉,与运动关系密切。肾藏精,主骨生髓,为先天之本,是体力产生的原动力和源泉。肾精不足,骨髓空虚,则会引起骨骼发育不良,容易产生运动性疲劳。祖国医学认为,肢体运动的能量来源有赖于肝的藏血充足和调节血量的作用,运动性疲劳的根源在于肝功能的盛弱。肝功能正常,肝血充盈,筋脉得养,运动有力,灵活而持久。若肝的气血不足,筋失所养,则筋力不健,运动无力而迟缓,故易于疲劳。祖国医学认为耳穴与人体脏腑、经络、气血运行密切相关。耳穴具有调节神经平衡、镇静止痛、疏通经络、调节气血阴阳、强身壮体等功能,广泛用于内、外、妇、儿、神经、五官、皮肤等各科疾病,如神经衰弱、情绪不稳定、忧郁、焦虑、紧张、疲劳综合症、神经功能及内分泌功能紊乱等症和器质性疾病,以及病毒、细菌、原虫所致的一些疾病均有治疗作用。如何使运动性疲劳更快更彻底地恢复是学术界一直在努力探索的问题,人们也已经找到了很多方法来促进疲劳的恢复,其中利用中医的方法是近几年研究的热门方向,这类方法充分发挥了中国中医药学的独特优势,取得了比较理想的效果。研究目的观察耳穴疗法对健康男性在校大学生运动性疲劳恢复的临床疗效。探讨耳穴贴压相关的作用机制。总结出一套简便、行之有效的耳穴贴压用于运动性疲劳的消除。研究方法本项研究在查阅文献的基础上,从中西医角度对运动性疲劳的产生原因及其机理进行了比较系统全面的认识和探讨,在此基础上结合临床研究,制定以耳穴为主,选择与运动相关的穴位进行贴压,以补肝脾肾、调理气血,并与空白组为对照,从而对耳穴对于消除运动后疲劳的机理及效果进行探讨。按照随机分组的方法将参与运动性疲劳实验的男性大学生分成空白对照组；左耳一组；左耳二组；右耳一组；右耳二组。试验采用单盲(对受试者设盲)的方法。让各组学生用极限强度跑完800米,记录其成绩。每天运动时间一次,共运动一周。从第一天运动结束后开始接受治疗。左耳一组、右耳一组选择内生殖器、胆、食道、眼、大肠、胃耳穴进行贴压治疗；右耳二组、左耳二组选择心、交感、气管、肺、肝、肾、脾耳穴进行贴压,空白对照组不进行任何处理,共治疗一个运动周期(一周)。选取测量心率和血压。分别在第一次运动前,第一次运动后,最后一次运动后即刻。留取第一次运动当天晨尿以及第一次运动完后尿液及最后一次运动后第二天晨尿,检测尿中乳酸、尿素、丙酮酸、游离脂肪酸水平。采用瑞典学者Borg的6-20分级(RPE)评分表进行疲劳主观感觉评分,询问时间为第一次运动后及最后一次运动后即刻进行。所有耳穴贴压组,由针灸专业研究生负责清洗耳朵后定位贴压。每位受试对象的耳穴贴压工作限制在5分钟内完成。贴压完成后,嘱受试对象运动当天晨起按揉一次,运动前30min按揉一次。其余时间每日自行按压3-5次,每次每穴按压30-60秒,以耳朵发红、明显胀痛感为度。研究结果1.左耳一组、右耳一组和左耳二组、右耳二组经治疗后,与空白组对照,最后一次运动后,心率、收缩压及舒张压均有所下降,差异有统计学意义(P<0.05),其中左耳二组和右耳二组较左耳一组和右耳一组下降幅度明显,而左耳一组与右耳一组相比无显著性差异,左耳二组与右耳二组相比无显著性差异。2.经过一周期治疗后,最后一次运动后第二天,左耳一组、右耳一组和左耳二组、右耳二组的游离脂肪酸、尿素、丙酮酸、乳酸水平与空白组比较,有所下降,差异有统计学意义(P＜0.05)。经过一个周期治疗后,左耳二组、右耳二组的乳酸、尿素水平更接近运动前安静状态下水平,与左耳一组、右耳二组相比差异有统计学意义(P＜0.05)。丙酮酸、游离脂肪酸浓度,左耳一组同左耳二组相比,右耳一组同右耳二组相比,差异无统计学意义(P>0.05)。3.左耳一组与右耳一组相比,左耳二组同右耳二组相比,最后一次运动后第二天,丙酮酸、游离脂肪酸、尿素、乳酸浓度差异无统计学意义(P>0.05)4.最后一次运动后,左耳二组和右耳二组比左耳一组和右耳一组RPE值下降更明显,两者相比有差异(P＜0.05)。研究结论耳穴贴压治疗可以提高人体的耐缺氧能力,从而在一定程度上增强了人体的体质,提高了人体对运动性疲劳的耐受性。耳穴贴压在消除运动后疲劳方面,疗效是明显的。经过一个周期的耳穴贴压后,可以加快游离脂肪酸、乳酸、丙酮酸、尿素等代谢产物的清除,使之更接近安静状态时的水平。但由于疲劳恢复过程的阶段性和异时性,造成了部分物质的消除速度过慢。耳穴治疗的选穴不同对治疗效果也是有影响的。耳穴二组选择了与运动密切相关的穴位进行贴压,治疗效果明显,优于耳穴一组,符合耳穴的治疗规律。耳穴一组选择与运动非密切相关的穴位,也有一定的治疗效果,可能与耳穴的非特异性及刺激一点可诱发多经感传的现象有关。使用同一组穴位,分别在左、右耳进行治疗时,疗效是没有差异的。但由于耳穴本身对机体刺激量不够大,故在部分实验室指标下降及疲劳缓解方面不是非常理想。有待改进治疗方法、治疗时间,或从分层随机的角度进行更进一步的深入研究,从而为进一步选择有效,便捷,易于接受的治疗方法提供理论依据。对于运动性疲劳的判定与治疗效果,本试验只选择了主观感觉量表及尿液的部分生化指标为观察对象。而对于运动后受试者的相关形态学改变,如下肢围度及体重变化,以及肌力,反应速度,皮肤感觉功能,心电图,肌电图,血液指标,如血液中血乳酸、血红蛋白的测定；内分泌指标中血浆睾酮、皮质醇测定；体液免疫、细胞免疫的测定等,均未进行判定。试验受试者,我们只选择了健康男性在校大学生,而疲劳的产生还与年龄、性别、运动水平、思想情绪、运动条件等等差异有关,故在日后的研究中,在这些方面有待深入挖掘。更多还原

【Abstract】 Background Recently, with the development of society, sports medicine has gradually been focused by sports and medical circle, which not only can prevent the sports diseases to ensure the atheletes, but also offer evidence for the development and application of medicine. In morden society, many researches of exercise-induced fatigue concertrated on sports circle, but actually, we should keep our eyes on the common people, because exercise-induced fatigue disturbe a lot of common people. Fatigue relief is not only required by sports man, coaches, but also needed by common people.The fatigue is always caused by large consumption of energies which are not able to supplement promptly. The energy consumption include high-energy phosphoric acid, blood sugar and glycogen. In intensive exercise, the human body is supplemented by ATP-CP. The decrease of ATP-CP is the main reason of fatigue. During the moderate exercise, the human body is supplied by aerobic oxidation. So the long-term exercise always consumes large sugar, which will affect the activity of nervous system and brain, and induce fatigue finally.On the other hand, the fatigue can also be caused by accumulation of metabolic products among which lactic acid is the major product. Lactic acid is the product of glucose under oxygen deficit condition. The accumulation of lactic acid can inhibit the glycolysis and retard the synthese of ATP. Ammonia also has close relationship with fatigue. The accumulation of ammonia can affect the coordination and control ability of exercise. Generally, short-term and severe exercise can disturb the balance the ammonia, and the physiological property of muscle and cell can be disturbed. So the fatigue comes into being.Although there was no the name of fatigue in classic works, the observation of fatigue is over 2,000 years. Most the scholars believe that exercise-induced fatige belongs to the scope of overstrain, asthenic disease and overexertion.TCM holds that qi is the commander of blood, while blood can carry qi. Qi and blood are the foundation of activity. Overlabor can damage qi and blood, so TCM often treat qi and blood together. Besides, exercise-induced fatigue also has relationship with the function of zang-fu. TCM believes that the spleen the acquired foundation and the origination of qi and blood. Spleen controls the four limbs and muscle which is related to exercise. The kidney hides the essence, controls the bone and marrow, and is often considered as the congenital foundation, the origination of power. The deficiency of kidney essence and marrow can affect the bone development which is easy to be induced to fatigue. The energy of activity derives from the condition of liver. The quantity of liver blood and its blood-regulation function can affect the body. Normal liver function, abundant liver blood can nourish the sinews, make the exercise forcefully, smoothly and persistently. Deficient liver blood induce the malnurition of sinew, so the exercise will become slow and easy to be fatigue.TCM believes that ear has close relationship with zang-fu, channel and qi-blood. Auricular acupoint can regulate the balance of neural system, tranquilize the mind and relieve pain, dredge channel and collateral, regulate yin-yang and qi-blood. So the auricualr therapy is widely applied in internal, external, gynaecology, pediatrics and ENT. Such as neurasthenia, melancholy, anxiety, tention, fatigue even disease caused by virus, bacteria and so on.How to promote the fatigue relief totally and quickly is a problem which has been explored by human being. People have found lots of ways to promote the recovery among which traditional Chinese medicine turned out to be the hot field. The ways of TCM take advantage of their special efficacy and obtain ideal effect.Objective observing the clinical efficacy on treating exercise-induced fatigue of healthy university students with auricular therapy. Exploring the mechanism of auricular therapy. Summing up a set of simple, effective therapy to relief exercise-induced therapy.Method all the students randomly devided into five groups as follows: control group, auricular points 1 of left ear, auricular points 1 of right ear, auricular points 2 of left ear, auricular acupoints 2 of right ear. The test use single blind method (single blind to all the experimenters)All the students were required finished 800m running test with all their strengths every day and the therapeutic course lasted one week. The aucricular therapy was exerted after the first exercise. Auricular points 1 was composed of internal genital(TF2), gallbaldder(CO11), esophagus (CO2), eye(LO5), large intestine(CO7), stomach(CO4), while auricular points 2 include heart (C015), sympathesis(AH6), trachea(C016), lung(COH), liver(C012), kidney (C010), spleen(C015). Control group had no any intervention.Instant test of heart rate and blood pressure were examined before the first exerise, after the first exercise and the last time exercise. Keep the morning urination of the first time exercise and the the day after last time exercise as sample and test the lactic acid, urea, pyruvic acid, free acid. Instant subjective grade was made according to RPE table made by Swedish expert Bory.All the auricular application were exerted by graduate students of acupuncture after cleaning the ear completely. Each student occupied at most 5 minutes to accept the therapy and they were also required press the acupoints each morning and 30 minutes before exercise. At the rest time of each day, they should press the acupoints 3-5 times,30-60 second each time untile the ear become light red and feels obvious swelling and soreness.Results comparing to control group, the students’s heart rate and blood pressure decreased in auricular points 1 of right ear, auricular points 2 of left ear, auricular acupoints 2 of right ear, auricular acupoints 2 of letf ear.There was statistic difference. Auricular acupoints 2 decreased more than auricular acupoints 1, but there were no statistic difference between auricular acupoint 1 of left and right ear, auricular acupoint 2 of left and right ear.After the therapeutic course, the students’s lactic acid, BUN, pyruvic acid, free acid decreased in the four therapeutic groups. Comparing to the control group, there was statistic difference. But comparing to auricular acupoints 1 groups, the the lactic acid and urea of auricular acupoints 2 groups decreased more and much closer to the normal condition. The difference has statistic significance. While the differences of pyruvic acid and free acid between auricular acupoints1 and 2 have no statistic significance.There were no statistic difference in pyruvic acid, free acid, lacitc acid and urea between auricular acupoint 1 of left and right ear, auricular acupoint 2 of left and right ear in the morning after the last exercise.There was statistic difference in RPE between auricular acupoints 1 and 2 at the last time exercise.Conclusion auricular therapy can increase the students’hypoxia tolerance and constitution, so the therapy raise the tolerance of exercise-induced fatigue.Auricular therapy can make a clear clinical effect on relief exercise-induced fatigue because it can promote the elimination of lactic acid, urea, pyruvic acid, free acid, and make them close to the level in normal condition. But due to the recovery has the characteristic of phase and heterochrony, some substance elimination become slowly.Different auricular acupoints can affect the clinical efficacy. Auricular 2 groups selected the acupoints which have close relationship with activity, so they got clear efficacy, while auricular 1 groups selects the acupoints which have non-close relationship with activity, they also got some efficacy possiblely due to auricular acupoint is nonspecific and mutil-channel sensation were induced by one point. There was no efficacy difference between left and right ear who share the same auricular aucpoints.But because the stimulation of auricular theray is not very large, some lab exam indexes didn’t decreased ideally. So we have to improve the auricular therapy, therapeutic course, stratified random or further research in order to select one more effective and convenient way.In this test, we observed ratings of perceived exertion and some bio-chemical indexes to measure the efficacy. Some other examinations, such as morphology test, length of lower leg and weight, muscle force, lectrocardiogram, electromyogram, and blood indexes, such as lactacidemia, hemoglobin, testosterone, cortisol, humoral immunity, cellular immunity have not been detected. We selected the college students as our examinee, while the fatigue has close relationship with age, sex, exercise level, mind condition and exercise condition. So it need further research.更多还原