【作者】 黄鑫；

【导师】 程昭寰； 朱建平；

【作者基本信息】 中国中医科学院 ， 中医基础理论， 2008， 博士

【摘要】 本文主要运用文献研究、理论研究的方法,参照动物试验与临床观察的结果,论证了温肝阳与滋肾阴合用,以时相组合的方式,改善运动性疲劳的理论基础。文章采用文献研究的方法,搜集“温肝阳”、“滋肾阴”、“时相组合”、运动性疲劳的相关资料,从中梳理脉络;运用中医理论对运动性疲劳的产生机理进行深入分析探讨,结合运动性疲劳的现代医学研究成果,参考动物实验和运动人体试验研究,提出温肝阳滋肾阴时相组合改善运动性疲劳的理念。本研究的意义:一是深入探讨了运动性疲劳的中医机理,借鉴“治未病”的思路,运用温肝阳的药物促进各脏阳气生化,激发脏腑活力,增加体能,采用滋肾阴的药物解除疲劳,恢复体能,两者合用,以时相组合的方式改善运动性疲劳;二是在中医理论的指导下,将现代时间医学和生物节律理论运用到改善运动性疲劳的研究领域,结合中医时间医学的理论,提出“时相组合”的概念,通过调整与运动密切相关的人体节律达到改善运动性疲劳的目的。课题所完成的部分动物实验和运动人体试验研究,为温肝阳滋肾阴时相组合改善运动性疲劳的理念提供了初步依据;三是通过对文献资料的挖掘和整理,梳理了温肝阳的理论体系,归纳了古人昼夜择时服药组合的经验,总结前人的制方思路与用药体会,为现代中医临床应用研究的发展提供了借鉴。本文的主体分为3个部分:运动性疲劳的中医机理;温肝阳滋肾阴改善运动性疲劳的理论研究;时相组合改善运动性疲劳的研究。运动性疲劳的中医机理运动性疲劳不同于古代疲劳。运动性疲劳的中医机理是,运动员作为健康人群,运动过度导致脏腑正常机能下降,劳损形体(肌肉、筋膜、骨骼、关节等),劳伤脏腑精气,劳耗神志,耗损大量阳气、精血、津液,尤以耗伤阳气为重,造成机体阴阳不调。运动性疲劳是由过劳所导致的、机体从内稳态向器官实质性病变发展过程的中间环节,介于健康和疾病之间的一种整体状态,经过休息和调养,可自行消除。本文借鉴中医“治未病”的思路,针对运动性疲劳产生的关键环节,运用中医药的方法延长原有运动水平的时间,延缓疲劳的出现,从而使得运动员在长时间的运动中始终保持精力充沛、情绪稳定、体力旺盛、反应灵敏的良好状态。温肝阳滋肾阴改善运动性疲劳的理论研究一、肝阳不足是导致运动性疲劳的主要机理(一)阳气不足是运动性疲劳产生的关键因素阳气主宰人的各种生命活动。阳气对于运动的重要性主要表现在3个方面:(1)气属阳,阳主动,人之阳气,总统一身脏腑经络,运行全身,温养脏腑组织器官,推动各脏气化,主持津血代谢过程,是生命活动的源动力,机体运动的主要能量来源;(2)阳气温煦筋骨,温养神志,保障运动的顺利进行。《素问·生气通天论篇》曰,“阳气者,精则养神,柔则养筋。”阳气温煦筋膜、肌肉、骨骼等支持运动的器官;温养神志,神志正常方能支配运动。故阳气充足,机体才能精力充沛,运动得力,反应灵敏,圆满的完成运动;(3)阳气化生和统摄血液、津液等液态精微物质,津血为运动所必需,由阳气所化生,故阳气对于运动尤为重要。运动过度耗损阳气。过劳则脏腑精气受损;过劳则神志不安;过劳则耗伤津液;过劳则耗伤筋骨,而上述因素都有赖于阳气的温煦、推动、生化作用。过劳耗损阳气,阳气不足,机体的体能下降,运动能力减弱,不能维持原有的水平。故运动性疲劳产生的关键因素在于阳气不足。运动需要阳气的推动。在机体运动的过程中,诸脏之阳各司其职,各尽其能。心阳温煦以生血、安神;胃阳受纳腐熟水谷,化生气血;肺吸入清气,有助机体代谢,以供运动所用;肾阳为全身阳气之源,促进运动:肝为生发之脏,肝阳启发肾阳,促进各脏阳气化生,敷布血液于全身,温养筋节,调节情绪。可见,在诸脏阳气中,肝阳对运动意义重大。(二)肝阳不足是运动性疲劳产生的重要环节1、肝阳的特点与功效中医认为肝与运动关系非常密切。《素问·六节藏象论》云,“肝者,罢极之本,动作出焉。”肝之阳气对于包括运动在内的各种生理活动都起到了关键性的作用。肝阳与肝阴相对而言,其性发散、疏泄、温煦,主升,主动。肝阳的功用主要表现在以下几点:(1)肝阳升发为全身气化之始《素问·玉机真藏论篇》云,“东方木也,万物所以始生也。”五脏之中唯有肝升发万物,《类证治裁》曰:“凡上升之气,皆从肝出”。肝升,万物方能欣欣向荣,机体才能生气勃勃。肝禀春生少阳之气,肝阳的升发调动肾中元阳,并将阳气敷布全身,推动、促进各脏阳气的化生和运行,故肝阳为诸脏生化之推动力,全身各脏阳气生化皆始于肝。《读医随笔》云,“脏腑十二经之气化,皆必藉肝胆之气以鼓舞之。”近代名医张锡纯亦强调了肝阳的升发为气化升发之始,认为肝为“人身元气萌芽之脏”,为“气化升发之始”。(2)肝阳升发以助脏腑功用肝阳升发可助肾生发,助脾运化,助心温煦,助肺敷布,助卫抗邪,振奋阴器。若肝阳升发不利,则脏腑气化不行。肝阳不足,升发不及,阳气化生与运行功能受阻,导致阳气匮乏、气滞、气陷,整体生命机能下降,诸病丛生。由此可见,肝阳对于人体的生理活动的重要性。2、劳伤筋骨,损伤肝阳通过对运动性疲劳产生过程的分析,本文认为,人身之筋节赖肝阳以温养,肝旺则筋旺,肝衰则筋衰,过劳损筋,亦损肝之精气。阳气者,柔则养筋,一方面,肝阳温煦筋节,供给筋节活动之能量;另一方面,过度运动易损伤筋节,筋节受损,肝之阳气被耗。运动员长期进行高强度的体育训练和竞技比赛,大量运动常耗损筋膜、韧带、关节之精气,而筋为肝所主,肝为罢极之本,故过劳常伤肝阳。肝阳为全身阳气升发之始,肝阳不足,疏泄温升不及,气化功能失常,无法正常促进各脏阳气生化,造成整体的生命活动能力减退,体能下降,出现疲劳。综上所述,中医认为,阳气不足是导致疲劳的核心之所在;而过劳损肝阳,肝阳不足,脏腑气化功能下降,机体生理功能减退,导致机体的运动能力下降,疲劳出现。故运动性疲劳产生的主要机理是运动过度损伤肝阳。二、温肝阳改善运动性疲劳的相关文献资料中医文献记载了治疗肝气虚寒或实寒证的温肝方药。温肝方剂的多用性味辛热、辛温之品,辛以散寒,配伍性味甘温,甘缓之品,其功效在于温肝散寒补虚。文献中明确记载的具有温肝功效的药物按照其功效、归经大体可分为3类。古人温肝的经验对于今天的临床与科研有着借鉴意义。根据《内经》“劳者温之”的法则,注重温养肝之阳气,推动各脏气化功能,充实肾阳,提高身体的综合生理机能,即体能,调整运动员身心疲惫的状态,改善运动性疲劳。需要指出的是,虽然运动过劳损肝阳,但较少伴随虚寒表现,故此处的温肝阳方药不同于文献记载的温肝散寒法,不是使用性味辛热或辛温的中药温通散寒,而是采用性味甘温,入肝经,具有温养肝阳、濡养筋骨,耐受疲劳功效的药物,促进各脏阳气化生,增强运动能力,改善运动性疲劳。三、温肝阳与滋肾阴合用改善运动性疲劳中医理论认为,独阳不生,孤阴不长,若单纯温肝阳,易消耗阴液,致使肝阳升发无制,产生负面效应,与滋肾阴同用,方能相互制约,互生互用,达到更好的温养效果。从温肝阳有助肾阴的化生、滋肾阴既有助温升肝阳,又能抑制肝阳过亢的角度阐述了温肝阳滋肾阴同治的可行性。对于运动员而言,运动过劳造成形体疲劳的同时,常伴随精神高度紧张,过于亢奋,出现神志不宁,烦乱不安,甚至失眠的表现。其原因在于劳损肝阳,肝阳升发不及,常郁闷不畅;劳伤阴液,虚火上炎,扰乱心神;肝肾精血暗耗,神志失养,眼差多梦,加重疲劳。故温肝阳与滋肾阴(精)合用可协调阴阳,既有助于促进运动,激发体能,又利于安神定志,提高睡眠质量,恢复疲劳,保障机体在运动后得到充分的修养和调整。两者合用效果叠加,可达到提高体能,改善运动性疲劳的更佳功效。时相组合改善运动性疲劳的研究时相组合是指在中医理论的指导下,结合现代时间生物医学的研究成果,在相关生理变量的不同时相点服用与该变量作用趋势一致的方药,以发挥更佳疗效的用药方法,其中时间、药物、治法三者之间关系密切。本文所论述的温肝阳滋肾阴改善运动性疲劳的时相组合,汲取中医时间医学的精粹,强调根据各种人体昼夜节律,在影响体能的主要内源性激素血睾酮、皮质醇分泌节律的峰值、谷值时相给予不同中药,通过药物生物活性提高机体生物节律对药物的利用率,促进或激活生物节律时段中组织机能活动的增强或协同效应,调整内源性激素分泌的节律水平,激发体能,达到运动训练或竞技所需的良好机能状态。以导师程昭寰教授为首的课题组通过对中医温肝阳、滋肾阴药物的相关文献整理,结合药理研究成果,筛选出鹿角胶、红景天等温肝阳,强筋骨,耐疲劳的药物,组成温阳激活颗粒;选用阿胶、灵芝等滋肾阴(精),耐疲劳的药物,组成滋阴修养胶囊,并进行了动物实验研究和运动人体试验研究。动物实验研究表明,(1)温阳激活颗粒可明显降低小鼠疲劳游泳后血中BUN的含量,用药量和效果之间有量效关系;降低游泳后血乳酸含量;提高肝糖原含量;明显延长小鼠负重游泳时间、增加常压下缺氧存活时间。滋阴修养胶囊具有明显缩短小鼠入睡时间、延长小鼠睡眠时间,提高睡眠质量的作用。(2)时相组合用药具有上述温阳激活颗粒和滋阴修养胶囊的功效,且可明显对抗雄性大鼠运动性疲劳后睾酮的过度降低,对雌雄大鼠皮质醇均有明显的调节作用;降低运动应激后血清NO水平。(3)在上述研究中,时相组合用药的效果比分别使用温阳激活颗粒或滋阴修养胶囊效果更佳。运动人体试验研究证实:时相组合能显著提高运动员血清睾酮水平与抗脂质过氧化能力;降低血尿素氮水平;防止血红蛋白下降;改善大负荷训练期运动员的睡眠质量和效果;调节运动员血清NO、NOS,提示该作用有利于改善骨骼肌、心肌的血供,因此有助于改善运动疲劳。研究结果提示,温阳激活颗粒和滋阴修养胶囊具有改善疲劳的作用,并可能通过调节中枢神经递质来达到该目的。实验为温肝阳滋肾阴时相组合改善运动性疲劳的理念提供了初步依据。结论本文在前人研究成果的基础上,根据运动性疲劳的中医机理,从调整运动员的整体状态入手,提出温肝阳滋肾阴时相组合改善运动性疲劳的理念,通过“温肝阳”以激发体能,“滋肾阴”以恢复疲劳,修复体能,温肝阳与滋肾阴的方药在不同时相点合用可有效改善运动性疲劳。本研究的创新点在于:(1)提出“劳损肝阳”是运动性疲劳的主要机理,在中医“治未病”思想的启发下,“温肝阳”以促进脏腑气化,增加体能;“滋肾阴”以解除疲劳,恢复体能,两者合用改善运动性疲劳;(2)在中医理论的指导下,结合中医时间医学和现代时间生物学,提出“时相组合”的概念,通过调整与运动性疲劳相关内源性激素的分泌节律来改善运动性疲劳,动物试验研究和运动人体试验研究,为该理念提供了初步的依据;(3)对“温肝阳”与“昼夜择时服药组合”的相关文献资料进行梳理,总结前人的制方思路和用药经验,为现代中医临床应用提供了借鉴。更多还原

【Abstract】 Sports fatigue is due to overload training and insufficient rest after frequent competition.The organism function cannot last the definite level or the reserved exercise intensity during the physiological process,with the organs in functional disorder.The Chinese medicine has the distinct predominance in the domain of eliminating sports fatigue,for it can make up the deficiency of the modern medicine,and push the development of sports medicine.The study select Chinese medicine of warming liver yang and tonifying kidney yin,adopt the method of phase combination,to achieve the purpose of improve sports fatigue.The study is based on the method of literature investigation,theory research,consult animal experiment,and clinical observation.The paper collect the document of warming liver yang,tonifying kidney yin,phase combination,sports fatigue,and try to find the thread of thought;investigate the mechanism of sports fatigue in the way of Chinese medical theory,and combine with the western medical research achievement to raise the idea;through the clinical observation of animal experiment,the idea is validated initially.The purpose of the research:to approach the mechanism of sports fatigue in the Chinese medical way,through the thought of"improve the disease",carry out the medicine of warming liver yang to promote the growth of yang qi,stimulate the zangfu organs,use the medicine of tonifying kidney yin to relive fatigue,and restore physical agility,with both methods to improve sports fatigue;under the direct of Chinese medical theory,the western chronomedicine and modern biological rhythm are applied to the field of eliminating sports fatigue,the conception of phase combination are carried out;through the excavation and arrangement of literature and documents,the system of warming liver yang is arranged,ancient experience of selecting time to take medicine is induced,the thought of making formula is summed up,to provide reference for the development of the clinical research. The main body of the paper is divided into three parts,the mechanism of sports fatigue;the research study of warming liver yang and tonifying kidney yin to improve sports fatigue;the study of phase combination to improve sports fatigue.The mechanism of sports fatigueThe conception of the ancient fatigue is different from that of sports fatigue.For the investigation of how to eliminate it with the Chinese medical method,the traditional methods of the literature can’t be copied.The produce of fatigue relate to the functional disorder of zangfu organs,blood and qi,tendons and bones. Over-movement lead to the descend of normal function of zangfu organs,the strain of zangfu organs,the hurt of mind,the waste of much qi,blood,essence, especially the qi,and result in the unbalance of yin-yang.Sports fatigue is due to over-fatigue,between the healthy state and disease. Following the improvement thought in Chinese medicine,medical method is carried out to improve the sports fatigue,so that athletes can stay in a good state during the movement.The theory research of warming liver yang and tonifying kidney yin to improve sports fatigueThe movement demands the push of qi.The importance of qi in movement can be demonstrated in the following aspects:first,yang qi can push the movement of zangfu organs and the life process of any fluid,so,it’s the power of vital movement,the energy source of movement;secondly,qi can warm the bones, tendons,and mind;thirdly,qi can metaplasia and govern the fluid essences.So, movement needs more yang qi.Yang qi play an important role in the vital movement. Liver yang can arouse kidney yang,promote the metaplasia of yang qi,compress blood to other parts of the body,warm the tendons,and regulate the mind.Over fatigue can waste qi.The essence of zangfu organs,the fluid,the tendons and bones all rely on the liver yang to warm,if yang is insufficient,the physical agility of the body is lowered,the locomotivity reduced,and sports fatigue easily to be caused.Through the analysis of the process and key link of sports fatigue,the idea that the deficiency of yang qi is the key of the mechanism,over exercise injury the liver yang,result in the lower of gasification is carried out.The paper drew the experience of warming liver yang from the literature,due to the method of warming the strain,carried out the idea of warming liver yang to improve sports fatigue.Relatively speaking,the liver yang is on the contrary of liver yin,it has the nature of exhale,abreaction,warm,to ascend,to initiative.The function of liver yang is mainly in the following aspects:First,the ascending liver yang is the beginning of the gasification of the body.Secondly,the rise of liver yang helps the effect of zangfu organs.The ancient doctors summarize the prescription and medicine to warm the liver. The experience of warming liver in the medical literature can be reference for the clinic nowadays.The paper emphasize that over fatigue hurt the liver yang,so that the vital movement decrease,gasification function lowered,impossible to promote the normal production of yang qi,the physical agility descend,and sports fatigue appear.Sports fatigue hurt liver yang,but the cold and deficiency appearance is seldom seen,so the herbs for warming liver yang is to improve fatigue,not those that can dispel the cold,but those of sweet and warm taste,with the effect of warming liver.The paper carried out the research of warming liver yang and tonifying kidney yin to improve sports fatigue.Warming liver yang and tonifying kidney yin together can restrict,reinforce and nourish each other.Warming liver yang can help the produce of kidney yin,while tonifying kidney yin can assist to warm the liver yang,and restrict the over rise of the liver yang.For the athletes,over exercise often lead to over tension of the mind,too excited,with the appearance of mind disorder,restlessness,even insomnia,that all due to the waste of liver yang,the loss of yin fluid,blood and essence.So, Warming liver yang and tonifying kidney together can raise the physiology ability, improve the sports fatigue.The research of phase combination to improve the sports fatigue Phase combination that under the guide of Chinese medical theory,combine with the achievement of modern science,take medicine according to the different phases of relative physiological index,the tendency of the medicine is the same with that of physiological rhythm,is a method to cure disease.The paper carry out the idea of warming liver yang and tonifying kidney yin phase combination to improve sports fatigue,which draw essence from the Chinese medical science,on the basis of all the human rhythms,have medicine in the crest value and ravine value of the main endogenous hormone secretion rhythm of andrusol and corticosteroid.It can regulate the rhythm level of the hormone secretion,stimulate the physical agility,to achieve the best state during exercise.The animal experiment shows that the warming yang drop can reduce the BUN content in the blood after fatigue;drug consumption and the result have the dose-effect relationship;lower the content of lactic acid;raise the hepatic glycogen; lengthen the swimming time of the mouse and the survival time of oxygen-poor state. Tonifying yin capsule can extend the bedtime of the mouse,promote sleep.The phase combination has both effect of the drop and capsule,prevent the andrusol too lower,and regulate the content of corticosteroid;lower the level of NO content.The effect of phase combination is better than that of each separately.Clinical observation confirm:both the drop and capsule can raise the level of andrusol,lower the level of BUN,improve the lower of hemoglobin,and improve the sleep quality,blood supply of the heart and muscle.ConclusionThe paper is on the basis of the Chinese medical science of sports fatigue,and carried out the idea of regulate the whole state of athletes to improve sports fatigue.The phase combination of warming yang and tonifying yin is a new method to explore the elimination of sports fatigue.The paper bring new ideas:first,to raise the mechanism of strain that hurt liver yang,and warming liver yang to stimulate the produce of yang qi,tonifying kidney yin to eliminate fatigue,both to support the sports fatigue;secondly,carried out the new idea of phase combination,and proved by Chinese medical literature and experimental research;thirdly,to comb the literature and summarize the experience and method of making prescription,provide reference for the clinical development nowadays.更多还原